Renal disease in persons with HIV has been a major cause of morbidity and mortality since the onset of the epidemic. HIV nephropathy (HIVAN) was the most common form of kidney disease initially seen, but in the post-antiretroviral therapy (ART) era it is much less common. Other renal conditions associated with HIV infection include immune complex disease and classic focal segmental glomerulosclerosis. The pathologic spectrum of renal disease in patients with HIV is extensive. Some conditions, including HIVAN, improve following treatment of the virus with ART. Acute kidney injury is much more common in HIV-infected patients and is associated with a sixfold increase in mortality. Patients with HIV are also much more likely to require renal replacement therapy, including dialysis and renal transplantation. ART may also contribute to renal disease in patients with HIV.