What are the cause and implications of HIV-associated nephropathy?
HIV-associated nephropathy, which is apparently the result of HIV infection of the kidney, presents as large, echogenic kidneys on ultrasound, nephrotic-range proteinuria, and rapidly progressing renal failure. This may occur at any stage of HIV but is most common as a late complication. Pre-ART studies show benefit from treatment with ACE inhibitors and possibly with corticosteroids; more recent studies show anecdotal evidence of a sometimes dramatic response to ART, but data from controlled trials are not available. Renal biopsy is necessary to establish the diagnosis. For patients with end-stage renal disease, there is increasing interest in and experience with renal transplantation. The usual criteria are irreversible renal failure combined with HIV response to ART resulting in virologic control and a CD4 cell count of >200mm3.
