Kidney nontumor
Primary glomerular diseases
Focal and segmental glomerulosclerosis - special form in IV drug abuse and AIDS

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 20 September 2017, last major update May 2012

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PubMed Search: Primary glomerular diseases HIV AIDS

Cite this page: Sangle, N. Focal and segmental glomerulosclerosis - special form in IV drug abuse and AIDS. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneyspecialformIV.html. Accessed October 23rd, 2017.
Definition / general
  • Rapid progression to end stage renal failure in AIDS (3 - 4 months) and IV drug abuse (2 - 4 years, Am J Med 1989;87:389)
  • 54% of the patients were black, 35% were white and 11% were Hispanic; 33% of the patients had a history of intravenous drug abuse (Am J Kidney Dis 2000;35:884)
  • Note: HIV also causes acute renal failure, postinfectious, membranous or membranoproliferative glomerulonephritis (Hum Pathol 1987;18:1293)
Pathogenesis
  • Nef and Vpr are key viral genes; Nef induces podocyte dysfunction; Vpr induces renal tubular epithelial cell apoptosis (Curr Opin Nephrol Hypertens 2011;20:306)
  • Genetic variants in nonmuscle myosin heavy chain 9 gene (MYH9) have a major influence on both FSGS and human immunodeficiency virus associated collapsing glomerulopathy, with odds ratios from 4 to 8 and attributable fractions of 70% to 100% (Semin Nephrol 2010;30:111, Nat Genet 2008;40:1175)
Microscopic (histologic) description
  • Often collapse and sclerosis of entire glomerular tuft with hypertrophic podocytes filling Bowman space
  • Large tubular hyaline casts, flattened epithelium
  • Also manifestations of severe tubulointerstitial injury such as epithelial degenerative changes, microcystic dilation of tubules and interstitial inflammatory infiltrate (primarily activated T cells)
Microscopic (histologic) images

Images hosted on other servers:

Various images including EM

No capillary loops, matrix collapse
with no adhesions (even though there
is global sclerosis), conspicuous
hypertrophied epithelial cells (silver stain)

Microscystic dilation of tubules (trichrome stain)

Electron microscopy description
  • Tubuloreticular structures in endothelium (nonspecific for infection, helps distinguish this from collapsing variant of FSGS, Hum Pathol 1988;19:1060), induced by interferon alpha
Electron microscopy images

Images hosted on other servers:

Tubuloreticular structures