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      Spontaneous Improvement of the Renal Function in a Patient with HIV-Associated Focal Glomerulosclerosis


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          Collapsing glomerulopathy is a pattern of renal injury that is seen in association with human immunodeficiency virus (HIV) infection. Patients with this HIV-associated nephropathy (HIVAN) present nephrotic syndrome and rapid deterioration of the renal function. There is no proven effective therapy for HIVAN, and the majority of the patients become dialysis dependent. We report a case of biopsy-proven HIVAN that showed spontaneous improvement of the renal function.

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          HIV-associated nephropathy.

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            Edema and acute renal failure.

            Acute renal failure (ARF) with overhydration and edematous state may follow Acute endocapillary proliferative glomerulonephritis and extracapillary glomerulonephritis, because of reduction of the glomerular capillary area available for filtration. But ARF may also be observed in edematous patients with minimal change nephrotic syndrome; it may require dialysis until recovery and is attributable to some of the following factors: (1) ischemic renal injury, (2) hypovolemia, (3) interstitial edema with tubular collapse, (4) redistribution of renal blood flow (RBF) from cortical to juxtaglomerular nephrons, (5) decrease of capillary filtration coefficient (Kf), (6) use of nonsteroidal antiinflammatory drugs. Congestive heart failure also leads to prerenal azotemia and edema formation secondary to salt retention. Multiple organ dysfunction syndrome (MODS) is frequently associated with ARF; but edema occurs even without ARF in septic patients with severe inflammatory response syndrome (SIRS). ARF may follow severe burns; burned patients are frequently edematous because of a rapid leak of fluid from the vascular bed into the wound; edema in undamaged areas occurs in the 'flow phase', because of a fall of oncotic pressure because of massive loss of plasma proteins into the wound. Edema must be treated with diuretics or by dialysis.

              Author and article information

              Am J Nephrol
              American Journal of Nephrology
              S. Karger AG
              August 2002
              02 August 2002
              : 22
              : 4
              : 369-371
              Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
              65229 Am J Nephrol 2002;22:369–371
              © 2002 S. Karger AG, Basel

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              Page count
              Figures: 1, References: 21, Pages: 3
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/65229
              Self URI (text/html): https://www.karger.com/Article/FullText/65229
              Self URI (journal page): https://www.karger.com/SubjectArea/Nephrology
              Case Report

              Cardiovascular Medicine,Nephrology
              HIV nephropathy,Spontaneous improvement, acute renal failure,Nephrotic syndrome


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