Membranous nephropathy in patients with HIV: a report of 11 cases
- PDF / 6,642,083 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 109 Downloads / 205 Views
RESEARCH ARTICLE
Open Access
Membranous nephropathy in patients with HIV: a report of 11 cases Vivek Charu1*, Nicole Andeen2, Vighnesh Walavalkar3, Jessica Lapasia4, Jin-Yon Kim5, Andrew Lin4, Richard Sibley1, John Higgins1, Megan Troxell1 and Neeraja Kambham1
Abstract Background: Membranous nephropathy (MN) has been recognized to occur in patients with human immunodeficiency virus (HIV) infection since the beginning of the HIV epidemic. The prevalence of phospholipase A2 receptor (PLA2R)-associated MN in this group has not been well studied. Methods: We conducted a retrospective review of electronic pathology databases at three institutions to identify patients with MN and known HIV at the time of renal biopsy. Patients with comorbidities and coinfections known to be independently associated with MN were excluded. Results: We identified 11 HIV-positive patients with biopsy-confirmed MN meeting inclusion and exclusion criteria. Patient ages ranged from 39 to 66 years old, and 10 of 11 patients (91%) were male. The majority of patients presented with nephrotic-range proteinuria, were on anti-retroviral therapy at the time of biopsy and had low or undetectable HIV viral loads. Biopsies from 5 of 10 (50%) patients demonstrated capillary wall staining for PLA2R. Measurement of serum anti-PLA2R antibodies was performed in three patients, one of whom had positive antiPLA2R antibody titers. Follow-up data was available on 10 of 11 patients (median length of follow-up: 44 months; range: 4–145 months). All patients were maintained on anti-retroviral therapy (ARV) and 5 patients (52%) received concomitant immunosuppressive regimens. Three patients developed end-stage renal disease (ESRD) during the follow-up period. Conclusions: MN in the setting of HIV is often identified in the setting of an undetectable viral loads, and similar to other chronic viral infection-associated MNs, ~ 50% of cases demonstrate tissue reactivity with PLA2R antigen, which may be seen without corresponding anti-PLA2R serum antibodies.
Background The spectrum of renal pathology in patients infected with HIV is broad and includes HIV-associated nephropathy (HIVAN), focal and segmental glomerulosclerosis (FSGS), thrombotic microangiopathy, and HIV-associated immune complex kidney disease (HIVICK), among others [1, 2]. HIVICK is a heterogenous category of disease, comprised of specific, well-characterized glomerular diseases (e.g. IgA nephropathy, membranoproliferative glomerulonephritis, * Correspondence: [email protected] 1 Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA 94304, USA Full list of author information is available at the end of the article
membranous nephropathy etc.), as well as immune-complex mediated diseases, not otherwise specified, including those with “lupus-like” features [3, 4]. In the era of antiretroviral therapy, some biopsy series in patients infected with HIV have suggested that the prevalence of HIVICK exceeds that of HIVAN [5]. The precise role that HIV plays i
Data Loading...
