HIVAN

Q: Hypertensive emergency is one of the classic symptoms of patients with HIV-associated nephropathy (HIVAN)?

 
A) True 

B) False 

Answer: B

In contrast to other patients with chronic kidney diseases, hypertension (HTN) is a rare presentation in HIVAN. It is present in only 12-25 percent of patients with HIVAN. Edema is also less likely in comparison to other patients with severe proteinuria and decreased estimated glomerular filtration rate (eGFR). This is an interesting paradox as patients with HIVAN are subject to nephrotic-range proteinuria on presentation. This is due to the fact that microalbuminuria usually goes undiagnosed in these patients earlier in the disease. 

Another unusual presentation of HIVAN is possible hematuria.

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References:

1. Medapalli RK, He JC, Klotman PE. HIV-associated nephropathy: pathogenesis. Curr Opin Nephrol Hypertens. 2011;20(3):306-311. doi:10.1097/MNH.0b013e328345359a

2. Lescure FX, Flateau C, Pacanowski J, et al. HIV-associated kidney glomerular diseases: changes with time and HAART. Nephrol Dial Transplant 2012; 27:2349. 

3. Bigé N, Lanternier F, Viard JP, et al. Presentation of HIV-associated nephropathy and outcome in HAART-treated patients. Nephrol Dial Transplant 2012; 27:1114.