PubMed · 9550621
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A H Cohen. 1998. HIV-associated nephropathy: current concepts.. https://doi.org/10.1093/ndt%2F13.3.540
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Podocytes are highly differentiated, postmitotic cells, whose function is largely based on their complex cytoarchitecture. The differentiation of podocytes coincides with progressive expression of maturity markers, including WT-1, CALLA, C3b receptor, GLEPP-1, podocalyxin, and synaptopodin. In collapsing forms of focal segmental glomerulosclerosis (FSGS), including idiopathic FSGS and HIV-associated nephropathy, podocytes undergo characteristic, irreversible ultrastructural changes. This study analyzes the expression pattern of the above differentiation markers and of the proliferation marker Ki-67 in collapsing idiopathic FSGS and HIV-associated nephropathy compared with minimal change disease, membranous glomerulopathy, as well as normal adult and fetal human kidney. In minimal change disease and membranous glomerulopathy, all mature podocyte markers were retained at normal levels despite severe proteinuria and foot process fusion; no cell proliferation was observed. In contrast, in collapsing idiopathic FSGS and HIV-associated nephropathy, there was disappearance of all markers from all collapsed glomeruli and of synaptopodin from 16% of noncollapsed glomeruli. This phenotypic dysregulation of podocytes was associated with cell proliferation in both diseases. It is concluded that the loss of specific podocyte markers defines a novel dysregulated podocyte phenotype and suggests a common pathomechanism in collapsing FSGS, whether idiopathic or HIV-associated.
We describe the frist reported case in Switzerland of HIV-associated nephropathy (HIVAN). HIVAN shows a typical combination of clinical findings: black race, proteinuria, large hyper-echogenic kidneys, normal blood pressure, positive HIV serology and no autoantibodies. The histologic findings are typical: focal segmental glomerulosclerosis of the collapsing variant, often with marked interstitial nephritis. The disease normally appears before AIDS symptoms develop and follows a very aggressive course to end-stage renal disease. Therapy consists of a combination of nucleoside reverse transcriptase and proteinase inhibitors, ACE inhibitors, and possibly steroids. In end-stage renal disease patients can be managed by haemodialysis, continuous ambulatory peritoneal dialysis (CAPD) or kidney transplantation.
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