A 48 year old male who has HIV presents with lab repos showing: Low albumin, massive proteinuria, renal ultrasound showing large, echogenic kidneys. Blood pressure is normal. Which of the following is the most likely cause?: (A) Minimal change disease, (B) IgA nephropathy, (C) Focal segmental glomerulosclerosis, (D) Membranoproliferavtive glomerulonephritis
Answer is C. This patient with HIV presents with massive protienuria and hypoalbuminemia, suggestive of HIV-1-associated nephropathy (HIVAN) - A form of Focal segmental glomerulosclerosis (FSGS). Proteinuria is the hallmark of this disorder. Edema and hypeension are rare. A definitive diagnosis is obtained through renal biopsy. Histologically, focal segmental glomerulosclerosis is present in 80%, and mesangial proliferation in 10-15% of cases. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition