Renal disease in HIV

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