A cross-sectional study of HIV-seropositive patients
with varying degrees of proteinuria in South Africa
Human immunodeficiency virus (HIV)-associated
nephropathy (HIVAN) is the most common finding on renal
biopsy in HIV-infected black patients and is also the
commonest cause of end-stage renal disease in these
patients. Early detection of HIVAN may be beneficial in
evaluating early treatment. This study examined the pattern
of renal diseases in HIV-infected South Africans and also
attempted to diagnose HIVAN at an early stage. In this
single-center cross-sectional study, 615 HIV-infected patients
were screened for proteinuria. Thirty patients with varying
degrees of proteinuria underwent renal biopsy. Patients with
diabetes mellitus, uncontrolled hypertension, known causes
of chronic kidney disease, and serum creatinine above
250 lmol/l were excluded. Patients in this study were not on
antiretroviral therapy. HIVAN was found in 25 (83%) patients.
Six of them (24%) had microalbuminuria. Altogether, seven
patients with persistent microalbuminuria were biopsied and
six (86%) showed HIVAN. Other biopsy findings included
membranoproliferative nephropathy in two (7%) and
interstitial nephritis in three (10%). Four patients with HIVAN
had associated membranous nephropathy. HIVAN is the
commonest biopsy finding among our study patients with
HIV infection who present with varying degrees of
proteinuria. Microalbuminuria is a manifestation of HIVAN
in our study patients. Therefore, microalbuminuria may be
an early marker of HIVAN, and screening for its presence may
be beneficial. Renal biopsy may be considered in seropositive
patients who present with persistent microalbuminuria,
especially with low CD4 counts irrespective of good renal
function. This will allow diagnosis and treatment of HIVAN at
an early stage and may prevent further disease progression.
