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Clinical characteristics and outcomes of HIV-associated immune complex kidney disease.
- Source :
-
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2016 Dec; Vol. 31 (12), pp. 2099-2107. Date of Electronic Publication: 2016 Jan 18. - Publication Year :
- 2016
-
Abstract
- Background: The pathogenesis and natural history of HIV-associated immune complex kidney disease (HIVICK) is not well understood. Key questions remain unanswered, including the role of HIV infection and replication in disease development and the efficacy of antiretroviral therapy (ART) in the prevention and treatment of disease.<br />Methods: In this multicentre study, we describe the renal pathology of HIVICK and compare the clinical characteristics of patients with HIVICK with those with IgA nephropathy and HIV-associated nephropathy (HIVAN). Poisson regression models were used to identify risk factors for each of these pathologies.<br />Results: Between 1998 and 2012, 65 patients were diagnosed with HIVICK, 27 with IgA nephropathy and 70 with HIVAN. Black ethnicity and HIV RNA were associated with HIVICK, receipt of ART with IgA nephropathy and black ethnicity and CD4 cell count with HIVAN. HIVICK was associated with lower rates of progression to end-stage kidney disease compared with HIVAN and IgA nephropathy (P < 0.0001). Patients with HIVICK who initiated ART and achieved suppression of HIV RNA experienced improvements in estimated glomerular filtration rate and proteinuria.<br />Conclusions: These findings suggest a pathogenic role for HIV replication in the development of HIVICK and that ART may improve kidney function in patients who have detectable HIV RNA at the time of HIVICK diagnosis. Our data also suggest that IgA nephropathy should be viewed as a separate entity and not included in the HIVICK spectrum.<br /> (© The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
- Subjects :
- AIDS-Associated Nephropathy blood
AIDS-Associated Nephropathy immunology
AIDS-Associated Nephropathy therapy
Adult
CD4 Lymphocyte Count
Disease Progression
Female
Glomerular Filtration Rate
Glomerulonephritis, IGA blood
Glomerulonephritis, IGA immunology
Glomerulonephritis, IGA therapy
Humans
Kidney pathology
Kidney physiopathology
Kidney Failure, Chronic blood
Kidney Failure, Chronic immunology
Kidney Failure, Chronic therapy
Male
Middle Aged
Proteinuria blood
Proteinuria immunology
Proteinuria virology
RNA, Viral blood
Risk Factors
Treatment Outcome
AIDS-Associated Nephropathy pathology
Glomerulonephritis, IGA virology
Kidney Failure, Chronic virology
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2385
- Volume :
- 31
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
- Publication Type :
- Academic Journal
- Accession number :
- 26786550
- Full Text :
- https://doi.org/10.1093/ndt/gfv436