Freedman B I, Soucie J M, Stone S M, Pegram S
Internal Medicine/Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Am J Kidney Dis. 1999 Aug;34(2):254-8. doi: 10.1016/s0272-6386(99)70352-5.
Human immunodeficiency virus-associated nephropathy (HIVAN) develops more often in HIV-infected blacks than whites. Blacks also show marked familial clustering of other causes of end-stage renal disease (ESRD), particularly diabetes mellitus-, hypertension-, and systemic lupus erythematosus-associated ESRD. We compared the family history of ESRD in 201 blacks with ESRD caused by HIVAN (cases) to that of 50 HIV-infected blacks without renal disease (controls) to determine whether HIV-associated ESRD shows familial aggregation. Cases were identified using the Southeastern Kidney Council/ESRD Network 6 Family History of ESRD database. Cases initiated dialysis between September 1993 and October 1998. Controls were consecutively identified, HIV-infected blacks with serum creatinine concentrations of 1.3 mg/dL or less and no proteinuria, treated in an infectious disease clinic during September 1998. Cases and controls had similar mean ages and family sizes. First- or second-degree relatives with ESRD were reported by 24.4% of the cases compared with 6% of the controls (P = 0.004). Logistic regression analysis, controlling for sex, family size, and age, showed cases were 5.4 times more likely than controls to have close relatives with ESRD (P = 0.007). The 49 HIVAN cases who reported a positive family history had a mean of 1.2 additional relatives with ESRD per case (60 total relatives with ESRD). HIVAN was not listed as the cause of ESRD in any of the 27 relatives who underwent dialysis in Network 6 facilities. We conclude that ESRD clusters in the families of nearly 25% of blacks initiating renal replacement therapy for HIVAN. This familial aggregation of ESRD appears to be independent of HIV infection. Although environmental factors cannot be excluded, it is possible an inherited susceptibility to renal failure is present in many blacks with HIV infection who subsequently develop nephropathy.
人类免疫缺陷病毒相关性肾病（HIVAN）在感染人类免疫缺陷病毒（HIV）的黑人中比在白人中更常发生。黑人中终末期肾病（ESRD）的其他病因也呈现出明显的家族聚集性，尤其是与糖尿病、高血压和系统性红斑狼疮相关的ESRD。我们比较了201例因HIVAN导致ESRD的黑人（病例组）和50例未患肾病的HIV感染黑人（对照组）的ESRD家族史，以确定HIV相关的ESRD是否呈现家族聚集性。病例通过东南部肾脏委员会/ESRD网络6的ESRD家族史数据库进行识别。病例于1993年9月至1998年10月开始透析。对照组为连续识别的血清肌酐浓度为1.3mg/dL或更低且无蛋白尿的HIV感染黑人，于1998年9月在传染病诊所接受治疗。病例组和对照组的平均年龄和家庭规模相似。24.4%的病例报告有ESRD的一级或二级亲属，而对照组为6%（P = 0.004）。在控制性别、家庭规模和年龄的逻辑回归分析中，病例组有ESRD近亲的可能性是对照组的5.4倍（P = 0.007）。报告有阳性家族史的49例HIVAN病例，平均每例另有1.2名亲属患有ESRD（共有60名亲属患有ESRD）。在网络6设施中接受透析的27名亲属中，没有任何一人将HIVAN列为ESRD的病因。我们得出结论，近25%因HIVAN开始肾脏替代治疗的黑人家庭中存在ESRD聚集现象。ESRD的这种家族聚集似乎与HIV感染无关。尽管不能排除环境因素，但许多感染HIV并随后发展为肾病的黑人可能存在对肾衰竭的遗传易感性。
