A 28-year-old African American man with untreated HIV infection and CD4 count of 180 cells/mm3 develops nephrotic-range proteinuria and rapid decline in renal function. Biopsy shows collapse of glomerular capillary tufts with marked hypertrophy and hyperplasia of visceral epithelial cells filling Bowman space, plus microcystic tubular dilatation. Which statement is correct regarding this lesion?

• A It is an immune complex disease driven by circulating gp120 antibody complexes
• B Electron microscopy demonstrates dense deposits within the lamina densa of the GBM
• C Immunofluorescence shows linear IgG along the glomerular basement membrane
• D It is strongly associated with APOL1 risk variants and often progresses rapidly to ESRD ✓

Explanation

Collapsing glomerulopathy, the lesion of HIV-associated nephropathy, is linked to APOL1 G1 and G2 risk alleles carried disproportionately in individuals of West African ancestry and follows an aggressive course toward ESRD if untreated. Immunofluorescence is typically nondiagnostic or shows nonspecific trapping of IgM and C3, and there are no immune-type electron-dense deposits, ruling out options A, C and B.

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.