Abstract
Aim: to characterize and improve the differential diagnosis of morphological, histochemical and immunohistochemical changes of granulomatous inflammation in the kidneys of patients with tuberculosis, cryptococcosis and talcosis with co-infection with HIV/AIDS. Materials and methods. A retrospective, cohort, single-center, analytical analysis of 400 medical cards of inpatients from 2010 to 2022 inclusive was performed and cases were selected according to the inclusion criteria, data from pathology reports were analyzed, histological specimens were re-examined, and additional studies were performed - histochemical, immunohistochemical, and polarized light microscopy. Materials were obtained from 75 deceased with laboratory-verified HIV infection, aged 25 to 75 years, regardless of gender. Depending on the clinical data and the results of the autopsy examination, the patients were divided into 3 groups. The first group includes 30 cases with HIV/AIDS-tuberculosis co-infection; the second group includes 25 cases diagnosed with talc granulomatosis and HIV/AIDS; the third group includes 20 cases with cryptococcosis and HIV/AIDS. Results. The study of the material from the group of patients with TB-HIV/AIDS co-infection revealed that granulomas were represented by all size variants, with a predominance of small and medium-sized types. The inflammatory cellular shaft was uniform in most cases, but the altering component/caseous necrosis was not found in all granulomas and had a different degree of severity. No alterative necrotic changes, including caseous inflammation, were found outside the granulomas. The fibrous component was detected in most of the studied cases in varying degrees of maturity. Histologic examination with hematoxylin and eosin staining in the cases of the second study group did not reveal granulomatous inflammation, including that induced by talc deposits. The third group with cryptococcal renal lesions included several forms of inflammatory reactions - granulomatous and without granuloma formation (cystic defects, cryptococcal dissemination in all histological structures of the kidney). In most cases (24, 80%), glomerular changes were detected in the form of thickening of the basal membranes of glomerular capillaries, some with pseudo-splitting; collapsed changes in the glomerular capillary loops; mesangial hypercellularity and mild proliferation of the endothelium of the capillary loops. Some cases (17, 56.6%) demonstrated focal segmental glomerulosclerosis. In one case, nodules with complete sclerosis were detected. There were focal interstitial infiltrates of lymphoplasmacytic composition. Conclusions. The lifetime diagnosis of specific renal damage in generalized infectious processes in patients with HIV/ AIDS remains unrealized despite the availability and minimally invasive nature of existing diagnostic methods