Complicaciones renales de la infección por VIH-1

Renal involvement in AIDS may be specific or unspecific. Unspecific lesions, the most common, are usually an acute tubular necrosisproduced by hemodynamic, infectious or electrolytic alterations that lead to an acute renal failure or drug nephrotoxicity. Specific lesions are segmental and focal hyalinosis, immune complex glomerulonephritisand thrombotic microangiopathy. Focal and segmental hyalinosis is observed almost exclusively in black people and produces a rapidly progressive renal failure. Lesions are a consequence of HIV stimulation of TGF beta in mesangial cells. Immune complex glomerulonephritis, formed by HIV antigens and anti HIV antibodies, is observed in white and black people. The glomerular lesion in this condition is less severe than in the former. Thrombotic microangiopathycould be a consequence of a pathogenic effect of the virus over glomerular capillariesand arterioles. It is clinically expressed as a hemolytic uremic syndrome. This paper reports briefly the renal pathologicalstudy of 46 patients infected with HIV-1, seen at the NephrologyService of the Bichat Hospital in Paris.