Which histologic findings are characteristic of HIV-associated nephropathy (HIVAN)?

Updated: May 09, 2018
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Findings from light microscopy of kidney biopsy tissue are diagnostic in most cases. The most common histologic light microscopy finding is a collapsing form of focal segmental glomerulosclerosis. [14] The glomerular capillary tuft is collapsed (see the first image below) and may be segmentally or globally sclerosed. Visceral epithelial cells are hypertrophied and form a characteristic pseudocrescent in the Bowman space. Tubulointerstitial scarring, atrophy, and marked dilatation of the tubules (microcystic dilatations) are usually present (see the second image below).

Light microscopy with trichrome staining showing t Light microscopy with trichrome staining showing the collapse of the glomerular tuft, with segmental glomerular and interstitial sclerosis (bluish staining). The renal tubules are dilated and filled with proteinaceous material.
Light microscopy showing prominent microcystic dil Light microscopy showing prominent microcystic dilatation of renal tubules filled with proteinaceous material; this finding is characteristic of human immunodeficiency virus (HIV)–associated nephropathy, although it may also be observed in chronic glomerulonephritis.

Immunofluorescent microscopy helps to identify positive staining for albumin and immunoglobulin G in epithelial cells and for immunoglobulin M, C3, and, occasionally, A in mesangial or sclerotic areas.

Electron microscopy reveals wrinkling of the basement membranes, epithelial cell proliferation, and focal foot process effacement. Tubuloreticular structures in the glomerular endothelial cells (consisting of ribonucleoprotein and membrane, the synthesis of which is stimulated by alpha interferon) is highly predictive of HIVAN (see the image below).

Electron microscopy showing a segment of the glome Electron microscopy showing a segment of the glomerular basement membrane; foot process effacement (black arrow) and prominent tubuloreticular inclusions (red arrow) are present.

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