A 32-year-old African American man with poorly controlled HIV infection (CD4 count 90 cells/microliter) presents with rapidly worsening renal failure and proteinuria of 10 g/day. Renal biopsy shows collapse of glomerular tufts with marked podocyte hyperplasia and hypertrophy, plus microcystic tubular dilatation. Which statement about this condition is correct?

• A It is the tip lesion variant of FSGS and responds well to steroids
• B It is immune complex mediated and shows full house immunofluorescence
• C It represents collapsing glomerulopathy (HIV-associated nephropathy), strongly associated with APOL1 risk alleles and carrying a poor prognosis ✓
• D It is caused by direct infection of endothelial cells by HIV, producing tubuloreticular inclusions as the diagnostic lesion

Explanation

HIV-associated nephropathy is a collapsing variant of FSGS characterized by tuft collapse, podocyte hyperplasia forming pseudocrescents, microcystic tubular dilatation, and a rapid course toward ESRD, particularly in persons of African ancestry carrying two APOL1 risk alleles. Tubuloreticular inclusions support interferon-driven disease but are supportive, not diagnostic, which weakens option D. Full house staining belongs to lupus nephritis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.