Nephrology: HIV-associated nephropathy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Nephrology: HIV-associated nephropathy

Sample item

A 30-year-old man with untreated HIV infection presents with nephrotic-range proteinuria and rapidly declining renal function. Which biopsy pattern is expected?

AMembranous nephropathyBPost-infectious proliferative glomerulonephritisCMinimal change diseaseDCollapsing focal segmental glomerulosclerosis

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Collapsing focal segmental glomerulosclerosis

HIV-associated nephropathy classically shows collapsing FSGS with microcystic tubular dilatation and tubuloreticular inclusions. It progresses rapidly to end-stage kidney disease unless antiretroviral therapy is started. It is more common in people of African ancestry.

Option by option

A. Membranous nephropathy
Membranous nephropathy is linked to hepatitis B, malignancy and lupus rather than HIVAN.
B. Post-infectious proliferative glomerulonephritis
Post-infectious GN presents with a nephritic picture and low C3, not heavy proteinuria.
C. Minimal change disease
Minimal change disease does not cause rapid progressive renal failure in this setting.
D. Collapsing focal segmental glomerulosclerosis (correct)
Correct. Collapsing FSGS is the typical lesion of HIV nephropathy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Collapsing focal segmental glomerulosclerosis. HIV-associated nephropathy classically shows collapsing FSGS with microcystic tubular dilatation and tubuloreticular inclusions.

Why is "Membranous nephropathy" not the answer?

Membranous nephropathy is linked to hepatitis B, malignancy and lupus rather than HIVAN.

Why is "Post-infectious proliferative glomerulonephritis" not the answer?

Post-infectious GN presents with a nephritic picture and low C3, not heavy proteinuria.

Why is "Minimal change disease" not the answer?

Minimal change disease does not cause rapid progressive renal failure in this setting.

What concept does this question test?

It tests Nephrology: HIV-associated nephropathy in General Medicine. It progresses rapidly to end-stage kidney disease unless antiretroviral therapy is started. It is more common in people of African ancestry.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology: HIV-associated nephropathy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.