Patients with HIV infection can manifest a spectrum of potentially reversible forms of acute renal failure and a unique form of nephropathy clinically characterized by nephrotic syndrome, a rapid progression to irreversible uremia in weeks, and a poor prognosis despite maintenance dialysis therapy. Typical histologic features consist of focal and segmental glomerulosclerosis, with some distinct and unusual electron microscopic features in the kidney. HIV-associated nephropathy (HIVAN) is predominantly a disease of young black men; about half are intravenous drug addicts and the remaining half belong to various groups at risk for HIV infection. Evidence points to a viral etiology in the pathogenesis of HIVAN. Currently, no effective forms of therapy are available for HIV-associated nephropathy. It is hoped that the newer antiviral agents given early and for prolonged periods may change the natural history of HIVAN, which at present is a fulminant form of irreversible renal syndrome.