A kidney biopsy would most likely reveal which of the following?

A 23-year-old African American man with AIDS is sent for work up of the nephrotic syndrome. His blood pressure is 140/82 mm Hg. He has 3+ edema in both legs. His risk factor for AIDS is IV heroin use. His creatinine is 2.0 mg/dL, and his urine reveals +3 protein, no blood. A kidney biopsy would most likely reveal which of the following?

A. Diabetic nephropathy
B. Focal glomerular sclerosis
C. IgA nephropathy
D. Membranous nephropathy
E. Nil disease

Explanation: The correct answer is B. Focal glomerular sclerosis is the type of nephropathy most commonly seen in African American IV drug users with AIDS. It is likely to lead to a very rapid loss of renal function.

There is no clinical evidence to indicate that this person has diabetes, making diabetic nephropathy (choice A) unlikely.

Nil disease (choice E), IgA nephropathy (choice C) and membranous nephropathy (choice D) are only very rarely associated with AIDS.