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Kidney non-tumor

Primary glomerular diseases

Focal and segmental glomerulosclerosis-
Special form in IV drug abuse and AIDS


Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 6 May 2012, last major update May 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● 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. Thirty-three percent 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
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● 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)

Micro description
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● Often collapse and sclerosis of entire glomerular tuft with hypertrophic podocytes filling Bowmanís 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)

Micro images
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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
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● Tubuloreticular structures in endothelium (non-specific for infection, helps distinguish this from collapsing variant of FSGS, Hum Pathol 1988;19:1060), induced by interferon alpha

Electron microscopy images
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Tubuloreticular structures

End of Kidney non-tumor > Primary glomerular diseases > Focal and segmental glomerulosclerosis - special form in IV drug abuse and AIDS

Ref Updated: 4/27/12


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