The Changing Face of Human Immunodeficiency Virus-Mediated Kidney Disease

Chronic Kidney Disease and Accelerated Decline of Renal Function in Older Adults with HIV in Northern Thailand

Kidney disease remains prevalent in people living with HIV even in the antiretroviral treatment era. We determine the frequency of chronic kidney disease (CKD), rate of renal function decline, and associated factors in older adults with HIV (OAHIV) aged ≥50 years in northern Thailand. We used data from the medical records and calculated the estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration equation. Of the 269 participants (58% women, 61.8 years median age), 7.1% had CKD (eGFR <60 mL/min per 1.73 m2). There were 21 OAHIV (7.8%) with >25% decline in eGFR in the past year, 90 (33%) with accelerated (>5 mL/min per 1.73 m2 per year), and 44 (16%) with rapid (>10 mL/min per 1.73 m2 per year) declining eGFR. Female gender was the only factor associated with an accelerated decline in eGFR (odds ratio, 2.307; 95% confidence interval, 1.331-3.998; p = .003). Continuous monitoring of renal function is recommended for OAHIV to guide treatment modification and intervention.

ART and Serum albumin are influencing factors of the 5-year survival rate of people living with HIV undergoing maintenance hemodialysis caused by HIV: A cohort study

Human immunodeficiency virus (HIV) infection is one of the most prominent public health problems worldwide. The 5-year survival rate of people living with HIV undergoing maintenance hemodialysis (MHD) and the factors related to the survival rate have not been widely studied. This study calculated the 5-year survival rate of people living with HIV who were undergoing MHD and determined the risk factors that may affect the 5-year survival rate. All enrolled participants were followed up for more than 5 years from the first round of MHD. The survival rate of them was calculated, the Cox proportional hazards model was used for multivariate analysis, the Kaplan-Meier method was used to draw the survival curve, and the log-rank test was used to compare the survival time of different groups. A total of 121 participants were included in the study. Statistical analysis showed that the overall 5-year survival rate was 19.0%. The 6-, 12-, 24-, and 36-month survival rates were 71.90%, 56.20%, 41.32%, and 30.58%, respectively. Infection was the leading cause of death, accounting for 55.37%. The Cox proportional hazards model revealed that antiretroviral therapy (ART) and the serum albumin level after dialysis were independent protective factors for patient survival. The log-rank test showed that there was a significant difference in survival time between the ART and non-ART groups.

Treatment of HIV-Associated Lupus-like Membranous Nephropathy with Tacrolimus: A Case Report and Review of the Literature

Renal complications of HIV infection are common and histologically diverse. Besides HIV-associated nephropathy, which is the most well-defined glomerular disorder, immune-complex-mediated glomerulonephritis (HIVICK) is also encountered in the setting of HIV infection and may occasionally present with “lupus-like” features by light microscopy and immunofluorescence. Management of HIVICK remains controversial and mainly focuses on HIV viremia suppression with combined antiretroviral therapy. Immunosuppressive therapy may be used in order to mitigate the renal inflammation induced by the immune complex deposition. Data regarding the use of immunosuppressants in HIVICK are very limited, mostly including corticosteroids and mycophenolate acid analogues. Herein, we present the case of a 40-year-old HIV-infected Caucasian man with nephrotic syndrome, renal impairment, and a “lupus-like” membranous pattern in the kidney biopsy, who achieved a partial response of his proteinuria with a tacrolimus-based regimen in combination with antiretroviral therapy.

Drug-Induced Acute Kidney Injury

Medications are a common cause of AKI especially for patients admitted to hospital wards and the intensive care unit. Although drug-related kidney injury occurs through different mechanisms, this review will focus on three specific types of tubulointerstitial injury. Direct acute tubular injury develops from several medications, which are toxic to various cellular functions. Their excretory pathways through the proximal tubules contribute further to AKI. Drug-induced AKI may also develop through induction of inflammation within the tubulointerstitium. Medications can elicit a T cell-mediated immune response that promotes the development of acute interstitial nephritis leading to AKI. Although less common, a third pathway to kidney injury results from the insolubility of drugs in the urine leading to their precipitation as crystals within distal tubular lumens, causing a crystalline-related AKI. Intratubular obstruction, direct tubular injury, and localized inflammation lead to AKI. Clinicians should be familiar with the pathogenesis and clinical-pathologic manifestations of these forms of kidney injury. Prevention and treatment of AKI relies on understanding the pathogenesis and judiciously using these agents in settings where AKI risk is high.

The Crystalline Nephropathies

Crystalline nephropathies are a unique form of kidney disease characterized by the histologic finding of intrarenal crystal deposition. The intrinsic nature of some molecules and ions combined with a favorable tubular fluid physiology leads to crystal precipitation and deposition within the tubular lumens. Crystal deposition promotes kidney injury through tubular obstruction and both direct and indirect cytotoxicities. Further kidney injury develops from inflammation triggered by these crystals. From a clinical standpoint, the crystalline nephropathies are associated with abnormal urinalysis and urinary sediment findings, tubulopathies, acute kidney injury (AKI), and/or chronic kidney disease (CKD). Urine sediment examination is often helpful in alerting clinicians to the possibility of crystal-related kidney injury. The identification of crystals within the kidneys on biopsy by pathologists prompts clinicians to evaluate patients for medication-related kidney injury, dysproteinemia-related malignancies, and certain inherited disorders. This review will focus on the clinical and pathologic aspects of these 3 categories of crystalline nephropathies.

HIV-1 Tat and Heparan Sulfate Proteoglycans Orchestrate the Setup of in Cis and in Trans Cell-Surface Interactions Functional to Lymphocyte Trans-Endothelial Migration

HIV-1 transactivating factor Tat is released by infected cells. Extracellular Tat homodimerizes and engages several receptors, including integrins, vascular endothelial growth factor receptor 2 (VEGFR2) and heparan sulfate proteoglycan (HSPG) syndecan-1 expressed on various cells. By means of experimental cell models recapitulating the processes of lymphocyte trans-endothelial migration, here, we demonstrate that upon association with syndecan-1 expressed on lymphocytes, Tat triggers simultaneously the in cis activation of lymphocytes themselves and the in trans activation of endothelial cells (ECs). This "two-way" activation eventually induces lymphocyte adhesion and spreading onto the substrate and vascular endothelial (VE)-cadherin reorganization at the EC junctions, with consequent endothelial permeabilization, leading to an increased extravasation of Tat-presenting lymphocytes. By means of a panel of biochemical activation assays and specific synthetic inhibitors, we demonstrate that during the above-mentioned processes, syndecan-1, integrins, FAK, src and ERK_1/2 engagement and activation are needed in the lymphocytes, while VEGFR2, integrin, src and ERK_1/2 are needed in the endothelium. In conclusion, the Tat/syndecan-1 complex plays a central role in orchestrating the setup of the various in cis and in trans multimeric complexes at the EC/lymphocyte interface. Thus, by means of computational molecular modelling, docking and dynamics, we also provide a characterization at an atomic level of the binding modes of the Tat/heparin interaction, with heparin herein used as a structural analogue of the heparan sulfate chains of syndecan-1.

HIV-related nephropathy: new aspects of an old paradigm

The scenario of infection by the human immunodeficiency virus (HIV) has been undergoing changes in recent years, both in relation to the understanding of HIV infection and regarding the treatments available. As a result, the disease, which before was associated with high morbidity and mortality, is now seen as a chronic disease that can be controlled, regarding both transmission and symptoms. However, even when the virus replication is well controlled, the infected patient remains at high risk of developing renal involvement, either by acute kidney injury not associated with HIV, nephrotoxicity due to antiretroviral drugs, chronic diseases associated with increased survival, or glomerular disease associated to HIV. This review will cover the main aspects of kidney failure associated with HIV.