Thrombotic Microangiopathy and Other Glomerular Disorders in the HIV-Infected Patient

摘要: Summary Various forms of kidney disease have been related directly to human immunodeficiency virus (HIV) viral infection, including HIV-associated nephropathy (HIVAN), immune complex diseases, and thrombotic microangiopathy (TMA). HIVAN HIV glomerulonephritides are the most common HIV-specific nephropathies. TMA, although far less common, remains an important consideration. The diagnosis TMA in HIV, which has a poorly understood pathogenesis, can be suggested by thrombocytopenia, microangiopathic hemolytic anemia, acute renal failure, but only definitively diagnosed biopsy. Not surprisingly, incidence prevalence entities declined with advent highly active antiretroviral therapy. With this decline, however, other glomerular diseases increasing importance high-risk population. differential HIV-positive patient is therefore broad. Glomerular seen population include classic focal segmental glomerulosclerosis, IgA nephropathy, postinfectious glomerulonephritis, hepatitis B– C–related glomerulonephritides, membranous nephropathy. In addition, as HIV-infected ages, diabetic hypertensive nephropathies likely become more prevalent. overlapping presentations these entities, definitive often difficult, necessitating As consequence establishing accurate diagnosis, improved outcome best accomplished through disease-specific intervention.