Details

Autor(en) / Beteiligte

• Zaidan, Mohamad
• Lescure, François-Xavier
• Brochériou, Isabelle
• Dettwiler, Sarah
• Guiard-Schmid, Jean-Baptiste
• Pacanowski, Jérôme
• Rondeau, Eric
• Pialoux, Gilles
• Girard, Pierre-Marie
• Ronco, Pierre
• Plaisier, Emmanuelle

Titel

Tubulointerstitial Nephropathies in HIV-Infected Patients over the Past 15 Years: A Clinico-Pathological Study

Ist Teil von

• Clinical journal of the American Society of Nephrology, 2013-06, Vol.8 (6), p.930-938

Ort / Verlag

United States: American Society of Nephrology

Erscheinungsjahr

2013

Link zum Volltext

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• The therapy and outcome of HIV infection have dramatically changed over the last 15 years, resulting in a change in renal complications. This study analyzed the characteristics of HIV-infected patients and biopsy-proven tubulointerstitial nephropathies to define disease patterns and therapeutic implications. A clinico-pathologic retrospective study of 59 consecutive renal biopsies showing predominant tubular and/or interstitial lesions in HIV-infected patients referred to the nephrology department between 1995 and 2011 was performed. HIV-associated nephropathy and vascular diseases were excluded from the study. Tubulointerstitial nephropathies accounted for 26.6% of 222 native renal biopsies performed in HIV-infected patients. Two pathologic groups were analyzed, tubulopathy and interstitial nephritis, which represented 49% and 51% of tubulointerstitial nephropathies, respectively. Most patients presented with AKI (76.3%) and high-grade proteinuria (57.7%). Drug-related nephrotoxicity was the leading cause (52.5%). Alternative etiologies included infections (15.2%), dysimmune disorders (8.5%), malignancies (3.4%), and chronic (10.2%) and acute (10.2%) tubulointerstitial nephropathies of undetermined origin. Tubulopathy was strongly associated with antiretroviral drug toxicity (75.9%) and mostly caused by tenofovir (55.2%), which was associated with proximal tubular dysfunction (87.5%), overt Fanconi's syndrome (37.5%), and nephrogenic diabetes insipidus (12.5%). Interstitial nephritis was associated with a broader spectrum of pathologic lesions and etiologies. In this series, tubulointerstitial nephropathies accounted for 26.6% of renal diseases in HIV-infected patients. Considering the therapeutic implications of diagnoses of drug toxicity, infection, and dysimmune syndromes, this study underscores the importance of monitoring renal parameters in HIV-infected patients and points to the relevance of kidney biopsy to allow an accurate diagnosis.