Renal disease in HIV patients

From IDWiki

Differential Diagnosis

  • Infection-related
    • HIV-associated nephropathy (HIVAN)
    • Immune complex-mediated glomerular disease
    • Coinfection with hepatitis B or C
  • Treatment-related
    • Tenofovir: Fanconi syndrome
    • Pantamidine, foscarnet, and aminoglycosides: ATN
    • Indinavir, sulfadiazine, and IV acyclovir: tubular obstruction from crystals

HIV-associated nephropathy (HIVAN)

Clinical Manifestations

  • Proteinuria, mild creatinine elevation, normal-seized echogenic kidneys on renal US
  • Usually have a detectable viral load, and decreased CD4 <200
  • Biopsy shows FSGS

Management

  • Treat the HIV with usual therapy
  • Steroids for 8 to 12 weeks
  • ACEi/ARB as tolerated