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J Nephropathol. 2022;11(4): e17269.
doi: 10.34172/jnp.2022.17269
  Abstract View: 177
  PDF Download: 33

Original Article

Kidney outcomes of immune-complex associated mesangiocapillary glomerulonephritis in patients with and without HIV

Abdul-Jalil Inusah 1 ORCID logo, Liezel Coetzee 2 ORCID logo, William Bates 2 ORCID logo, Mogamat-Yazied Chothia 1* ORCID logo

1 Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
2 Department of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Cape Town South Africa
*Corresponding Author: Corresponding author: Mogamat-Yazied Chothia, Email: , Email: yaziedc@sun.yaziedc@sun.ac.zaac.za

Abstract

Introduction: HIV-associated kidney diseases continue to be a major problem in South Africa.

Objectives: We aimed to determine the kidney outcomes of immune-complex associated mesangiocapillary glomerulonephritis (MCGN) in patients with and without HIV.

Patients and Methods: A retrospective cohort study was conducted on all adult patients with a kidney biopsy diagnosis of immune-complex associated MCGN from 1 January 2000 to 31 December 2016. We compared the proportion of HIV-positive and HIV-negative patients that reached the composite endpoint of either doubling of the serum creatinine or end-stage kidney disease. Cox proportional hazards models were employed to examine the association between the composite endpoint and predictor variables.

Results: A total of 79 patients were included of which 20 (25.3%) were HIV-positive. Twenty-four patients (30.4%) reached the composite endpoint. The cumulative proportions reaching the composite endpoint at one and four years were 25.3% and 30.4% with no difference between HIV-positive and HIV-negative patients (45.0% versus 25.4%, respectively; P= 0.10). Multivariable Cox proportional hazards model identified estimated glomerular filtration rate at biopsy (hazard ratio [HR] = 0.92; 95% confidence interval [CI]: 0.84-1.00, P=0.04) and proteinuria at follow-up (HR = 1.60; 95% CI: 1.21-2.11, P<0.01) as predictors of the composite endpoint at one-year. On survival analysis, there was no difference in the composite endpoint for HIV status (P=0.09; log-rank).

Conclusion: Immune-complex associated MCGN continues to be a common histopathological pattern of injury at our center. Due to late presentation, kidney outcomes remain poor, regardless of HIV status.


Implication for health policy/practice/research/medical education:

HIV immune-complex associated MCGN remains a common histopathological pattern of injury in developing countries with a high HIV prevalence. Due to late presentation of both the HIV diagnosis and the glomerular disease, the outcome is poor, regardless of the HIV status. Educating healthcare providers about chronic glomerular diseases along with frequent screening of at-risk populations should be prioritized so that early interventions can be instituted to prevent progression to end-stage kidney disease, particularly in countries where access to kidney replacement therapy is being rationed.

Please cite this paper as: Inusah A, Coetzee L, Bates W, Chothia M. Kidney outcomes of immune-complex associated mesangiocapillary glomerulonephritis in patients with and without HIV. J Nephropathol. 2022;11(4):e17269. DOI: 10.34172/jnp.2022.17269.

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Submitted: 16 Aug 2021
Accepted: 14 Dec 2021
ePublished: 02 Jan 2022
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