Observations on a cohort of HIV-infected patients undergoing native renal biopsy

Adam R. Berliner, Derek M Fine, Gregory M Lucas, M Hafizur Rahman, Lorraine C Racusen, Paul J. Scheel, Mohamed Atta

Research output: Contribution to journalArticle

Abstract

Aims: This study aims to explore the spectrum of renal disease in HIV-infected patients, identify clinical predictors of HIV-associated nephropathy (HIVAN), and investigate the performance of renal biopsy in HIV-infected patients. Method: Of 263 HIV-infected patients with renal disease evaluated between 1995 and 2004, 152 had a renal biopsy, while 111 had not. A group comparison was performed. Results: The leading biopsy diagnoses were HIVAN (35%), noncollapsing focal segmental glomerulosclerosis (22%), and acute interstitial nephritis (7.9%), amongst over a dozen others. There was a trend of decreasing yearly incidence of HIVAN diagnoses, paralleling the use of antiretroviral therapy. By multivariate logistic regression, CD4 counts >200 cells/mm3 and higher estimated glomerular filtration rate were strong negative predictors of HIVAN. HIVAN patients were more likely to require dialysis (p <0.0001) and had worse overall survival (p = 0.02). Younger age and lower estimated glomerular filtration rate were significant predictors of renal biopsy in multivariate regression analysis. More biopsied patients progressed to dialysis (51 vs. 25%, p = 0.001) and death (15 vs. 5.4%, p = 0.001), despite more frequent corticosteroid treatment (29 vs. 3.6%, p = 0.001). Conclusion: These findings may reflect more severe acute and/or chronic disease at the time of biopsy and suggests that earlier renal biopsy may be warranted in HIV-infected patients, especially in light of the changing spectrum of renal disease in this group.

Original languageEnglish (US)
Pages (from-to)478-486
Number of pages9
JournalAmerican Journal of Nephrology
Volume28
Issue number3
DOIs
Publication statusPublished - Apr 2008

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Keywords

  • Chronic kidney disease
  • End-stage renal disease
  • Renal biopsy, HIV-infected patients

ASJC Scopus subject areas

  • Nephrology

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