Paul L. Kimmel, MD; Laura Barisoni, MD; Jeffrey B. Kopp, MD
Kimmel PL, Barisoni L, Kopp JB. Pathogenesis and Treatment of HIV-Associated Renal Diseases: Lessons from Clinical and Animal Studies, Molecular Pathologic Correlations, and Genetic Investigations. Ann Intern Med. 2003;139:214-226. doi: 10.7326/0003-4819-139-3-200308050-00019
Download citation file:
Published: Ann Intern Med. 2003;139(3):214-226.
. Data obtained from the Centers for Disease Control and Prevention. Reproduced with permission from reference 27, Kidney Int. 2003; 63:1618-31.
. Interferon-α protein was assessed in microdissected renal glomerular and interstitial tissue from 6 patients with HIV-associated nephropathy, 4 patients with HIV-associated immune-mediated glomerulonephritis, 3 HIV-infected patients who died without autopsy evidence of renal disease, 9 patients with idiopathic focal segmental glomerulosclerosis in the absence of HIV infection, and renal tissue of uninfected patients without clinical or pathologic evidence of renal disease by high-performance immunoaffinity chromatography and chemiluminescent enzyme-linked immunosorbent assay. Renal interstitial and glomerular interferon-α protein levels were significantly higher in renal tissue from patients with HIV-associated nephropathy than in tissue from all other groups ( = 0.002; analysis of variance). A similar pattern was noted for nonpolymorphic major histocompatibility II locus and interferon-γ receptor protein levels. Error bars indicate SEs. * = 0.002.
Human HIV-associated nephropathy: A glomerulus shows global collapse of capillary lumina. The glomerular basement membranes are wrinkled and folded, and the urinary space is occupied by proliferating podocytes forming pseudocrescents. Numerous protein reabsorption droplets are present in the podocyte cytoplasm, and this cytoplasm is more abundant than normal (silver staining; original magnification, ×60). Tubulointerstitial damage includes interstitial fibrosis with inflammation, tubular atrophy, and microcysts. Eosinophilic casts are present in the dilated tubular lumina (silver staining; original magnification, ×40). Ultrastructural analysis shows a collapsed glomerular capillary. Note the wrinkling of the glomerular basement membrane. Podocytes ( ) have lost foot processes and primary processes, and their cell body sits directly on the glomerular basement membrane. There is focal detachment of podocytes from the underlying glomerular basement membrane and new matrix deposition ( ). (Original magnification, ×8000.) Membrane nephropathy in HIV-1 transgenic mice: Immunostaining for synaptopodin in wild-type ( ) and HIV-1 transgenic mice ( ): All the glomeruli are stained for synaptopodin in kidneys from wild type ( ). No staining is noted in the kidney of the HIV-1 transgenic mice ( ). (Original magnification, ×20.) Immunostaining for adducin ( ) and Na , K –adenosine triphosphatase ( ) in HIV-1 transgenic mice: No basolateral staining is noted in this dilated tubule, whereas the nondilated tubules display a delicate basolateral staining ( ). (Original magnification, ×40.).
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only