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Tubulointerstitial nephropathies in HIV-infected patients over the past 15 years: a clinico-pathological study.


ABSTRACT: BACKGROUND AND OBJECTIVES: 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. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 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. RESULTS: 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. CONCLUSIONS: 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.

SUBMITTER: Zaidan M 

PROVIDER: S-EPMC3675854 | biostudies-other | 2013 Jun

REPOSITORIES: biostudies-other

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Tubulointerstitial nephropathies in HIV-infected patients over the past 15 years: a clinico-pathological study.

Zaidan Mohamad M   Lescure François-Xavier FX   Brochériou Isabelle I   Dettwiler Sarah S   Guiard-Schmid Jean-Baptiste JB   Pacanowski Jérôme J   Rondeau Eric E   Pialoux Gilles G   Girard Pierre-Marie PM   Ronco Pierre P   Plaisier Emmanuelle E  

Clinical journal of the American Society of Nephrology : CJASN 20130221 6


<h4>Background and objectives</h4>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.<h4>Design, setting, participants, & measurements</h4>A clinico-pathologic retrospective study of 59 consecutive renal biopsies showing predominant tubular a  ...[more]

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