Journal Article

Malignant hypertension in HIV-associated glomerulonephritis

Enrique Morales, Elena Gutierrez-Solis, Eduardo Gutierrez, Roberto González, Miguel Angel Martínez and Manuel Praga

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 23, issue 12, pages 3901-3907
Published in print December 2008 | ISSN: 0931-0509
Published online July 2008 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfn407
Malignant hypertension in HIV-associated glomerulonephritis

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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

Journal Article.  4387 words.  Illustrated.

Subjects: Nephrology

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