The spectrum of HIV-related nephropathy in children.

Abstract

BACKGROUND:

Despite the burden of human immunodeficiency virus (HIV) disease in Southern Africa, there have been few reports of HIV-related nephropathy in children. This study outlines the spectrum of HIV-1-related kidney diseases of children in KwaZulu-Natal, South Africa.

METHODS:

A review of the clinical presentation, laboratory and histopathological findings of children diagnosed with HIV-related nephropathy.

RESULTS:

Forty-nine out of 71 children (1-16 years old) with HIV-1 related nephropathy underwent kidney biopsy. The most common histopathological finding was focal segmental glomerulosclerosis (FSGS), which was present in 32 (65.3%) children; 13 (26.5%) having collapsing glomerulopathy and 19 (38.8%) classic FSGS. The majority of patients showed haematological (86.4%) and electrolyte abnormalities (69.4%). Renal impairment was present in 41% of patients on initial presentation. However, end-stage kidney disease was present in only 4% of these patients. All patients were treated with highly active anti-retroviral therapy (HAART), the majority (79.6%) showed decreased proteinuria with 38.8% having complete remission.

CONCLUSIONS:

This study, one of the largest series of children reported from Africa, demonstrates that nephrotic syndrome due to HIV-associated nephropathy (HIVAN) is the commonest presentation of HIV-related nephropathy in childhood. Highly active anti-retroviral therapy in combination with angiotensin-converting enzyme antagonists is highly effective in decreasing proteinuria and preserving renal function.

• Authors: Duran Ramsuran, Rajendra Bhimma, Pratistadevi K Ramdial, Elaene Naicker, Miriam Adhikari, Julian Deonarain, Yetish Sing, Thajasvarie Naicker
• Journal: Pediatric nephrology (Berlin, Germany) (Pediatr Nephrol) Vol. 27 Issue 5 Pg. 821-7 (May 2012) ISSN: 1432-198X [Electronic] Germany
• PMID: 22205506 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin-Converting Enzyme Inhibitors

Topics

• AIDS-Associated Nephropathy (complications, pathology, physiopathology)
• Adolescent
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Antiretroviral Therapy, Highly Active
• Blotting, Western
• Child
• Child, Preschool
• Enzyme-Linked Immunosorbent Assay
• Female
• Glomerulosclerosis, Focal Segmental (etiology, pathology)
• Growth Disorders (etiology)
• HIV Infections (epidemiology)
• HIV Seropositivity
• Humans
• Infant
• Kidney (pathology)
• Kidney Failure, Chronic (etiology, pathology)
• Kidney Function Tests
• Male
• Nephrotic Syndrome (etiology)
• Proteinuria (drug therapy, etiology)
• South Africa (epidemiology)
• Viral Load