Observations on a Cohort of HIV-Infected Patients Undergoing Native Renal Biopsy

• Published in: American journal of nephrology Vol. 28; no. 3; pp. 478 - 486
• Main Authors: Berliner, Adam R., Fine, Derek M., Lucas, Gregory M., Rahman, M. Hafizur, Racusen, Lorraine C., Scheel, Paul J., Atta, Mohamed G.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2008
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; AIDS-Associated Nephropathy - pathology; Biopsy; Cohort Studies; Female; Glomerular Filtration Rate; Human immunodeficiency virus; Humans; Kidney - pathology; Male; Middle Aged; Original Report: Patient-Oriented, Translational Research; Retrospective Studies; End-stage renal disease; Renal biopsy, HIV-infected patients; Chronic kidney disease
• ISSN: 0250-8095; 1421-9670
• DOI: 10.1159/000112851

Aims: This study aims to explore the spectrum of renal disease in HIV-infected patients, identify clinical predictors of HIV-associated nephropathy (HIVAN), and investigate the performance of renal biopsy in HIV-infected patients. Method: Of 263 HIV-infected patients with renal disease evaluated between 1995 and 2004, 152 had a renal biopsy, while 111 had not. A group comparison was performed. Results: The leading biopsy diagnoses were HIVAN (35%), noncollapsing focal segmental glomerulosclerosis (22%), and acute interstitial nephritis (7.9%), amongst over a dozen others. There was a trend of decreasing yearly incidence of HIVAN diagnoses, paralleling the use of antiretroviral therapy. By multivariate logistic regression, CD4 counts >200 cells/mm 3 and higher estimated glomerular filtration rate were strong negative predictors of HIVAN. HIVAN patients were more likely to require dialysis (p < 0.0001) and had worse overall survival (p = 0.02). Younger age and lower estimated glomerular filtration rate were significant predictors of renal biopsy in multivariate regression analysis. More biopsied patients progressed to dialysis (51 vs. 25%, p = 0.001) and death (15 vs. 5.4%, p = 0.001), despite more frequent corticosteroid treatment (29 vs. 3.6%, p = 0.001). Conclusion: These findings may reflect more severe acute and/or chronic disease at the time of biopsy and suggests that earlier renal biopsy may be warranted in HIV-infected patients, especially in light of the changing spectrum of renal disease in this group.