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01-11-2009 | Review

Taking a hard look at the pathogenesis of childhood HIV-associated nephropathy

Author: Patricio E. Ray

Published in: Pediatric Nephrology | Issue 11/2009

Abstract

Childhood human immunodeficiency virus-associated nephropathy (HIVAN) is defined by the presence of proteinuria associated with mesangial hyperplasia and/or global-focal segmental glomerulosclerosis, in combination with the microcystic transformation of renal tubules. This review discusses the pathogenesis of childhood HIVAN and explores how the current pathological paradigm for HIVAN in adults can be applied to children. The Human Immunodeficiency Virus-1 (HIV-1) induces renal epithelial injury in African American children with a genetic susceptibility to develop HIVAN. The mechanism is not well understood, since renal epithelial cells harvested from children with HIVAN do not appear to be productively infected. Children with HIVAN show a renal up-regulation of heparan sulphate proteoglycans and a recruitment of circulating heparin-binding growth factors, chemokines, and mononuclear cells. Macrophages appear to establish a renal HIV-reservoir and transfer viral particles to renal epithelial cells. All of these changes seem to trigger an aberrant and persistent renal epithelial proliferative response. The paradigm that viral products produced by infected renal epithelial cells per se induce the proliferation of these cells is not supported by data available in children with HIVAN. More research is needed to elucidate how HIV-1 induces renal epithelial injury and proliferation in HIV-infected children.

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Title: Taking a hard look at the pathogenesis of childhood HIV-associated nephropathy
Author: Patricio E. Ray
Publication date: 01-11-2009
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 11/2009
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-009-1155-4

At a glance: The STEP trials

Springer Medicine

Taking a hard look at the pathogenesis of childhood HIV-associated nephropathy

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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