Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The evaluation and management of children with HIV nephropathy provide a great challenge to the pediatric nephrologist caring for patients with this tragic illness, of which the nephropathy is only part of their problem and extends beyond the patient to the family and all of the supportive team involved. Care decisions should be based on a multi-disciplinary approach in which the infectious disease component is included. There are many areas that require a better understanding, particularly the pathogenesis of HIV nephropathy and the approach to treatment of the nephropathy with specific drugs. Early identification of children affected with this condition and an aggressive approach to management seem essential to the improvement of the outcome of these patients.
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PMID:HIV nephropathy in children. 861 96

To determine whether human immunodeficiency virus (HIV) infection is associated with incipient tubular or glomerular defects, we determined the urinary excretion of four low molecular weight proteins (LMWP); beta2-microglobulin (U-beta2-m), cystatin C (U-cyst C), Clara cell protein (U-CC16), and retinol-binding protein (U-RBP), the markers of tubular dysfunction, the excretion of albumin (U-Alb), a marker of glomerular defect, and the excretion of N-acetyl-beta-D-glucosaminidase (U-NAG), a marker of structural damage of the proximal tubular epithelium. Their determinants have been assessed by stepwise regression analysis using as possible predictors age, sex, serum-beta2-m (S-beta2-m), CD4 lymphocyte count, or HIV infection stage and therapy. The study involved 76 HIV-infected patients without renal disease, 56 with S-beta2-m < 5 mg/L (Group B1), 20 with S-beta2-m > or = 5 mg/L (Group B2), and 30 HIV-negative controls. Fourteen patients (18.4%) had no abnormal urinary protein loss, and 62 (81.6%) had elevated urinary excretion of at least one protein (Alb, LMWP, or NAG). A single urinary protein was abnormal in 21 patients (U-beta2-m, n = 9; U-RBP, n = 2; U-CC16, n = 4; and U-Alb, n = 6). At least two LMWP were abnormal without increased U-Alb in 23 patients (12 with increased and 11 with normal U-NAG). Ten patients had an increased urinary excretion of at least one LMWP together with U-Alb (5 with increased and 5 with normal U-NAG). An increased urinary excretion of all proteins was observed in the last 8 patients. The average urinary excretion of all proteins (except cyst C) was significantly higher in HIV than in the control group. As expected, U-beta2-m and the prevalence of abnormal U-beta2-m values were higher in the B2 than in the B1 group (P = 0.0001), whereas the average urinary excretion and the prevalence of elevated values of Alb, LMWP (except beta2-m) or NAG were the same in both HIV groups. By stepwise regression analysis, age emerged as a significant determinant of urinary excretion of beta2-m and CC16, whereas male sex was associated with increased U-CC16. S-beta2-m, CD4-lymphocyte count, or HIV infection stage emerged as significant determinants only for U-beta2-m as a consequence of a close correlation between S-beta2-m and either HIV infection stage (r = -0.52, P = 0.0001), or CD4 count (r = -0.45, P = 0.0002). Over 80% of HIV-infected patients without overt renal disease have evidence of glomerular permeability defects or tubular dysfunction, whatever the stage of the disease. U-Alb, RBP, and CC16 appear as the most sensitive and reliable early markers of these abnormalities. Their cause and prognostic value remain to be determined.
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PMID:Low molecular weight proteinuria in human immunodeficiency virus-infected patients. 865 Dec 44

The complications of drug abuse encompass a spectrum of glomerular, interstitial, and vascular diseases. They comprise the heroin-associated nephropathy seen in African-American intravenous drug addicts, which, however, has given way in the 1990s to HIV-associated nephropathy. Infections with methicillin-resistant Staphylococcus aureus may cause acute glomerulonephritis by releasing bacterial superantigens. Hepatitis C has supplanted hepatitis B and may give rise to membranoproliferative glomerulonephritis and cryoglobulinemia. Addicts who inject drugs subcutaneously ('skin popping') may develop amyloidosis. Cocaine causes rhabdomyolysis, severe hypertension, occasionally renal failure in the absence of rhabdomyolysis, and may hasten progression to uremia in patients with underlying renal insufficiency. 'Ecstasy', an amphetamine-like recreational drug, has caused acute renal failure, electrolyte disturbances, and malignant hypertension. In Belgium and some other European countries, women taking Chinese herbs in a slimming regimen have developed a severe and irreversible interstitial fibrosis that is assuming epidemic proportions.
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PMID:Drugs of abuse and renal disease. 874 32

The pathogenesis of human immunodeficiency virus-associated nephropathy (HIVAN) is unknown, but it is characterized by aggressive glomerulosclerosis, tubulopathy, and interstitial inflammation. Currently, no therapy has been proven effective for HIVAN. Angiotensin II has been implicated in the pathogenesis of progressive renal disease in the absence of HIV infection, and treatment with captopril enhances renal survival in patients with diabetic glomerulosclerosis. Serum angiotensin-converting enzyme levels are elevated in patients with HIV infection. We therefore compared the course of 18 patients with biopsy-proven HIVAN (nine treated three times per day with captopril and nine not treated [controls]). The controls were matched to the study patients by age, race, gender, and level of serum creatinine concentration. Renal survival was measured from time of biopsy and treatment with captopril until onset of therapy for end-stage renal disease. Differences between the groups' survival were assessed by Kaplan-Meier and Cox regression analyses. Seven African-American men and two women were in the captopril-treated group, and eight African-American men and one woman were in the control group. No control patient died before the initiation of dialysis. There was no difference between initial mean serum creatinine concentration (3.4 +/- 0.7 mg/dL v 3.7 +/- 0.5 mg/dL), CD4 count (66 +/- 27/microL v 92 +/- 15/microL), or age (41.4 +/- 4.1 years v 36.4 +/- 2.6 years) in the study patients and controls, respectively, but the mean urinary protein to creatinine ratio was higher in the study patients. Renal survival was enhanced in the patients compared with the controls (mean renal survival, 156 +/- 71 days v 37 +/- 5 days, respectively; curves different; P < 0.002, Mantel-Cox log-rank test). Captopril and antiretroviral therapy were associated with enhanced renal survival in a Cox regression analysis, while age, level of serum creatinine, urinary protein to creatinine ratio, and CD4 count were not. These data suggest that treatment with captopril and antiretroviral therapy might be useful in delaying the rapidly progressive renal failure characterizing HIVAN. Captopril might exert its effects by reducing angiotensin II levels, or, alternatively, through decreasing renal tissue expression of growth factors and cytokines or by affecting HIV protease activity and therefore extent of productive renal infection. Such findings must be confirmed by randomized, double-blind, placebo-controlled trials.
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PMID:Captopril and renal survival in patients with human immunodeficiency virus nephropathy. 876 14

Over the last 2 decades, we have learnt that focal segmental glomerulosclerosis (FSGS) is a ubiquitous phenomenon underlying the progressive deterioration of many different types of renal diseases in both pediatric and adult populations. FSGS may also be the primary renal lesion, whether in new disease entities such as glycogen storage disease and human immunodeficiency virus infection, or in idiopathic FSGS. Although the mechanism which triggers the development of primary FSGS still remains unknown, laboratory and clinical studies have identified several key pathophysiological events leading to end-stage renal disease. While therapeutic modalities have not changed remarkably, a recent study, although uncontrolled, demonstrated an impressive efficacy of intravenous steroid pulse therapy in inducing remission. Nevertheless, it remains largely unknown whether such a forced remission decreases the overall risk of developing chronic renal failure. Studies have revealed an important pathophysiological role of angiotensin and the therapeutic efficacy of angiotensin converting enzyme inhibitors in progressive loss of renal function in diseases where glomerulosclerosis is secondary; however, it remains to be verified whether these results hold true in primary FSGS. As a result of the improvement in allograft survival rate, the benefit of renal transplant outweighs the risk of recurrence of FSGS, hence transplantation continues to be a vital therapy for FSGS patients who have reached renal failure. Thus, FSGS is not one disease, but rather a range of lesions seen in many settings. The type of lesions and the patient's unique genetic factors contribute to prognosis, and also may dictate choice of optimum therapy.
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PMID:Focal segmental glomerulosclerosis. 903 90

The objective of this study was to define the demographic, immunologic, and clinical characteristics of children with acquired immunodeficiency syndrome (AIDS) and AIDS nephropathy, and contrast this with the existing adult data. Data from 62 pediatric patients with AIDS who were treated at SUNY Health Science Center, Brooklyn, New York, between 1983 and 1993 were analyzed. Human immunodeficiency virus (HIV) infection was acquired during the neonatal period by vertical transmission (n = 60) or blood transfusion (n = 2). All children with AIDS who exhibited clinical nephropathy died (n = 16), with mean survival of 55.3 months. In contrast, 32 of 56 AIDS patients (70%) who did not manifest nephropathy were alive at the end of the study period. Patients with nephropathy were noted to have significantly lower CD4+ lymphocyte counts than those without nephropathy. These observations suggest that the predominant renal lesion in pediatric patients who acquired HIV infection during the perinatal period is focal segmental glomerulosclerosis, although a variety of other histological lesions were present. As in adults, the survival in children is dismal following the onset of clinical renal disease. In contrast to the adult population in whom multiple risk factors can potentially contribute to AIDS-associated nephropathy, occurrence of nephropathy in children with vertical HIV transmission provides convincing evidence for the pathogenetic role of HIV infection.
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PMID:Childhood AIDS nephropathy: a 10-year experience. 880 30

HIV-associated nephropathy is infrequently cited as a common cause of ESRD. It is likely, however, that by the end of the decade, HIV-associated nephropathy will be the third leading cause of ESRD in African Americans between the ages of 20 and 64. Underreporting for reasons of confidentiality and a failure to track this specific diagnostic category nationally may account for the nephrology community's inattention. As a result of this community's failure to define this issue, national agencies are poorly prepared to recognize and anticipate the changing demographics of the AIDS epidemic as it affects the practice of nephrology. The study presented here concluded: that a national registry should be created to track the incidence of HIV-associated nephropathy as a cause of ESRD; that renal biopsies should be routinely performed to confirm the clinical diagnosis of HIV-associated nephropathy; that anonymous serological screening of all patients and health care providers in dialysis units be reconsidered in order to maintain vigilance for potential unit outbreaks; that the National Institutes of Health and the Office of AIDS Research be better appraised of the importance of this issue by the nephrology community; and that special attention be directed toward the underlying cause(s) of HIV-associated nephropathy and the cofactor(s) that determine the predilection of this disease in blacks.
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PMID:Are we missing an epidemic of HIV-associated nephropathy? 880 3

We determined the pharmacokinetics of zidovudine (AZT) and its metabolite (GAZT) in HIV-infected patients with end-stage renal disease (ESRD), between dialysis sessions, and compared these to HIV-infected patients with normal renal function. Clearance of AZT in ESRD patients was not significantly different from controls. The mean serum AZT levels in ESRD patients were six times greater than the levels in normal controls at 4 h. Serum levels of GAZT were higher in ESRD patients at 90 min, and by 4 h were more than an order of magnitude greater than normal controls. If the AZT serum level is a good index of toxicity, we conclude that the currently recommended dose of 200 mg AZT three times a day is probably safe for use in HIV-infected patients with ESRD. The enterohepatic metabolism of AZT, the effect of such a dosing schedule and the effects of circulating levels of GAZT on outcomes in HIV-infected patients with ESRD must be further investigated.
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PMID:Pharmacokinetics of zidovudine in HIV-infected patients with end-stage renal disease. 882 Nov 98

We describe a 39-year-old bisexual man with clinical category B2 human immunodeficiency virus (HIV) infection who subsequently developed systemic lupus erythematosus (SLE). SLE was diagnosed on the basis of a clinical presentation of malar rash, polyarthritis, membranous glomerulonephritis, and characteristic serology. To our knowledge, this is the fourth reported case of a patient with HIV infection to develop SLE and the second adult patient with HIV and coexistent SLE nephropathy.
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PMID:SLE nephropathy in a patient with HIV infection: case report and review of the literature. 941 70

There has been a steady increase in the number of dialysis patients with human immunodeficiency viral (HIV) infection. HIV-associated nephropathy (HIVAN) is the most common cause of end-stage renal disease in this patient population. Although the major potential category of risk of HIV transmission is from the dialysis patient to staff, there are no data to indicate that this has occurred. Dialysis of patients with HIV infection is challenging and requires effective care to prolong survival.
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PMID:Patients with HIV infection and end-stage renal disease. 891 90


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