A32-year old African-American male presents with recurrent edema of the feet and periorbital swelling. He has a history of high risk sexual behavior. The blood pressure was 110/85 mm Hg. Results of the laboratory investigations are as follows : HBs Ag : Negative Blood glucose : Normal HIV ELISA : Positive 24-hour urine protein : 3.9 g Urine microscopy : Fatty casts, oval fat bodies. An H and E stain of the renal biopsy is most likely toshow-

Renal disease Acute kidney injury is common, usually due to acute infection or nephrotoxicity of drugs (e.g. tenofovir ), amphotericin B HIV-associated nephropathy (HIVAN) is the most impoant cause of chronic kidney disease (CKD) and is seen most frequently in patients of African descent and those with low CD4 counts. Progression to end-stage disease is more rapid than with most other causes of CKD, and renal size is usually preserved. HIVAN presents with nephrotic syndrome, CKD or a combination of both. A has some effect in slowing progression of HIVAN. Other impoant HIV-associated renal diseases include HIV immune complex kidney diseases and thrombotic microangiopathy. With the overall improvement in life expectancy from A, conditions such as diabetes mellitus, hypeension and vascular disease add to the burden of CKD. Outcomes of renal transplantation are good in patients on A. Ref Harrison20th edition pg 997