A Risk Factor for AIDS Nephropathy

Douglas Shemin, MD, Division of Renal Diseases, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903 (USA) Dear Sir, With the increasing prevalence of AIDS, attention has been focused on its nephrologic manifestations. A specific AIDS-related nephropathy has been identified, associated with progressive azotemia, heavy proteinuria and focal segmental glomerulosclerosis on renal biopsy [1]. Is this the same lesion as heroin-associated nephropathy, and are AIDS patients without a history of intravenous drug abuse at a similar risk for focal segmental glomerulosclerosis? Dr. Rao et al. [1] at Downstate Medical Center in Brooklyn examined a large series of patients with AIDS and azotemia or proteinuria. All of these patients were black. About half of the group were biopsied and findings were consistent with focal segmental glomerulosclerosis in almost all cases, but only 55% of the group reported a history of intravenous drug abuse. Humphreys and Schoenfeld [2] from the University of California in San Francisco report a series of 90 patients with AIDS whose kidneys were examined at autopsy; only 1 had focal segmental glomerulosclerosis. The specific risk factor for AIDS in that patient was not identified, but intravenous drug abuse as a risk factor for AIDS is relatively uncommon (13% of cases) in San Francisco; moreover, only 6% of AIDS patients in San Francisco are black. We examined the charts of all patients seen in the Rhode Island Hospital AIDS Clinic for evidence of renal disease. While 200 patients are intermittently followed in the clinic, we limited our analysis to the 47 patients who had AIDS documented by a positive HIVtiter and either a reversal of T helper/T suppressor cell ratio, bacteri-ologic evidence of an opportunistic infection, or Ka-posi’s sarcoma and who also had an Scr and a urinalysis measured. Of this group, 64% were intravenous drug abusers and 43% were blacks. Of this group of 47, 4 had clinical renal disease as demonstrated by an Scr of > 2.0 mg/dl or > 2 + proteinuria. All of these patients were black and all had a history of intravenous drug abuse.