Renal pathology in the HIV-positive child: from nephrosis to nephritis and everything in between

Renal involvement is a common manifestation of human immunodeficiency virus (HIV) infection and is a cause of significant morbidity and mortality, even in the age of highly active antiretroviral therapy (HAART). This review discusses the spectrum of renal pathology in the HIV-positive child and includes diseases that occur in any child regardless of the HIV status and those which are specific to the disease. A ‘syndromic matrix’ is presented comprising haematuria/nephritic syndrome and proteinuria/nephrotic syndrome. Primary glomerular diseases, including HIV-associated nephropathy (HIVAN), HIV immune-complex kidney (HIVICK) and mesangial hyperplasia, are discussed, as well as tubulo-interstitial and vascular diseases. The incidence, prevalence and progression of HIV-associated renal disease in childhood is not well characterized or documented, raising the opportunity for future research. An awareness of the pathogenesis and clinical manifestations of HIV-associated renal pathology is essential for pathologists to interpret laboratory results and renal biopsies, and to allow thorough clinicopathological correlation in the HIV-positive child.