Kidney In HIV

Ans. is ‘a’ i.e., Focal segmental GN

Most characteristic lesion of HIV-associated nephropathy is collapsing glomerulopathy, a morphological variant of focal segmental glomerulosclerosis.

Morphological changes in FSGS

o Sclerosis of some glomeruli with involvement of only a portion of capillary tuft.

o Collapse of GBM.

o Increase in matrix.

o Segmental insudation of plasma proteins along the capillary wall (Hyalinosis).

o Lipid droplets and foam cells.

o Diffuse effacement of foot processes characteristic of minimal change disease, but in addition, there is focal detachment of the epithelial cells with denudation of the underlying GBM.

o IgM and C₃ deposits in sclerosed area and in the mesangium.

Collapsing alomerulorlathy

o It is a morphological variant of FSGS.

o Characterized by collapse and sclerosis of the entire glomerular tuft in addition to the usual FSGS lesions.

o A characteristic feature is proliferation and hypertrophy of glomerular visceral epithelial cells (podocytes). o There is prominent tubular injury with formation of microcystes.

o It is the most characteristic lesion of HIV nephropathy.

Epithelial damage is the hallmark of FSGS.

Following information has been added in 8^,h/e of Robbins

• Sclerosis is characterized by accumulations of extracellular collagenous matrix, either confined to mesangial areas involving the capillary loops or both. The sclerosing process may also result in obliteration of capillary lumens in affected glomeruli.

o In contrast Hyalinosis refers to accumulation of homogeneous, amorphous, eosinophic material into glomerular structure. Hyaline is made up of plasma proteins that have insudated from circulation into glomerular structure. Hyalinosis may also result in obliteration of cappillary lumen of glomerular toff. Hyalinosis is usually a consequence of endothelial or capillary wall injury and typically the end result of various form of glomerular damage. It is a common feature of FSGS.

Ans. is ‘c’ i.e., Collapsing glomerulopathy

Glomerulopathy in I-1W infection

The classic and most common HIV associated glomerulopathy is an aggressive form of focal segmented glomeruloscrelosis, an entity that is termed HIV associated nephropathy (HIVAN). (It was earlier called collapsing glomerulopathy).

Ans. is ‘a’ i.e., Membranous GN; ‘c’ i.e. Focal segmental Glomerulosclerosis

o Most common kidney lesion in AIDS is focal segmental glomerulosclerosis (80%) and mesangioproliferative glomerulonephropathy (10% -15%).

o Other kidney lesions are;

         Acute diffuse proliferative glomerulonephritis                                MPGN                               MCD

         IgA nephropathy                                                                       Membranous

Answer is A (Hepatitis B)

`Hepatitis B’ has not been mentioned to have any association with minimal change disease’.

Major Causes of Minimal Change Disease / (Nil) disease / Lipoid Nephrosis

In association with systemic diseases or drugs

1. HIV infection^Q
2. Hodgkins disease° and other Lymphoproliferative malignancies
3. Drug induced Interstitial Nephritis^Q
   1. NSAIDS
   2. Rifampicin
   3. Interferon

Answer is A (FSGN):

The most charachteristic Glomerulopathy in HIV is focal segmental Glomerulosclerosis (FSGS) which typically reveals collapse of the glomerular capillary tuft called collapsing glomerulopathy.

HIV associated Nephropathy is severe rapidly progressive collapsing form of FSGS

Answer is A (Focal Segmental Glomerulosclerosis):

The most characteristic glomerulopathy in HIV is Focal Segmental Glomerulosclerosis (FSGS) which typically reveals collapse of the glomerular capillary tuft called collapsing glomerulopathy.

HIV associated Nephropathy is a severe rapidly progressive collapsing form of FSGS.

Answer is C (Collapsing glomerulopathy):

The most charachteristic glomerulonephritis in HIV is focal segmental Glomerulosclerosis (FSGS).

The FSGS characteristically reveals collapse of glomerular capillary tuft and is called collapsing glomerulopathy.

Ans. D: Chronic glomerulonephritis

Chronic kidney disease is long-standing, progressive deterioration of renal function.

Symptoms develop slowly and include anorexia, nausea, vomiting, stomatitis, nocturia, lassitude, fatigue, pruritus, decreased mental acuity, muscle twitches and cramps, water retention, under nutrition, GI ulceration and bleeding, peripheral neuropathies, and seizures.

Diagnosis is based on laboratory testing of renal function, sometimes followed by renal biopsy.

Patients with chronic renal failure have small shrunken kidneys (usually < 10 cm in length) with thinned, hyperechoic cortex.

Treatment is primarily directed at the underlying condition but includes fluid and electrolyte management, erythropoietin for anemia, and often dialysis or transplantation.