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May 2, 2017

Pushing Glass (May 2, 2017)

A 45 year-old African American man presented with pneumonia, colitis and acute kidney injury (serum creatinine- 6 mg/dL). What is the most likely diagnosis?
A. Infection associated glomerulonephritis
B. Ischemic glomerulopathy due to sepsis
C. HIV-associated nephropathy
D. Focal and segmental glomerulosclerosis
E. Acute pyelonephritis

Answer: C
HIV-associated nephropathy (HIVAN) is a characteristic renal disease developing in the setting of HIV infection. It is manifested clinically by nephrotic-range proteinuria (full nephrotic syndrome is uncommon), acute renal failure and microscopic hematuria and morphologically by collapsing glomerulopathy. Some APOL1 polymorphisms, which are more prevalent in African American, predispose to HIVAN. 
HIV-associated immune complex kidney disease (HIVICK) is another common glomerular disease in the setting of HIV and may have an identifiable post-infectious association, such as Staphylococcus. Epidemiologic studies show that HIVICK is more dominant in HIV-positive populations of European origin while HIVAN is less common. Conversely, HIVAN is more common in HIV+ patients of African origin due to increased deleterious APOL1 polymorphisms in this population. End-stage renal disease (ESRD) progression can occur in HIVICK or HIVAN but is more common in HIVAN.