Kidney Week

Abstract: FR-PO0668

FSGS Not Otherwise Specified, Not HIV-Associated Nephropathy, Predominates in Kidney Biopsy Pathology in a Contemporary Urban HIV Cohort

Session Information

• Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - ANCA/FSGS
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Abraham, Mona, Emory University School of Medicine, Atlanta, Georgia, United States

Mona Abraham, MD

• Mahayni, Zade, Morehouse School of Medicine, Atlanta, Georgia, United States

Zade Mahayni

• Pierre, Luckencia, Emory University School of Medicine, Atlanta, Georgia, United States

Luckencia Pierre, MD

• Fountain, Faith A., Emory University School of Medicine, Atlanta, Georgia, United States

Faith A. Fountain

• Daswatta, Dilini M., Emory University School of Medicine, Atlanta, Georgia, United States

Dilini M. Daswatta, DO

• Thomas, Brittany Jamille, Emory University School of Medicine, Atlanta, Georgia, United States

Brittany Jamille Thomas, MD

• Jagannathan, Geetha, Emory University School of Medicine, Atlanta, Georgia, United States

Geetha Jagannathan, MBBS

• Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States

Jason Cobb, MD, FASN

Background

The spectrum of HIV-related kidney disease has evolved in the antiretroviral therapy (ART) era, but contemporary North American biopsy data using KDIGO classification remain limited. Prior studies, including Kudose et al. (Kidney Int 2020), analyzed biopsies through 2018, demonstrating substantial HIV-associated nephropathy (HIVAN) and immune complex glomerulonephritis (ICGN) prevalence. We present a 2020–2026 case series of kidney biopsy pathology in patients with HIV from a predominantly Black cohort.

Methods

We performed a retrospective electronic medical record review within an urban academic health system from January 2020 to January 2026, identifying patients with HIV who underwent kidney biopsy. Demographics, comorbidities, ART status, and laboratory data were collected. Biopsies were classified using the 2018 KDIGO pathologic classification. Potential eligibility for APOL1-targeted clinical trials was also explored.

Results

Thirty patients were included (77% male; median age 45.8 years; 80% Black). Comorbidities included hypertension (67%), diabetes (40%), syphilis (23%), and hepatitis B/C coinfection (27%). Sixty-seven percent were receiving ART at biopsy, with 57% adherence. Focal segmental glomerulosclerosis, not otherwise specified (FSGS-NOS), was the predominant biopsy finding (40%, n=12), followed by ICGN (17%, n=5), diabetic nephropathy (10%, n=3), and IgA nephropathy (7%, n=2). Only one patient (3%) had HIVAN. Other diagnoses included thrombotic microangiopathy, light chain cast nephropathy, interstitial nephritis, and syphilitic membranous nephropathy. Among patients with FSGS-NOS, 20% had undetectable viral loads and 44% had CD4 counts >200. Mean initial creatinine was 3.34 mg/dL (eGFR 31 mL/min), and 37% required dialysis. Patients on ART had lower proteinuria (2.87 vs. 4.50 g/g) and lower final creatinine (2.50 vs. 2.79 mg/dL).

Conclusion

In this predominantly Black urban cohort, FSGS-NOS—not HIVAN—was the predominant biopsy finding (40% vs. 3%), suggesting a paradigm shift from the historical dominance of HIVAN. FSGS-NOS occurred across the spectrum of virologic control, supporting multifactorial pathophysiology involving immune dysregulation, comorbid disease, and genetic susceptibility. These findings support APOL1 genotyping to identify APOL1-mediated podocytopathy and candidates for targeted therapies.