TOPIC DISCUSSION: HIV and the KIDNEY

This is a wide topic but recently in ACKD, Dr. Novak and Dr. Szczech reviewed many aspects of the role of the nephrologists in the care of the HIV patient.

It starts with a general overview of the HIV illness and where we are now in terms of ART therapy.  A chapter on CKD screening in HIV is good as it outlines that the risk factors for CKD in HIV are : age, race, CKD family history, HIV disease state(CD4 count, HIV viral load), History of cocaine use, cigarette use, nephrotoxic medication use and comorbid conditions like Diabetes, HTN and Hep C co infection.
The pathogenesis of HIVAN is reviewed in detail about the Nef induced podocyte dedifferentiation and leading to proliferation.

An interesting chapter is on Gene interactions on HIVAN in the African American population.  There is an emerging concept of MYH9 Gene nephropathies in the AA population.  Polymorphisms in this gene has been associated with kidney diseases historically called Hypertensive nephroscloerosis in the AA population.
It might be the renal failure susceptibility gene independent of HIV infection in AA.  It has been associated with idiopathic FSGS as well. The authors postulate that established CKD risk factor, this gene susceptibility and a second unknown hit might be instigators for HIVAN in AA population. Very interesting.

Finally, the supplement concludes with non HIVAN related diseases in HIV patients.They link them based on groups. Group 1 is diseases which have causal links have been made with HIV infection and the nephropathy( HIV associated Immune complex GN, HIV associated IG A nephroapthy, HIV associated TMA)
Group 2 is indivudual cases and causal links to HIV infection ( Post infectious GN, Lupus like GN, MPGN, Cryoglobulinemia, Immunotactoid GN, Fibrillary GN).
Group 3 are kidney diseases in which causal links largely have not been made to the virus( Interstitial Nephritis, Minimal change, Membranous, Amyloidosis)

A must read!