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: 11 July 2018, 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 July 21st, 2018.
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

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