HIV-related renal disease - A clinical and practical approach in the South African context
Human immunodeficiency virus-related renal diseases occur in up to 10% of patients infected with HIV. The majority of such patients are black and the commonest pathology seen is HIV-associated nephropathy (HIVAN). This is a clinicopathological entity characterised by proteinuria and rapidly developing renal failure and histologically by a collapsing variant of focal and segmental glomerulosclerosis with acute tubular necrosis and mild interstitial inflammation. It may progress rapidly to end-stage renal disease (within 6 months). HIVAN appears to be the commonest cause of renal disease in HIV-infected patients in South Africa, although the exact prevalence is unknown. The disease affects predominantly black males, although it has been described in patients of mixed race. Current thoughts with regard to pathogenesis revolve around the role of HIV in the renal epithelium and the effects of cytokines, including transforming growth factor-beta and basic fibroblast growth factor, on renal structures. Treatment modalities available locally include corticosteroids, angiotensin-converting enzyme (ACE) inhibitors and where possible antiretroviral agents. The demographics of the HIV/AIDS epidemic indicate that the risk pool for HIVAN will continue to rise, and with it the prevalence of renal failure.