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Abstract: SA-PO696

The Modern Spectrum of Kidney Biopsy Findings in HIV-Infected Patients

Session Information

Category: Pathology and Lab Medicine

  • 1602 Pathology and Lab Medicine: Clinical

Authors

  • Kudose, Satoru, Columbia University Medical Center , New York, New York, United States
  • Santoriello, Dominick, Columbia University Medical Center , New York, New York, United States
  • Bomback, Andrew S., Columbia University Medical Center , New York, New York, United States
  • Batal, Ibrahim, Columbia University Medical Center , New York, New York, United States
  • Stokes, Michael Barry, Columbia University Medical Center , New York, New York, United States
  • Markowitz, Glen S., Columbia University Medical Center , New York, New York, United States
  • D'Agati, Vivette D., Columbia University Medical Center , New York, New York, United States
Background

The epidemiology of HIV-associated kidney disease is evolving rapidly. However, few North American studies address modern trends and none has applied the pathologic classification proposed by the 2018 Kidney Disease Improving Global Outcomes (KDIGO) consensus.

Methods

To characterize the modern spectrum, we performed a retrospective analysis of all HIV-positive patients (pts) with kidney biopsy interpreted at Columbia University from 2010-2018 using KDIGO guidelines.

Results

The biopsy cohort of 437 HIV pts had median age 53 years, including 66% male, 78% on anti-retroviral therapy (ART), 27% with hepatitis C (HCV), 6% with hepatitis B coinfection, 57% with hypertension, and 31% with diabetes. Race, known in 308 pts, included 179 African American (AA), 77 White, 51 Hispanic and 1 Asian. The frequency of diabetic nephropathy and immune complex (IC)GN each outnumbered classic HIVAN, followed by tenofovir nephrotoxicity (Table 1). However, classic HIVAN was the most common disease in ART-naïve or noncompliant pts (43%) and associated with AA race (95%). The association of FSGS (NOS) with AA race (62%) and ART (79%) suggests that some FSGS (NOS) may represent an attenuated form of HIVAN. The most common ICGNs were IgA nephropathy and membranous GN, both associating with ART (>90% pts). Of the 26 cases of unclassified ICGN, 54% were not on ART and 54% lacked an identifiable etiology, a subset of which may represent true HIVICK. IgM-dominant ICGN was most common in hypocomplementemic and HCV-infected pts. The presence of dual diagnoses in 88 (20%) pts underscores lesion complexity.

Conclusion

ART is changing the landscape of HIV-associated kidney diseases in the U.S. towards diabetic nephropathy, diverse ICGN and tenofovir nephrotoxicity, but has not eradicated classic HIVAN.