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HIV Associated Nephropathy

Pathology Editor: Agnes Fogo, MD
Medical Photographer: Brent Weedman

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Fig 1. The most common lesion in patients with HIV infection-related renal disease is so-called HIV associated nephropathy (HIVAN). This manifests as glomerulosclerosis in a focal and segmental pattern with collapse of the glomerular tufts and disproportionate cystic changes of the tubules, as illustrated in this autopsy case. Tubules are filled with proteinaceous material, and Bowman's capsule also appears enlarged in part due to the small retracted, collapsed glomeruli. (Jones' silver stain, original magnification X100).
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Fig 2. The collapsing glomerular appearance in HIVAN is due to retraction of each of the individual lobules of the glomerulus, with a corrugated wrinkled appearance of the glomerular basement membrane, frequently with overlying visceral epithelial cell hyperplasia. In this case, in addition to overlying increased visceral epithelial cells, there are also numerous protein droplets in Bowman's space. (Jones' silver stain, original magnification X400).
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Fig 3. Both idiopathic collapsing glomerulopathy and HIVAN share similar light microscopic appearances. However, only in HIVAN is there a frequent increase in reticular aggregates in endothelial cell cytoplasm, as shown in this case. (Transmission electron microscopy, original magnification X20,000).

From the Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
Address author queries to Agnes Fogo, MD, Department of Pathology, Vanderbilt University Medical Center, MCN C-3310, Nashville, TN 37232.
Am J Kidney Dis 36(3):E13, 2000 (available
 Copyright 2000 by the National Kidney Foundation, Inc.

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