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Collapsing glomerulopathy in an HIV-positive patient in a low-incidence belt.

Naaz I, Wani R, Najar MS, Banday K, Baba KM, Jeelani H - Indian J Nephrol (2010)

Bottom Line: The worldwide incidence of collapsing glomerulopathy (CG) in HIV-positive patients is high in Americans.But in India and other Asian countries, other forms of kidney diseases are more commonly seen.We report the first case of CG in the state of Jammu and Kashmir which also happens to be a very low incidence belt for HIV.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.

ABSTRACT
Human immunodeficiency virus (HIV) involves glomerular, tubulointerstitial, and vascular compartments of the kidney. The most common glomerular lesion is HIV-associated focal segmental glomerulosclerosis (FSGS) and related mesangiopathies collectively termed HIV-associated nephropathy (HIVAN). A variety of immune-complex mediated glomerular diseases such as membranoproliferative glomerulonephritis (MPGN), IgA nephropathy, and lupus-like glomerulonephritis also occur. HIVAN is restricted to patients presenting with proteinuria and progressive reduction of renal function and with distinctive but not pathognomonic pathology (FSGS often coexisting with glomerular collapse and tubular microcystic dilatations). The worldwide incidence of collapsing glomerulopathy (CG) in HIV-positive patients is high in Americans. But in India and other Asian countries, other forms of kidney diseases are more commonly seen. We report the first case of CG in the state of Jammu and Kashmir which also happens to be a very low incidence belt for HIV.

No MeSH data available.


Related in: MedlinePlus

Photomicrograph showing collapsed glomerulus, severe interstitial injury with hyaline and haemorrhagic casts within the dilated tubules. (H and E stain, ×40)
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Figure 0002: Photomicrograph showing collapsed glomerulus, severe interstitial injury with hyaline and haemorrhagic casts within the dilated tubules. (H and E stain, ×40)

Mentions: Renal biopsy was done. Light microscopic examination of the renal biopsy revealed nine glomeruli with five glomeruli showing global collapse of the capillary tuft, obliteration of the capillary lumens, increase in the mesangial matrix, expansion of the urinary space, and focal glomerulosclerosis. There was proliferation of visceral epithelial cells and showed cytoplasmic vacuolization, associated with microcystic dilatation of tubules, focal tubular atrophy, and the presence of large dense periodic acid-Schiff (PAS)-positive tubular casts. Interstitium showed severe inflammatory infiltration, comprising of both acute and chronic inflammatory cells, and interstitial fibrosis resulting in destruction of tubules at places. Vessels showed features of vasculitis [Figures 1 and 2]. PAS staining showed areas of focal glomerulosclerosis and casts within the tubules [Figure 3]. Immunofluorescence showed only weak nonspecific glomerular IgM deposits. The diagnosis of FSGS collapsing variant was arrived at.


Collapsing glomerulopathy in an HIV-positive patient in a low-incidence belt.

Naaz I, Wani R, Najar MS, Banday K, Baba KM, Jeelani H - Indian J Nephrol (2010)

Photomicrograph showing collapsed glomerulus, severe interstitial injury with hyaline and haemorrhagic casts within the dilated tubules. (H and E stain, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3008952&req=5

Figure 0002: Photomicrograph showing collapsed glomerulus, severe interstitial injury with hyaline and haemorrhagic casts within the dilated tubules. (H and E stain, ×40)
Mentions: Renal biopsy was done. Light microscopic examination of the renal biopsy revealed nine glomeruli with five glomeruli showing global collapse of the capillary tuft, obliteration of the capillary lumens, increase in the mesangial matrix, expansion of the urinary space, and focal glomerulosclerosis. There was proliferation of visceral epithelial cells and showed cytoplasmic vacuolization, associated with microcystic dilatation of tubules, focal tubular atrophy, and the presence of large dense periodic acid-Schiff (PAS)-positive tubular casts. Interstitium showed severe inflammatory infiltration, comprising of both acute and chronic inflammatory cells, and interstitial fibrosis resulting in destruction of tubules at places. Vessels showed features of vasculitis [Figures 1 and 2]. PAS staining showed areas of focal glomerulosclerosis and casts within the tubules [Figure 3]. Immunofluorescence showed only weak nonspecific glomerular IgM deposits. The diagnosis of FSGS collapsing variant was arrived at.

Bottom Line: The worldwide incidence of collapsing glomerulopathy (CG) in HIV-positive patients is high in Americans.But in India and other Asian countries, other forms of kidney diseases are more commonly seen.We report the first case of CG in the state of Jammu and Kashmir which also happens to be a very low incidence belt for HIV.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.

ABSTRACT
Human immunodeficiency virus (HIV) involves glomerular, tubulointerstitial, and vascular compartments of the kidney. The most common glomerular lesion is HIV-associated focal segmental glomerulosclerosis (FSGS) and related mesangiopathies collectively termed HIV-associated nephropathy (HIVAN). A variety of immune-complex mediated glomerular diseases such as membranoproliferative glomerulonephritis (MPGN), IgA nephropathy, and lupus-like glomerulonephritis also occur. HIVAN is restricted to patients presenting with proteinuria and progressive reduction of renal function and with distinctive but not pathognomonic pathology (FSGS often coexisting with glomerular collapse and tubular microcystic dilatations). The worldwide incidence of collapsing glomerulopathy (CG) in HIV-positive patients is high in Americans. But in India and other Asian countries, other forms of kidney diseases are more commonly seen. We report the first case of CG in the state of Jammu and Kashmir which also happens to be a very low incidence belt for HIV.

No MeSH data available.


Related in: MedlinePlus