A 42-year-old HIV-positive man from sub-Saharan Africa presents with nephrotic syndrome. Biopsy shows collapsing focal segmental glomerulosclerosis with tubuloreticular inclusions on electron microscopy. The FSGS variant here is specifically linked to which viral mechanism?

• A Immune complex deposition from HIV envelope glycoproteins
• B Anti-podocyte antibodies generated during HIV seroconversion
• C Direct HIV viral protein (Nef, Vpr) infection of podocytes causing podocyte dedifferentiation and proliferation ✓
• D HIV-induced T-regulatory cell depletion releasing a podocyte permeability cytokine

Explanation

HIV-associated nephropathy (HIVAN) is caused by direct infection of podocytes and tubular cells by HIV; viral proteins Nef and Vpr drive podocyte dedifferentiation, proliferation and collapse of the glomerular tuft (collapsing FSGS). Tubuloreticular inclusions (interferon footprints) are characteristic. It is not an immune complex disease and is more common in individuals of African ancestry.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.