Clinical Presentation and Histopathological Description of the Spectrum of Renal Diseases in HIV Infected Adults Presenting With Renal Insufficiency at the University Teaching Hospital,Lusaka Zambia

Abstract

Introduction: The spectrum of renal diseases in HIV infected adults undergoing biopsy is vast. Previous studies have indicated that HIV-associated nephropathy (HIVAN) is the commonest diagnosis in HIV-infected patients presenting with renal insufficiency. More than 90% of patients with HIVAN are black. The natural history of the renal diseases associated with HIV infection has been radically changed by antiretroviral therapy. There are other diseases, however, that account for a good percentage to the spectrum of renal diseases other than HIVAN. A group of diseases known as HIV immune complex kidney diseases have gained prominence in this regard. Other diseases include acute tubular necrosis, acute and chronic interstitial nephritis, haemolytic uremic syndrome and many others. Objective: To determine the clinical presentation and histopathological description of the spectrum of renal diseases in HIV infected adult patients presenting with renal insufficiency at the University Teaching Hospital, Lusaka Methods: This was a descriptive cross-sectional study of HIV infected adults presenting with renal insufficiency who underwent kidney biopsy. It was conducted at the University Teaching Hospital from June 2014 up to November 2015. The primary outcome was proportion of major histological diagnosis of renal diseases in this patient population while secondary outcomes included proportion of other renal histological diagnoses and the patient’s clinical characteristics. We compared the clinical characteristics of the commonest histological diagnoses. Results: The commonest histological diagnoses in this study were HIV immune complex kidney disease (HIVICK) (32%) and focal segmental glomerulosclerosis (FSGS) (29%) of various histologic variants other than the collapsing type. We did not see the classic HIVAN on histopathology in our study population. All the patients presented with severe renal dysfunction with mean eGFR of 17 ml/min/173m2 and massive proteinuria of 3+. Patients had advanced HIV infection with mean CD4 count of 197 cells/mm3. Majority of patients (64.5%) were not yet been initiated cART. 16% of the study patients were hypertensive. Conclusion: HIVICK and FSGS were the commonest histological diagnoses. Classical HIVAN on histopathology was not found in this patient population at the UTH. Recommendation: Kidney biopsy should be mandatory to make a definitive diagnosis in all patients presenting with renal dysfunction let alone those with HIV. In view high prevalence of HIVICK seroprevalence of Hepatitis C needs to be further explored in HIV positive population. Keywords: Renal insufficiency, biopsy, HIV immune complex kidney disease, HIVAN, FSGS