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Authors: CALDIN, BrunoHUNG, JamesREPIZO, LilianyMALHEIROS, Denise M.BARROS, RuiWORONIK, Viktoria
Citation: NEPHROLOGY DIALYSIS TRANSPLANTATION, v.27, suppl.2, p.191-192, 2012
Abstract: Introduction and Aims: Human Immunodeficiency Virus (HIV) is associated to many kidney pathologies, like glomerular, vascular and tubule-interstitial alterations. Few data on renal biopsies in HIV patients are available in Brazil. Our objective is to reveal the prevalence and outcomes related to the different diagnosis concerning kidney pathology in a single brazilian reference center. Methods: From 1985 to 2010, we performed 69 kidney biopsies in HIV-positive patients at the Hospital das Clínicas, University of São Paulo. We correlated clinical and laboratorial data to the results of kidney biopsies from these patients and established clinical outcomes depending on the kind of glomerular lesion. Eight biopsies were excluded from analysis due to incomplete data. Results: Mean age of this population was 39,6 ± 11,3 years (range: 15 to 65 years) and 66% were men. Only 3 patients were not under antiretroviral therapy. Main indications for biopsy were: nephrotic syndrome (47%), loss of renal function (37%) and hematuria (31%). The most prevalent glomerulopathy (GP) was focal and segmental glomerulosclerosis (FSGS), which was found in 24 patients (39%), followed by membranoproliferative glomerulonephritis (MPGN) (10 patients, 16% of the total). Six patients (10%) were diagnosed as membranous glomerulonephritis. Vascular disease (atherosclerosis, nephrosclerosis) and acute tubular necrosis were found in three patients each, representing 10% of the population. IgA nephropathy and diabetic GP were diagnosed in two patients each. Other diagnosis, like chronic and acute interstitial nephritis and mesangial glomerulonephritis were made, but represented only 5% of the population. In three patients, diagnosis was not conclusive. To evaluate whether the pattern of glomerular injury has somehow impact under renal prognosis, we divided the patients into two subgroups: FSGS and non-FSGS GP (24 vs 22 biopsies). Clinical and laboratorial aspects are depicted in table 1. Table 1 Clinical and laboratorial characteristics of the study populaton Follow-up between these two groups was slightly different: 22,8 ± 17 months for FSGS group vs 40,7 ± 31,6 months for non-FSGS GP group (p = 0,047). Only hematuria was more prevalent in the non-FSGS GP group. Composite outcome defined as hemodialysis or duplication of serum creatinine resulted in no differences between these groups (p = 0,71) during the follow up (7 patients out of 21 in FSGS group vs 5 patients out of 18 in non-FSGS GP group), as shown in figure 1. Figure 1. Composite outcome in FSGS group vs non-FGSG group FSGS was also compared to a combined group of MPGN and crioglobulinemia (12 patients). Again, only hematuria was different between these groups (22% vs 75%, p = 0,01). Nevertheless, coinfection with HCV was more prevalent in the latter group (50% of the patients, against 16% in the FSGS group, p = 0,027). Conclusions: The main indication for kidney biopsy in HIV-positive patients in our center is nephrotic syndrome and FSGS was the single most prevalent GP. MPGN was the second most prevalent diagnosis and is strongly associated to coinfection with HCV. Our composite outcome showed that the kind of GP found in kidney biopsy does not correlate to renal prognosis.
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Comunicações em Eventos - FM/MCM
Departamento de Clínica Médica - FM/MCM

Comunicações em Eventos - HC/ICHC
Instituto Central - HC/ICHC

Comunicações em Eventos - LIM/16
LIM/16 - Laboratório de Fisiopatologia Renal

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