Abstract: SA-PO0721
The Glomerulus That Refused to Quit: Renal Recovery in HIV-Associated Nephropathy (HIVAN)
Session Information
- Glomerular Diseases: Complement-Mediated Glomerulopathies and Infection-Related GN
October 24, 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
- Al Amer, Zain, Portsmouth Regional Hospital, Portsmouth, New Hampshire, United States
- Kulkarni, Swathi Deepak, Portsmouth Regional Hospital, Portsmouth, New Hampshire, United States
- Joshi, Sucharit, Portsmouth Regional Hospital, Portsmouth, New Hampshire, United States
Group or Team Name
- HCA healthcare - Portsmouth Regional Hospital
Introduction
HIVAN is a collapsing variant of FSGS that causes rapidly progressive kidney failure in uncontrolled HIV. Prior to the use of ARTS,HIVAN affected approximately 3.5–10% of people with HIV in the U.S, with higher prevalence among African descent. HIVAN shows rapid progression with 50% cases reaching ESRD in 3 years.The initiation of ART has reduced HIVAN incidence by 60%.
Case Description
A 39-year-old male with African descent and no prior medical history presented with progressive bilateral lower extremity edema and pain since 2 weeks. Patient had severe AKI with creatinine 14.68 mg/dL, hyperkalemia, proteinuria (>500 mg/dL) and hypoalbuminemia requiring hemodialysis for 10 days.
HIV-1 was reactive with a viral load of 72,600 copies/mL and a CD4 count of 1 cell/µL, confirming AIDS. Renal biopsy confirmed collapsing FSGS indicating HIVAN. Patient's hospital course was complicated by moderate pericardial effusion in the setting of uremia, oral candidiasis, and CMV colitis. ART was initiated, Prednisone was discontinued given no therapeutic role in HIVAN.
He was discharged on hospital day 23 with a creatinine of 2.22 mg/dL (eGFR 37.7 mL/min/1.73 m) and ART with close outpatient follow-up.
Discussion
HIVAN disproportionately affects individuals of African descent with APOL1 high-risk genotypes. Other risk factors are advanced immunosuppression, high viral load, hepatitis C coinfection and family history of kidney disease. Kidney involvement occurs in 30% of untreated HIV-positive cases, supporting early screening for proteinuria in high-risk populations.
This case study demonstrates that early initiation of CRRT and ART can result in functional renal recovery and prevent progression to ESRD, proving that HIVAN is potentially reversible despite a severe initial presentation.
Outcomes in patients with HIVAN requiring dilaysis are typically poor with reported 90-day mortality of 56–75%. The favorable renal recovery observed in this case was likely driven by early kidney biopsy confirming FSGS, a high index of clinical suspicion prompting timely HIV testing in the setting of new-onset renal failure and intitation of ART.