Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Pediatric Nephrology
Published in: Pediatric Nephrology 5/2012

01-05-2012 | Original Article

The spectrum of HIV-related nephropathy in children

Authors: Duran Ramsuran, Rajendra Bhimma, Pratistadevi K. Ramdial, Elaene Naicker, Miriam Adhikari, Julian Deonarain, Yetish Sing, Thajasvarie Naicker

Published in: Pediatric Nephrology | Issue 5/2012

Login to get access

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.
Literature
1.
UNAIDS (2010) UNAIDS report on the global AIDS epidemic 2010. UNAIDS
2.
Agaba EI, Agaba PA, Sirisena ND, Anteyi EA, Idoko JA (2003) Renal disease in the acquired immunodeficiency syndrome in north central Nigeria. Niger J Med 12:120–125PubMed
3.
Anochie IC, Eke FU, Okpere AN (2008) Human immunodeficiency virus-associated nephropathy (HIVAN) in Nigerian children. Pediatr Nephrol 23:117–122PubMedCrossRef
4.
Han TM, Naicker S, Ramdial PK, Assounga AG (2006) A cross-sectional study of HIV-seropositive patients with varying degrees of proteinuria in South Africa. Kidney Int 69:2243–2250PubMedCrossRef
5.
6.
Daugas E, Rougier JP, Hill G (2005) HAART-related nephropathies in HIV-infected patients. Kidney Int 67:393–403PubMedCrossRef
7.
Humphreys MH (1995) Human immunodeficiency virus-associated glomerulosclerosis. Kidney Int 48:311–320PubMedCrossRef
8.
Kimmel PL, Barisoni L, Kopp JB (2003) Pathogenesis and treatment of HIV-associated renal diseases: lessons from clinical and animal studies, molecular pathologic correlations, and genetic investigations. Ann Intern Med 139:214–226PubMed
9.
10.
Ross MJ, Klotman PE (2002) Recent progress in HIV-associated nephropathy. J Am Soc Nephrol 13:2997–3004PubMedCrossRef
11.
Lindegren ML, Steinberg S, Byers RH Jr (2000) Epidemiology of HIV/AIDS in children. Pediatr Clin North Am 47:1–20PubMedCrossRef
12.
Ray PE (2009) Taking a hard look at the pathogenesis of childhood HIV-associated nephropathy. Pediatr Nephrol 24:2109–2119PubMedCrossRef
13.
Barre-Sinoussi F, Chermann JC, Rey F, Nugeyre MT, Chamaret S, Gruest J, Dauguet C, Axler-Blin C, Vezinet-Brun F, Rouzioux C, Rozenbaum W, Montagnier L (1983) Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science 220:868–871PubMedCrossRef
14.
Fauci AS (1999) The AIDS epidemic—considerations for the 21st century. N Engl J Med 341:1046–1050PubMedCrossRef
15.
Pardo V, Meneses R, Ossa L, Jaffe DJ, Strauss J, Roth D, Bourgoignie JJ (1987) AIDS-related glomerulopathy: occurrence in specific risk groups. Kidney Int 31:1167–1173PubMedCrossRef
16.
Ray PE, Xu L, Rakusan T, Liu XH (2004) A 20-year history of childhood HIV-associated nephropathy. Pediatr Nephrol 19:1075–1092PubMedCrossRef
17.
Mitsuya H, Weinhold KJ, Furman PA, St Clair MH, Lehrman SN, Gallo RC, Bolognesi D, Barry DW, Broder S (1985) 3'-Azido-3'-deoxythymidine (BW A509U): an antiviral agent that inhibits the infectivity and cytopathic effect of human T-lymphotropic virus type III/lymphadenopathy-associated virus in vitro. Proc Natl Acad Sci U S A 82:7096–7100PubMedCrossRef
18.
Esezobor CI, Iroha E, Onifade E, Akinsulie AO, Temiye EO, Ezeaka C (2010) Prevalence of proteinuria among HIV-infected children attending a tertiary hospital in Lagos, Nigeria. J Trop Pediatr 56:187–190PubMedCrossRef
19.
Kala U, Petersen K, Faller G, Goetsch S (2007) Spectrum of severe renal disease in children with HIV/Aids at Chris Hani Baragwanath Hospital, Johannesburg [abstract]. Pediatr Nephrol 22:301
20.
McCulloch MI (2007) Introduction to pediatric HIV disease [abstract]. Pediatr Nephrol 22:298
21.
McCulloch MI (2007) Infections in paediatric transplantation in developing countries. Paper presented at: 4th Congress of the International Pediatric Transplant Association (IPTA) on Pediatric Transplantation; Cancun, Mexico
22.
Gerntholtz TE, Goetsch SJ, Katz I (2006) HIV-related nephropathy: a South African perspective. Kidney Int 69:1885–1891PubMedCrossRef
23.
Nourse PJ, Cotton MF, Bates WD (2010) Renal manifestations in children co-infected with HIV and disseminated tuberculosis. Pediatr Nephrol 25:1759–1763PubMedCrossRef
24.
Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263PubMed
25.
National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266CrossRef
26.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576CrossRef
27.
Churg J, Habib R, White RH (1970) Pathology of the nephrotic syndrome in children: a report for the International Study of Kidney Disease in Children. Lancet 1:1299–1302CrossRef
28.
Lopes GS, Marques LP, Rioja LS, Basilio-de-Oliveira CA, Oliveira AV, Nery AC, Santos Oda R (1992) Glomerular disease and human immunodeficiency virus infection in Brazil. Am J Nephrol 12:281–287PubMedCrossRef
29.
Nochy D, Glotz D, Dosquet P, Pruna A, Guettier C, Weiss L, Hinglais N, Idatte JM, Mery JP, Kazatchkine M, Druet P, Barjety J (1993) Renal disease associated with HIV infection: a multicentric study of 60 patients from Paris hospitals. Nephrol Dial Transplant 8:11–19PubMed
30.
Kimmel PL, Phillips TM, Ferreira-Centeno A, Farkas-Szallasi T, Abraham AA, Garrett CT (1992) Brief report: idiotypic IgA nephropathy in patients with human immunodeficiency virus infection. N Engl J Med 327:702–706PubMedCrossRef
31.
Jindal KK, Trillo A, Bishop G, Hirsch D, Cohen A (1991) Crescentic IgA nephropathy as a manifestation of human immune deficiency virus infection. Am J Nephrol 11:147–150PubMedCrossRef
32.
Ross MJ, Klotman PE, Winston JA (2000) HIV-associated nephropathy: case study and review of the literature. AIDS Patient Care STDS 14:637–645PubMedCrossRef
33.
Ahuja TS, Abbott KC, Pack L, Kuo YF (2004) HIV-associated nephropathy and end-stage renal disease in children in the United States. Pediatr Nephrol 19:808–811PubMedCrossRef
34.
Winston JA, Klotman ME, Klotman PE (1999) HIV-associated nephropathy is a late, not early, manifestation of HIV-1 infection. Kidney Int 55:1036–1040PubMedCrossRef
35.
Burns GC, Paul SK, Toth IR, Sivak SL (1997) Effect of angiotensin-converting enzyme inhibition in HIV-associated nephropathy. J Am Soc Nephrol 8:1140–1146PubMed
36.
Cachat F, Cheseaux JJ, Guignard JP (1998) HIV-associated nephropathy in children. Arch Pediatr 5:1353–1358PubMedCrossRef
37.
Ray PE, Rakusan T, Loechelt BJ, Selby DM, Liu XH, Chandra RS (1998) Human immunodeficiency virus (HIV)-associated nephropathy in children from the Washington, D.C. area: 12 years’ experience. Semin Nephrol 18:396–405PubMed
38.
Herman ES, Klotman PE (2003) HIV-associated nephropathy: epidemiology, pathogenesis, and treatment. Semin Nephrol 23:200–208PubMedCrossRef
39.
D’Agati V, Appel GB (1998) Renal pathology of human immunodeficiency virus infection. Semin Nephrol 18:406–421PubMed
40.
Strauss J, Abitbol C, Zilleruelo G, Scott G, Paredes A, Malaga S, Montane B, Mitchell C, Parks W, Pardo V (1989) Renal disease in children with the acquired immunodeficiency syndrome. N Engl J Med 321:625–630PubMedCrossRef
41.
Kopp JB, Winkler C (2003) HIV-associated nephropathy in African Americans. Kidney Int Suppl (83):S43–S49PubMedCrossRef
42.
Bologa R (1999) HIV-associated nephropathy: clinical characteristics and therapeutic options. AIDS 9:38–42
43.
Weiner NJ, Goodman JW, Kimmel PL (2003) The HIV-associated renal diseases: current insight into pathogenesis and treatment. Kidney Int 63:1618–1631PubMedCrossRef
44.
Tokars JI, Frank M, Alter MJ, Arduino MJ (2002) National surveillance of dialysis-associated diseases in the United States, 2000. Semin Dial 15:162–171PubMedCrossRef
45.
Smith MC, Austen JL, Carey JT, Emancipator SN, Herbener T, Gripshover B, Mbanefo C, Phinney M, Rahman M, Salata RA, Weigel K, Kalayjian RC (1996) Prednisone improves renal function and proteinuria in human immunodeficiency virus-associated nephropathy. Am J Med 101:41–48PubMedCrossRef
46.
Eustace JA, Nuermberger E, Choi M, Scheel PJ Jr, Moore R, Briggs WA (2000) Cohort study of the treatment of severe HIV-associated nephropathy with corticosteroids. Kidney Int 58:1253–1260PubMedCrossRef
47.
Szczech LA, Edwards LJ, Sanders LL, van der Horst C, Bartlett JA, Heald AE, Svetkey LP (2002) Protease inhibitors are associated with a slowed progression of HIV-related renal diseases. Clin Nephrol 57:336–341PubMed
48.
Kimmel PL, Mishkin GJ, Umana WO (1996) Captopril and renal survival in patients with human immunodeficiency virus nephropathy. Am J Kidney Dis 28:202–208PubMedCrossRef
Metadata
Title
The spectrum of HIV-related nephropathy in children
Authors
Duran Ramsuran
Rajendra Bhimma
Pratistadevi K. Ramdial
Elaene Naicker
Miriam Adhikari
Julian Deonarain
Yetish Sing
Thajasvarie Naicker
Publication date
01-05-2012
Publisher
Springer-Verlag
Published in
Pediatric Nephrology / Issue 5/2012
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-011-2074-8

Other articles of this Issue 5/2012

Pediatric Nephrology 5/2012 Go to the issue

Review

Is fibroblast growth factor 23 a harbinger of mortality in CKD?

Original Article

Comparing cystatin C and creatinine in the diagnosis of pediatric acute renal allograft dysfunction

Review

Renal salt-wasting syndrome in children with intracranial disorders

Original Article

Renin–angiotensin–aldosterone system inhibitors in pediatric focal segmental glomerulosclerosis

Editorial Commentary

A history of the International Pediatric Nephrology Association (IPNA)

Clinical Quiz

Asymptomatic proteinuria in a child with recurrent urinary tract infections—answers