HISTOLOGIC SPECTRUM OF KIDNEY DISEASE AMONG PEOPLE LIVING WITH HIV AT A TERTIARY HOSPITAL IN HYDERABAD, INDIA

 

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HISTOLOGIC SPECTRUM OF KIDNEY DISEASE AMONG PEOPLE LIVING WITH HIV AT A TERTIARY HOSPITAL IN HYDERABAD, INDIA

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FRED
MAATE
FRED MAATE FREDMAATE@GMAIL.COM UNIVERSITY OF ZAMBIA, SCHOOL OF MEDICINE DEPARTMENT OF PATHOLOGY AND MICROBIOLOGY LUSAKA Zambia *
STEPFANIE SIYUMBWA stepfanie.siyumbwa@gmail.com UNIVERSITY OF ZAMBIA, SCHOOL OF MEDICINE DEPARTMENT OF PATHOLOGY AND MICROBIOLOGY LUSAKA Zambia -
SWARNALATA GOWRISHANKAR SWARNALATAG@GMAIL.COM APOLLO HOSPITALS, JUBILEE HILLS DEPARTMENT OF HISTOPATHOLOGY HYDERABAD India -
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There is a paucity of data on biopsy-proven kidney disease among people living with Human Immunodeficiency Virus (HIV) in India, where 2.5 million people are living with HIV. People living with HIV have a higher risk of kidney disease than those who are not. This study aimed to characterise the spectrum of biopsy-proven kidney disease among persons living with HIV, and to assess the association between the main histologic outcome and the clinical and demographic features.

We conducted a cross-sectional descriptive and analytical study of 107 native kidney biopsies of people living with HIV reported between January 1st 2023, and July 31st 2025. We retrospectively obtained clinicopathologic data. Descriptive and inferential statistics were applied, with inferential statistics utilised to assess associations between the primary outcome and clinical variables. A P-value of less than 0.05 was considered significant at a 95% CI.

The patients had a mean age of 51 years (±10 years), and 61.7% were male. Seventy-four (69.1%) patients were on antiretroviral therapy (ART), one (0.9%) was not, and 29.9% were of unknown ART status. Median cluster of differentiation (CD4) cell count (n=8) was 498 cells/μl (IQR 222.3-983.5). Median duration of ART (n=36) was 8 years (IQR 4.5-11.0). Most patients were on a Tenofovir-based ART regimen (31/51, 60.8%). Diabetes mellitus was reported in 46.0% (n=65) and hypertension in 61.0% (n=66) of the patients. Acute Kidney Injury was the most common presentation (61/107, 57.0%). Pathology (Figures 1 to 3) showed that tubulointerstitial dominant disease (TID) was the most common (60.7%), and this was associated with increasing age (AOR = 1.06, 95% CI: 1.02–1.12, p = 0.007). The diseases also included glomerular dominant (23.4%), vascular dominant (2.8%), and other diseases (13.1%). Immune complex-mediated diseases were common, including IgA Nephropathy (8.4%), Membranous Nephropathy (MN, 7.5%) and Lupus Nephritis (1.9%). Fifty per cent of MN cases were Phospholipase A2 receptor positive. Diabetic nephropathy accounted for 6.5% of the cases. Figure 1: Photomicrographs of histologic lesions. (a) Periodic acid Schiff stain (PAS) (x10): Case of acute tubular injury. The section shows tubular injury with dilated lumina, loss of brush border, flattened and focally denuded epithelium; (b). PAS stain(x40): Case of minimal change disease, showing normal glomeruli with no increase in cellularity, basement membrane thickening, segmental sclerosis or crescents. (c.). Haematoxylin and Eosin stain (x40). IgA nephropathy case: mild mesangial expansion and hypercellularity. The insert shows immunofluorescence for IgA with mesangial coarse granular deposits of IgA. (d). PAS stain (x40): Case of thrombotic microangiopathy showing a glomerulus with fibrin thrombi within the capillary lumina. (e). Masson Trichrome stain (x4): Case of chronic tubulointerstitial nephritis, showing 2 sclerosed glomeruli, atrophic tubules, and interstitial inflammation and fibrosis. (g). Periodic acid silver methenamine stain (x40): Case of membranous nephropathy showing a glomerulus which had thickened capillary walls and subepithelial spikes. (h). Case of diabetic nephropathy, showing a glomerulus with prominent PAS-positive mesangial widening with Kimmelstiel-Wilson lesion. (g). PAS stain: Case of arteriosclerosis showing an artery with intimal fibrosis and duplication of the internal elastic lamina.Figure 2: Immunohistochemistry (IHC) for Myoglobin, Neural epidermal growth factor like 1 (NELL-1) and phospholipase A2 receptor (PLA2R).  (a). H&E stain (x10): Case of myoglobin cast nephropathy showing a normal glomerulus, tubular injury and pigmented casts (arrow). (b). Myoglobin IHC for the same case as in part a (x4), showing positive staining. The insert shows a positive control. (c.). NELL-1 IHC showing negative staining. (d). PLA2R showing positive stain with a granular staining pattern.

The spectrum of kidney disease among people living with HIV was varied. Tubulointerstitial dominant disease was the most common, and it was associated with increasing age. Increased awareness of the spectrum of kidney disease among people living with HIV may lead to improved early diagnosis, treatment, and better outcomes. This work was presented at the Annual Conference of Indian Society of Renal and Transplantation Pathology in Ahmedabad, India ( September 18-20, 2025). 

Kewords