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INTRODUCTION: End-stage renal disease (ESRD) related to HIV is becoming a leading cause of renal replacement therapy requirement is some areas of the world. Our study aims to describe the incidence and renal outcomes of HIV-associated nephropathy (HIVAN), and immune-mediated kidney disease related to HIV (HIVICK) in Colombia. METHODOLOGY: A retrospective cohort study was performed, including all HIVAN or HIVICK incident cases assessed by the infectious diseases division in a high complexity institution in Colombia, between 2004 and 2018. A longitudinal data model under the Generalized Estimating Equations (GEE) method was used to determine changes on the glomerular filtration rate (GFR) over time. RESULTS: Within a cohort composed by 1509 HIV-infected patients, we identified 22 with HIV-associated glomerular disease. Cumulative incidence was 1.45%. At diagnosis, GFR was above 30 mL/min in 90.8% of patients, and 77.2% displayed sub-nephrotic proteinuria. Factors associated with GFR at diagnosis were: level of CD4 (Coefficient 0.113, CI 95 %: 0.046, 0.179, p < 0.01), and the inverse of the CD4/CD8 ratio. The GEE model did not demonstrate significant changes in the GFR over a 3-year period. Findings were similar when comparing GFR at diagnosis with GFR at 12 (-3.9 mL/min/1.73m2, CI 95% -7.3, 0.4, p = 0.98), 24 (-2.47 mL/min/1.73m2, CI 95% -7.0, 2.1, p=0.85), and 36 months (0.39 mL/min/1.73m2, CI 95% -4.4, 5.2, p = 0.43) of follow-up. CONCLUSIONS: Patients with glomerular disease associated with HIV have stable GFR over a 3-year period, and low rates of progression towards dialysis requirement. Differences with previous reports could be related with early diagnosis and treatment with highly active antiretroviral therapy.

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HIV infection has different clinical presentations. We report a 21-year-old male with longstanding isolated microscopic hematuria attributed to thin glomerular basement membrane disease, who after 15 years of follow-up presented with significant proteinuria. A kidney biopsy was performed, revealing the presence of tubulo-reticular inclusions in the glomerular endothelial cells. This finding led to suspect an HIV infection, which was verified. Antiretroviral therapy, angiotensin-converting enzyme and angiotensin II receptor blockers were prescribed. At 6 years of diagnosis the patient is asymptomatic and has normal kidney function. Microscopic hematuria and low level proteinuria persists.

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HIV infection has different clinical presentations. We report a 21-year-old male with longstanding isolated microscopic hematuria attributed to thin glomerular basement membrane disease, who after 15 years of follow-up presented with significant proteinuria. A kidney biopsy was performed, revealing the presence of tubulo-reticular inclusions in the glomerular endothelial cells. This finding led to suspect an HIV infection, which was verified. Antiretroviral therapy, angiotensin-converting enzyme and angiotensin II receptor blockers were prescribed. At 6 years of diagnosis the patient is asymptomatic and has normal kidney function. Microscopic hematuria and low level proteinuria persists.

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OBJECTIVE: This study evaluated the incidence, epidemiology, aetiology and outcome of chronic renal failure (CRF) in Jamaican children < 12 years old between 2001 and 2006. METHODS: The required data on all children who fulfilled inclusion criteria were obtained from their medical records at the University Hospital of the West Indies, Bustamante Hospital for Children and from practitioners in hospitals serving children islandwide. RESULTS: Eighteen new children (72.2% male) presented with CRF. The cumulative annual incidence was 4.61/million child population under age 12 years or 1.14/million total population. Congenital urological disease (44.5%) was the commonest cause of CRF, followed by glomerulonephritis (33.3%). Half of the cases of glomerulonephritis were secondary to HIV-associated nephropathy. Although all children with posterior urethral valves were diagnosed before age 6 months and promptly treated, renal failure present at birth proved irreversible. The mean age at diagnosis of CRF was 6.72 years. Ten children (55.6%) were already in CRF at first presentation with renal disease. Of these, the five with non-urological disease were already in End Stage Renal Disease (ESRD). Mortality was 44.4%. Five children died in ESRD without the benefit of dialysis. CONCLUSION: The incidence of CRF has increased from the 1985-2000 local study and is mainly due to urological pathology which progresses despite early diagnosis and treatment. Non-urological renal disease is presenting too late for therapeutic intervention. Greater public awareness of symptoms of renal disease is needed. Children's access to dialysis is unpredictable. A paediatric dialysis and transplantation programme is needed.

OBJETIVO: Este estudio evaluó la incidencia, epidemiología, etiología y resultado de la insuficiencia renal crónica (IRC) en niños jamaicanos menores de 12 años entre 2001 y 2006. MÉTODOS: Los datos requeridos sobre los niños que satisfacían los criterios de inclusión, fueron obtenidos a partir de sus historias clínicas en el Hospital Universitario de West Indies y en el Hospital Pediátrico Bustamante, así como a partir de médicos en hospitales que prestan atención a niños en todo el país. RESULTADOS: Dieciocho nuevos niños (72.2% varones) presentaron IRC. La incidencia acumulada anual fue de 4.61 por millón de población infantil menor de 12 años de edad o 1.14 por millón de población total. La enfermedad urológica congénita (44.5%) fue la causa más común de IRC, seguida por la glomerulonefritis (33.3%). La mitad de los casos de glomerulonefritis fueron secundarios a la nefropatía asociada al VIH. Aunque todos los niños con válvulas uretrales posteriores fueron diagnosticados antes de los 6 meses de edad y puestos bajos tratamiento, la insuficiencia renal presente al nacer resultó irreversible. La edad promedio al momento del diagnóstico de la IRC fue 6.72 años. Diez niños (55.6%) se hallaban ya con IRC desde que se les presentara inicialmente la enfermedad renal. De estos, los cinco con enfermedad no urológica se hallaban ya en la fase terminal de la enfermedad renal (ERT). La mortalidad fue de 44.4%. Cinco niños murieron en la ERT sin el beneficio de la diálisis. CONCLUSIÓN: La incidencia de la IRC ha aumentado desde el estudio local de 1985-2000, principalmente debido a patologías urológicas que progresan a pesar del diagnóstico precoz y el tratamiento. La enfermedad renal no urológica se está presentando demasiado tarde para una intervención terapéutica. Se requiere mayor conciencia pública de los síntomas de la enfermedad renal. El acceso de los niños a la diálisis es imprescindible. Hace falta una diálisis infantil y un programa de transplante.

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OBJECTIVE: This study evaluated the incidence, epidemiology, aetiology and outcome of chronic renal failure (CRF) in Jamaican children < 12 years old between 2001 and 2006. METHODS: The required data on all children who fulfilled inclusion criteria were obtained from their medical records at the University Hospital of the West Indies, Bustamante Hospital for Children and from practitioners in hospitals serving children islandwide. RESULTS: Eighteen new children (72.2% male) presented with CRF. The cumulative annual incidence was 4.61/million child population under age 12 years or 1.14/million total population. Congenital urological disease (44.5%) was the commonest cause of CRF, followed by glomerulonephritis (33.3%). Half of the cases of glomerulonephritis were secondary to HIV-associated nephropathy. Although all children with posterior urethral valves were diagnosed before age 6 months and promptly treated, renal failure present at birth proved irreversible. The mean age at diagnosis of CRF was 6.72 years. Ten children (55.6%) were already in CRF at first presentation with renal disease. Of these, the five with non-urological disease were already in End Stage Renal Disease (ESRD). Mortality was 44.4%. Five children died in ESRD without the benefit of dialysis. CONCLUSION: The incidence of CRF has increased from the 1985-2000 local study and is mainly due to urological pathology which progresses despite early diagnosis and treatment. Non-urological renal disease is presenting too late for therapeutic intervention. Greater public awareness of symptoms of renal disease is needed. Children's access to dialysis is unpredictable. A paediatric dialysis and transplantation programme is needed.

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Human immunodeficiency virus (HIV)-related glomerular disease is a cause of end-stage renal disease, though there is no recent data from Brazil concerning this syndrome. Persistent proteinuria (PPt) is the main marker for glomerular disease, especially levels above 1.5 g. We examined the prevalence of and associated risk factors for PPt, along with the prevalence of HIV-associated nephropathy (HIVAN) among AIDS patients. We interviewed 411 patients who were attended at the HIV/AIDS section of the Clinical Hospital of the Federal University of Pernambuco (Brazil) from January through June 2004. PPt was defined as a positive urine dipstick exam on at least two occasions. The analyzed risk factors were: black race, a low CD4 lymphocyte count (<200 cells/mm(3)), an HIV RNA level of >100,000 copies/mL and patients on highly-active antiretroviral therapy (HAART). The patients were classified according to urinary protein/creatinine ratio (Up/Uc) < 1.0, 1.0-3.0 and > 3.0. Patients with Up/Uc >3.0 were submitted to renal biopsy. Among the 411 HIV/AIDS patients, the mean age was 37 years, 70% were male, 37.5% were black, the mean CD4 count was 363 cells/mm(3) (+/- 95), the mean RNA HIV count was 44,475 copies/mL (+/- 40,369), and 92% were on HAART. The prevalence of PPt was 5.6% (95% CI = 3.6 to 8.3%), and it was significantly associated with a low CD4 lymphocyte count (p<0.048). HIVAN was found in just one patient, and two patients improved after HAART.

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Human immunodeficiency virus (HIV)-related glomerular disease is a cause of end-stage renal disease, though there is no recent data from Brazil concerning this syndrome. Persistent proteinuria (PPt) is the main marker for glomerular disease, especially levels above 1.5 g. We examined the prevalence of and associated risk factors for PPt, along with the prevalence of HIV-associated nephropathy (HIVAN) among AIDS patients. We interviewed 411 patients who were attended at the HIV/AIDS section of the Clinical Hospital of the Federal University of Pernambuco (Brazil) from January through June 2004. PPt was defined as a positive urine dipstick exam on at least two occasions. The analyzed risk factors were: black race, a low CD4 lymphocyte count (<200 cells/mm³), an HIV RNA level of >100,000 copis/mL and patients on highly-active antiretroviral therapy (HAART). The patients were classified according to urineary protein/creatinine ratio (Up/Uc) < 1.0, 1.0-3.0 and > 3.0. Patients with Up/Uc >3.0 were submitted to renal biopsy. Among the 411 HIV/AIDS patients, the mean age was 37 years, 70 percent were male, 37.5 percent were black, the mean CD4 count was 363 cells/mm³ (± 95), the mean RNA HIV count was 44,475 copies/mL (± 40,369), and 92 percent were on HAART. The prevalence of PPt was 5.6 percent (95 percent CI = 3.6 to 8.3 percent), and it was significantly associated with a low CD4 lymphocyte count (p<0.048). HIVAN was found in just one patient, and two patients improved after HAART.

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Se analiza la nefropatía asociada a HIV (NAHIV) en Uruguay, su baja incidencia en relación a la casuística en EE.UU. que vinculamos a un subdiagnóstico, pero sobre todo a factores genéticos y ambientales. Se describe el primer caso de diagnóstico anatomopatológico de NAHIV en nuestro país, con la particularidad de ser de raza blanca, tener mala evolución y asociarse a múltiples complicaciones infecciosas oportunistas

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Se analiza la nefropatía asociada a HIV (NAHIV) en Uruguay, su baja incidencia en relación a la casuística en EE.UU. que vinculamos a un subdiagnóstico, pero sobre todo a factores genéticos y ambientales. Se describe el primer caso de diagnóstico anatomopatológico de NAHIV en nuestro país, con la particularidad de ser de raza blanca, tener mala evolución y asociarse a múltiples complicaciones infecciosas oportunistas(AU)

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Renal involvement in AIDS may be specific or unspecific. Unspecific lesions, the most common, are usually an acute tubular necrosis produced by hemodynamic, infectious or electrolytic alterations that lead to an acute renal failure or drug nephrotoxicity. Specific lesions are segmental and focal hyalinosis, immune complex glomerulonephritis and thrombotic microangiopathy. Focal and segmental hyalinosis is observed almost exclusively in black people and produces a rapidly progressive renal failure. Lesions are a consequence of HIV stimulation of TGF beta in mesangial cells. Immune complex glomerulonephritis, formed by HIV antigens and anti HIV antibodies, is observed in white and black people. The glomerular lesion in this condition is less severe than in the former. Thrombotic microangiopathy could be a consequence of a pathogenic effect of the virus over glomerular capillaries and arterioles. It is clinically expressed as a hemolytic uremic syndrome. This paper reports briefly the renal pathological study of 46 patients infected with HIV-1, seen at the Nephrology Service of the Bichat Hospital in Paris.

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