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Currently filtering by tag: HIVAN

Twitter Poll (August 19, 2020)

collapsing FSGS, twitter poll, Arkana Laboratories
Answer: A, Collapsing FSGS   HIV-associated nephropathy classically demonstrates collapsing FSGS. Other features include increased proximal tubule protein resorption droplets, and microcystic tubular dilatation. While this disease has markedly diminished in the presence of highly active antiretroviral therapy (HAART), the rate is still high in areas of sub-Saharan Africa. Within the United States, approximately 90% of cases occur in African Americans and are associated with genetic mutations in the APOL1 gene (G1/G2 alleles). The typical presentation is that of nephrotic syndrome secondary to widespread foot process effacement seen by electron microscopy. Interestingly, the CD4 count has not shown to be...


HIVICK, arkana Laboratories, teaching point
The patient is a 24 year-old African American male who has recently been diagnosed with HIV infection. He has not received HAART therapy and presents to the hospital with 1.2 g/g of proteinuria and a creatinine of 2.9 mg/dL. Figure 1 shows segmental sclerosis. Figure 2 shows tubular atrophy and interstitial inflammation. Figure 3 shows "hole" formation in glomerular basement membranes. Figures 4, 5, and 6 shows IgG, kappa, and lambda, respectively. Figure 7 shows mesangial and capillary wall electron dense deposits. This is a case of HIV immune complex disease of the kidney (HIVICK). HIV immune complex disease of...

Art of Medicine: Collapsing Glomerulopathy

Collapsing Glomerulopathy
The above painting shows a glomerulus with capillary tuft collapse, visceral epithelial cell hyperplasia, and numerous protein resorption droplets within Bowman’s space; findings that can be seen in collapsing glomerulopathy.  A PAS stain from a case of collapsing glomerulopathy is also shown in the photomicrograph below.  Initially, collapsing glomerulopathy was considered a severe form of focal segmental glomerulosclerosis and placed into the Columbia classification. According to the Columbia classification, collapse of at least one capillary loop with obliteration of the lumen and proliferation and hypertrophy of overlying podocytes is sufficient for a diagnosis of the collapsing glomerulopathy.  Tubulointerstitial damage is...

Collapsing Glomerulopathy

Collapsing glomerulopathy is characterized by glomerular tuft collapse with overlying epithelial hypertrophy and hyperplasia in Bowman’s space. This pattern of glomerular injury is most commonly seen in African Americans and has been shown to be strongly associated with the presence of APOL1 risk variants in a number of associated diseases including HIV infection, lupus nephritis, interferon therapy, PLA2R-positive membranous glomerulopathy, and idiopathic cases.

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...