A 30-year-old man with recently diagnosed HIV (CD4 count 180 cells/microliter) presents with nephrotic-range proteinuria (6.8 g/day), enlarged kidneys on ultrasound, and normal blood pressure. Which kidney biopsy finding is MOST likely?
- A Membranous nephropathy with subepithelial deposits
- B Collapsing variant of focal segmental glomerulosclerosis ✓
- C IgA nephropathy with mesangial deposits
- D Minimal change disease with foot process effacement
Correct answer: B. Collapsing variant of focal segmental glomerulosclerosis
Explanation
HIV-associated nephropathy (HIVAN) classically presents with collapsing FSGS on biopsy, nephrotic-range proteinuria, enlarged kidneys, and rapid progression to ESRD. It is seen in advanced immunosuppression. This is distinct from HIV-immune complex disease which resembles membranous or lupus-like patterns. Antiretroviral therapy and RAAS blockade are the mainstays of treatment.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.