HIV-associated nephropathy: links, risks and management

Laura Palau,1,* Steven Menez,1,* Javier Rodriguez-Sanchez,1 Tessa Novick,1 Marco Delsante,2 Blaithin A McMahon,1 Mohamed G Atta1 1Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; 2Department of Pathology, Johns Hopkins University, Baltimore, MD, USA *These authors contri...

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Autores principales:	Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA, Atta MG
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	HIVAN HIV APOL1 polymorphism ESRD Kidney transplant Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/452bd86ea2364967b3585b194d37bcdc
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spelling	oai:doaj.org-article:452bd86ea2364967b3585b194d37bcdc2021-12-02T06:34:43ZHIV-associated nephropathy: links, risks and management1179-1373https://doaj.org/article/452bd86ea2364967b3585b194d37bcdc2018-05-01T00:00:00Zhttps://www.dovepress.com/hiv-associated-nephropathy-links-risks-and-management-peer-reviewed-article-HIVhttps://doaj.org/toc/1179-1373Laura Palau,1,* Steven Menez,1,* Javier Rodriguez-Sanchez,1 Tessa Novick,1 Marco Delsante,2 Blaithin A McMahon,1 Mohamed G Atta1 1Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; 2Department of Pathology, Johns Hopkins University, Baltimore, MD, USA *These authors contributed equally to this work Abstract: Despite the decreased incidence of human immunodeficiency virus (HIV)-associated nephropathy due to the widespread use of combined active antiretroviral therapy, it remains one of the leading causes of end-stage renal disease (ESRD) in HIV-1 seropositive patients. Patients usually present with low CD4 count, high viral load and heavy proteinuria, with the pathologic findings of collapsing focal segmental glomerulosclerosis. Increased susceptibility exists in individuals with African descent, largely due to polymorphism in APOL1 gene. Other clinical risk factors include high viral load and low CD4 count. Advanced kidney disease and nephrotic range proteinuria have been associated with progression to ESRD. Improvement in kidney function has been observed after initiation of combined active antiretroviral therapy. Other treatment options, when clinically indicated, are inhibition of the renin–angiotensin system and corticosteroids. Further routine management approaches for patients with chronic kidney disease should be implemented. In patients with progression to ESRD, kidney transplant should be pursued, provided that viral load control is adequate. Screening for the presence of kidney disease upon detection of HIV-1 seropositivity in high-risk populations is recommended. Keywords: HIVAN, HIV, APOL1 polymorphism, ESRD, kidney transplantPalau LMenez SRodriguez-Sanchez JNovick TDelsante MMcMahon BAAtta MGDove Medical PressarticleHIVANHIVAPOL1 polymorphismESRDKidney transplantImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol Volume 10, Pp 73-81 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	HIVAN HIV APOL1 polymorphism ESRD Kidney transplant Immunologic diseases. Allergy RC581-607
spellingShingle	HIVAN HIV APOL1 polymorphism ESRD Kidney transplant Immunologic diseases. Allergy RC581-607 Palau L Menez S Rodriguez-Sanchez J Novick T Delsante M McMahon BA Atta MG HIV-associated nephropathy: links, risks and management
description	Laura Palau,1,* Steven Menez,1,* Javier Rodriguez-Sanchez,1 Tessa Novick,1 Marco Delsante,2 Blaithin A McMahon,1 Mohamed G Atta1 1Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; 2Department of Pathology, Johns Hopkins University, Baltimore, MD, USA *These authors contributed equally to this work Abstract: Despite the decreased incidence of human immunodeficiency virus (HIV)-associated nephropathy due to the widespread use of combined active antiretroviral therapy, it remains one of the leading causes of end-stage renal disease (ESRD) in HIV-1 seropositive patients. Patients usually present with low CD4 count, high viral load and heavy proteinuria, with the pathologic findings of collapsing focal segmental glomerulosclerosis. Increased susceptibility exists in individuals with African descent, largely due to polymorphism in APOL1 gene. Other clinical risk factors include high viral load and low CD4 count. Advanced kidney disease and nephrotic range proteinuria have been associated with progression to ESRD. Improvement in kidney function has been observed after initiation of combined active antiretroviral therapy. Other treatment options, when clinically indicated, are inhibition of the renin–angiotensin system and corticosteroids. Further routine management approaches for patients with chronic kidney disease should be implemented. In patients with progression to ESRD, kidney transplant should be pursued, provided that viral load control is adequate. Screening for the presence of kidney disease upon detection of HIV-1 seropositivity in high-risk populations is recommended. Keywords: HIVAN, HIV, APOL1 polymorphism, ESRD, kidney transplant
format	article
author	Palau L Menez S Rodriguez-Sanchez J Novick T Delsante M McMahon BA Atta MG
author_facet	Palau L Menez S Rodriguez-Sanchez J Novick T Delsante M McMahon BA Atta MG
author_sort	Palau L
title	HIV-associated nephropathy: links, risks and management
title_short	HIV-associated nephropathy: links, risks and management
title_full	HIV-associated nephropathy: links, risks and management
title_fullStr	HIV-associated nephropathy: links, risks and management
title_full_unstemmed	HIV-associated nephropathy: links, risks and management
title_sort	hiv-associated nephropathy: links, risks and management
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/452bd86ea2364967b3585b194d37bcdc
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HIV-associated nephropathy: links, risks and management

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