February 1990

Rapid Renal Failure in AIDS-Associated Focal Glomerulosclerosis

Author Affiliations

From the Hypertension and Renal Disease Section, Departments of Medicine (Drs Lang and Baldwin), Pediatrics (Dr Schacht), and Pathology (Drs Gallo and Sidhu), New York University School of Medicine and Manhattan Veterans Administration Medical Center, New York, NY.

Arch Intern Med. 1990;150(2):287-292. doi:10.1001/archinte.1990.00390140041009

• We studied the clinical features, pathologic findings, and course of 18 patients who were found to have glomerular disease at the time of hospitalization with manifestations of acquired immunodeficiency syndrome or acquired immunodeficiency syndrome—related complex at New York University Medical Center, New York, NY, during 1984 through 1987. Focal glomerulosclerosis, characterized by segmental and/or global collapse of capillary walls, was observed in 15 of these patients; mesangial proliferation in 2, and membranous nephropathy in 1. Those with focal glomerulosclerosis typically demonstrated heavy protein-uria without edema or hypertension and progressed rapidly to renal failure in less than 1 year from the time of discovery. This form of focal glomerulosclerosis is characterized by a fulminant course, the collapse type of sclerosis, and the frequent occurrence of uremia without advanced glomerular obliteration. The absence of widespread glomerular sclerosis and the rapid course suggest that unique renal hemodynamic mechanisms may be responsible for the progression.

(Arch Intern Med. 1990;150:287-292)