HIV-infected patients may present with a variety of patterns of renal involvement.
Acute renal failure is common and most often a result of
sepsis,
hypotension, and nephrotoxic agents. It is potentially avoidable, and support through the period of
renal failure may lead to resolution of the renal dysfunction.
HIV-associated nephropathy is a unique pattern of sclerosing glomerulopathy that ranges in prevalence from 1 to 10% of the HIV-infected population in different geographic locales. This complication of
HIV infection will likely present a growing challenge to the medical community as
HIV infection continues to spread worldwide. Deciphering the pathogenetic mechanisms of this most rapidly progressive form of focal segmental
sclerosis is not only clinically relevant, but will hopefully provide valuable insights into the mediation of the more common idiopathic form of the disease. The potential for improved renal survival of patients with
HIV-associated nephropathy has become more realistic with the development and use of
antiretroviral agents, as well as studies on the role of immunosuppression and ACE inhibition in this population. An awareness of other glomerular lesion and tubulointerstitial lesions has broadened our understanding of populations with renal disease who have been infected by HIV. Moreover, as prolonged survival of HIV-infected individuals is being achieved with modern
antiviral therapy, the percentage of patients surviving with nephropathy will likely grow in coming years. Awareness of the growth of this population and those requiring short- and long-term
hemodialysis and
peritoneal dialysis will allow appropriate planning for
ESRD in the HIV-infected population.