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The spectrum of HIV-related nephropathy in children

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Abstract

Background

Despite the burden of human immunodeficiency virus (HIV) disease in Southern Africa, there have been few reports of HIV-related nephropathy in children. This study outlines the spectrum of HIV-1-related kidney diseases of children in KwaZulu-Natal, South Africa.

Methods

A review of the clinical presentation, laboratory and histopathological findings of children diagnosed with HIV-related nephropathy.

Results

Forty-nine out of 71 children (1–16 years old) with HIV-1 related nephropathy underwent kidney biopsy. The most common histopathological finding was focal segmental glomerulosclerosis (FSGS), which was present in 32 (65.3%) children; 13 (26.5%) having collapsing glomerulopathy and 19 (38.8%) classic FSGS. The majority of patients showed haematological (86.4%) and electrolyte abnormalities (69.4%). Renal impairment was present in 41% of patients on initial presentation. However, end-stage kidney disease was present in only 4% of these patients. All patients were treated with highly active anti-retroviral therapy (HAART), the majority (79.6%) showed decreased proteinuria with 38.8% having complete remission.

Conclusions

This study, one of the largest series of children reported from Africa, demonstrates that nephrotic syndrome due to HIV-associated nephropathy (HIVAN) is the commonest presentation of HIV-related nephropathy in childhood. Highly active anti-retroviral therapy in combination with angiotensin-converting enzyme antagonists is highly effective in decreasing proteinuria and preserving renal function.

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Acknowledgements

The authors wish to thank the medical managers of Inkosi Albert Luthuli Central Hospital and King Edward VIII Hospital, Durban, South Africa, for granting permission for the study; Mrs M. Moodley for administrative assistance; Mr D. Sookhdeo and Ms V. Naidoo for case tracing; and Mr Clive Sydney for laboratory work. Three of the authors are supported by the Medical Research Council (SA), the National Research Foundation (SA) and the David Hepburn Foundation (SA).

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Any opinion, findings and conclusions or recommendations expressed in this manuscript are those of the authors and therefore the funding bodies do not accept any liability in regard thereto.

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Authors and Affiliations

  1. Optics and Imaging Centre, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa

    Duran Ramsuran & Thajasvarie Naicker

  2. Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, 4013, KwaZulu-Natal, South Africa

    Rajendra Bhimma, Elaene Naicker & Miriam Adhikari

  3. Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa

    Pratistadevi K. Ramdial, Julian Deonarain & Yetish Sing

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  1. Duran Ramsuran
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Correspondence to Rajendra Bhimma.

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Ramsuran, D., Bhimma, R., Ramdial, P.K. et al. The spectrum of HIV-related nephropathy in children. Pediatr Nephrol 27, 821–827 (2012). https://doi.org/10.1007/s00467-011-2074-8

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  • DOI: https://doi.org/10.1007/s00467-011-2074-8

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