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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2014  |  Volume : 25  |  Issue : 2  |  Page : 425-427
Renal histopathological study of Human Immunodeficiency Virus - Positive patients with clinical evidence of renal disease in Benin City, Nigeria


Renal Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria

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Date of Web Publication11-Mar-2014
 

How to cite this article:
Odonmeta A B, Oviasu E, Ojogwu L I. Renal histopathological study of Human Immunodeficiency Virus - Positive patients with clinical evidence of renal disease in Benin City, Nigeria. Saudi J Kidney Dis Transpl 2014;25:425-7

How to cite this URL:
Odonmeta A B, Oviasu E, Ojogwu L I. Renal histopathological study of Human Immunodeficiency Virus - Positive patients with clinical evidence of renal disease in Benin City, Nigeria. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Nov 15];25:425-7. Available from: http://www.sjkdt.org/text.asp?2014/25/2/425/128609
To the Editor,

Chronic kidney disease is a global health-problem and various studies have shown that sero-positive status with human immunodefi­ciency virus (HIV) predisposes a person to various forms of renal disease ranging from acute renal failure to end-stage renal disease. [1],[2] About 33.2 million people worldwide are in­fected with HIV, [3] which is associated with various renal lesions. HIV-associated nephro­pathy (HIVAN) has been the most common in the developed world. The renal complications of HIV in Africa and Nigeria remain poorly understood and hence form the essence of this study. HIV AN is a common form of renal di­sease that is rapidly progressive, making early diagnosis and treatment very important. Spe­cific clinical manifestations are suggestive, but renal biopsy findings are diagnostic.

This study was carried out at the University of Benin Teaching Hospital, Benin City, Edo State, in Southern Nigeria. The institution is a referral center with patients coming in from the neighboring states in the Niger delta area. By the 2006 estimate, the population of people in Benin City was found to be 1,147,188. The major tribe is Bird and religion is Christianity. [4]

HIV-positive patients with evidence of renal disease and consenting to renal biopsy, and who were yet to commence anti-retroviral drugs, were recruited for the study. Enzyme-linked immunosorbent assay (ELISA) followed by confirmatory Western blot was used in tes­ting for HIV in the study patients.

Renal biopsy was performed with an 18-gauge spring-loaded biopsy needle under ultra­sound guidance. [5] The indications for the pro­cedure included proteinuria of 1+ and above and/or patients with glomerular filtration rate (GFR) less than 60 mL/min with normal sized kidneys on ultrasound scan. Staining of the biopsied material was carried out with hemato­xylin and eosin as well as special stains such as periodic acid Schiff and Masson trichome. The prepared slides were viewed under a light microscope.

Approval of the ethics and research com­mittee of the University of Benin Teaching Hospital was obtained before commencing this study.

A total of 17 patients were studied. Twelve patients (70.6%) had focal and segmental glo­merulosclerosis (FSGS) of the collapsing va­riant [Figure 1], two each (11.8%) had chronic pyelonephritis [Figure 2] and minimal change disease and one patient (5.9%) had membra­nous glomerulonephritis [Table 1].
Figure 1: Renal histology showing features suggestive of the collapsing variety of focal and segmental glomerulosclerosis (Mason tricrome).

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Figure 2: Renal histology showing features of chronic pyelonephritis (hematoxylin and eosin).

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Table 1: Renal histological pattern in human immunodeficiency virus-affected patients with renal disease.

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Renal disorder is a common manifestation in HIV infection, with the reported prevalence varying between 10 and 60%. [6],[7],[8] Because the prevalence of HIV is very high in sub-Saharan Africa, it can be presumed that the prevalence of renal manifestations of HIV in this region should also be very high. Proteinuria, of va­rying magnitude, is a common presentation of renal disease in HIV patients. In our study, 12 subjects (70.6%) had nephrotic-range protei­nuria while three subjects (17.6%) had protei­nuria of 1+. This supports a diagnosis of HIV AN. However, recent studies have repor­ted patients with HIV AN presenting with microalbuinuria. [9]

Seventeen patients were biopsied during the period of this study, and the histological pat­tern of kidney disease, on light microscopy, showed that 70.6% had FSGS of the collapsing variant, 11.8% each had minimal change di­sease and chronic pyelonephritis and 5.9% had membranous glomerulonephritis. This compares with a study conducted in Ife, Nigeria, where 70% of the biopsied cases had FSGS, [9] while in Johannesburg, South Africa, Gerntholtz et al showed that FSGS was present in only 27% of the 99 patients who were biopsied. [10] In Durban, South Africa, 30 renal biopsies performed on HIV patients with varying degrees of pro­teinuria revealed FSGS in 83.3% of the cases, while 13.3% had membranous glomerulonephritis. [11] This is not very different from the histo­logical pattern found in this study. HIV AN was not previously an acquired immunodefi­ciency syndrome-defining illness, but criteria have recently been revised by the World Health Organization and symptomatic HIV AN is considered a clinical stage-four disease. [12]

In our limited renal histopathological study of HIV patients with renal disease, the predo­minant histological type encountered was the collapsing variant of FSGS, a pattern which is in keeping with reports from other studies globally.

 
   References Top

1.Seney FD Jr, Burns DK, Silva FG. Acquired immunodeficiency syndrome and the kidney. Am J Kidney Dis 1990;16:1-13.  Back to cited text no. 1
    
2.Bourgoignie JJ, Meneses R, Ortiz C, Jaffe D, Pardo V. The clinical spectrum of renal disease associated with human immunodeficiency virus. Am J Kidney Dis 1987;12:131-7.  Back to cited text no. 2
    
3.UNAIDS/WHO AIDS, epidemic update: December 2007.  Back to cited text no. 3
    
4.Benin City, Nigeria, The Columbia Encyclo­pedia, Sixth Edition. 2006 Columbia Univer­sity Press. Retrieved February 18, 2007.  Back to cited text no. 4
    
5.Oviasu E, Ugbodaga P. Evaluation of percuta­neous renal biopsy as a day case procedure: Experience from Nigeria. J Nephrol 1999;11: 246-8.  Back to cited text no. 5
    
6.Szczech LN, Gupta SK, Habash R, et al. The clinical epidemiology and course of the spec­trum of renal diseases associated with HIV infection. Kidney Int 2004;66:145-52.  Back to cited text no. 6
    
7.Agaba EI, Agaba PA, Sirisena ND, Antenyi EA, Idoko JA. Renal disease in AIDS patients in North Central Nigeria. Niger J Med 2003; 12:120-5.  Back to cited text no. 7
    
8.Emem CP, Arogundade F, Sanusi A, delusola K, Wokoma F, Akinsola A. Renal Disease in HIV-Sero positive Patients in Nigeria: An Assessment of Prevalence, clinical features and risk factors. Nephrol Dial Transplant 2008;23: 741-6.  Back to cited text no. 8
    
9.Szcsech LA, Grunfield C, Scherzer R, et al. Microalbuminuria in HIV infection. Vol. 2. Philadelphia: Lippincott Williams & Williams Inc.; 2007. p. 1002-9.  Back to cited text no. 9
    
10.Gerntholtz TE, Goetsch SJ, Katz I. HIV-related nephropathy; a south African perspec­tive. Kidney Int 2006;69:1885-91.  Back to cited text no. 10
    
11.Atta MG, Choi MJ, Longenecker JC, et al. Nephrotic range proteinuria and CD4 count as non invasive indicators of HIV - associated nephropathy. Am J Med 2005;118:1288.  Back to cited text no. 11
    
12.World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV related disease in adults and children. 2007.  Back to cited text no. 12
    

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Correspondence Address:
A B Odonmeta
Renal Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City
Nigeria
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DOI: 10.4103/1319-2442.128609

PMID: 24626020

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