Anson Joseph, MD; Ravinder K. Wali, MD; Edward J. Weinman, MD
Joseph A, Wali RK, Weinman EJ. Renal Amyloidosis in AIDS. Ann Intern Med. 2000;133:75. doi: 10.7326/0003-4819-133-1-200007040-00019
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Published: Ann Intern Med. 2000;133(1):75.
TO THE EDITOR:
We recently evaluated a 41-year-old HIV-1–positive woman whose blood urea nitrogen and creatinine levels increased from 82 and 8.9 mg/dL, respectively, over 3 months. Kidney light microscopy and electron microscopy showed extensive deposition of amyloid. This case prompted a reconsideration of renal disease in HIV-positive patients.
A spectrum of unique renal diseases has been reported in HIV-positive patients (1). Many of these patients have collapsing focal segmental glomerulosclerosis (FSGS) (HIV-associated nephropathy) characterized by heavy proteinuria and rapid deterioration of renal function (2). Some clinicians use the designation of HIV-associated nephropathy to include all HIV-positive patients with renal insufficiency; this practice may have altered interpretation of some clinical experiences. For example, although FSGS appears most prevalent in African-American men, we have documented other diagnostic renal entities in this population, as well as FSGS in other patient groups. In addition, the literature suggests that AA amyloidosis is uncommon in HIV disease, a surprising observation given the propensity for repeated infections and antigenic stimulation in HIV-infected patients. Given the prognosis of FSGS, there is an understandable reluctance to pursue diagnostic testing, particularly in patients presenting with advanced renal failure.
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