NDT Advance Access originally published online on July 21, 2008
Nephrology Dialysis Transplantation 2008 23(12):3901-3907; doi:10.1093/ndt/gfn407
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Malignant hypertension in HIV-associated glomerulonephritis
1 Department of Nephrology 2 Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain
Correspondence and offprint requests to: Enrique Morales, Servicio de Nefrología, Hospital 12 de Octubre, Avda, Andalucía s/n, 28041 Madrid, Spain. Tel: +34-91390-8208; Fax: +34-91390-8393; E-mail: emoralesr{at}senefro.org
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Abstract |
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Background. Glomerular diseases other than HIVAN (HIV-associated nephropathy) are common among HIV patients but the information about their clinical characteristics and prognosis is very scarce. We have observed several HIV patients with glomerulonephritis in whom malignant hypertension (MHT) was the first clinical manifestation.
Methods. All HIV-infected individuals with a biopsy-proven glomerulonephritis at our hospital were reviewed. Information about clinical characteristics, histopathologic data and outcome was collected. The incidence of MHT among HIV and non-HIV patients with glomerulonephritis was studied.
Results. Thirty HIV patients with glomerulonephritis were identified. Ten of them (33%) presented with MHT (severe hypertension and grade III hypertensive retinopathy). In comparison with patients without MHT, they showed a significantly higher blood pressure at presentation, a higher finding of IgA nephropathy (50% versus 15%; P < 0.05) and of malignant nephrosclerosis (60% versus 0%; P < 0.05) in renal biopsies, a higher viral load and a lower CD4+ cell count at the end of follow-up and a worse patient and renal survival: six patients (60%) started chronic dialysis and seven (70%) died after a follow-up of 11.8 ± 16.2 and 39 ± 35 months, respectively. Co-infection by HCV (hepatitis C virus) and HBV (hepatitis B virus) was very frequent among patients with malignant hypertension. The incidence of malignant hypertension among non-HIV patients with glomerulonephritis was significantly lower than that among HIV-infected patients.
Conclusions. Malignant hypertension is a common presentation of patients with HIV-associated glomerulonephritis, particularly in those with IgA nephropathy, and is associated with a very poor patient and renal survival.
Keywords: malignant hypertension; HIV-associated glomerulonephritis; IgA nephropathy; HCV infection; glomerular disease
Received for publication: 14. 5.08
Accepted in revised form: 26. 6.08