Clinical and histopathological features of HIV-associated nephropathies diagnosed by renal biopsy

Abstract

The kidney is among the systems damaged by the human virus infection (HIV). The most relevant nephropathies include collapsing glomerulopathy, immune complex glomerulonephritis, thrombotic microangiopathy, antiviral drug-induced nephropathies, and others. Renal biopsy is the gold standard diagnostic method for most of them, whose frequencies are variable between different countries. In Brazil, this issue has been barely studied because there are few renal pathology laboratories. This hospital has a well-established renal pathology laboratory and significant experience with the evolution of these patients. According to our hypothesis, the collapsing glomerulopathy is the commonest biopsied HIV-associated nephropathy (HIVAN) in patients with proteinuria and hematuria, followed by immune complex glomerulonephritis. Furthermore, proteinuria level has an association with interstitial injury intensity, worse prognosis, and higher desmin glomerular expression, a marker of activated podocyte. Aims: to evaluate the frequency of renal biopsy diagnosed nephropathies in HIV-infected patients, and to investigate the association between the clinical course and the histopathological changes. Methods: in this retrospective study, the clinical charts of the HIV patients with nephropathies diagnosed by renal biopsy will be recorded. Clinical data as age, time since HIV diagnosis, drug prescription, proteinuria, renal function and diagnosis of the renal disease will be analyzed. A score scale will estimate the intensity of the interstitial injury and the desmin glomerular expression (immunohistochemistry). The evaluation of the clinical outcome will be done by analyzing the proteinuria level and serum creatinine concentration during the clinical course following the renal biopsy.