Cho Monique E, Kopp Jeffrey B
Kidney Disease Section, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health/DHHS, 9000 Rockville Pike, Bethesda, MD 20892, USA.
Curr HIV/AIDS Rep. 2004 Sep;1(3):109-15. doi: 10.1007/s11904-004-0016-9.
The first association between HIV-1 infection and kidney disease was made in 1984 and much has been learned over the past 20 years. In recent years, more effective therapies for HIV-1 infection and its associated opportunistic infections have led to improved patient survival. However, with prolonged survival, morbidity associated with renal disease has also increased. Among the multiple glomerulopathies that can affect patients with HIV, focal segmental glomerulosclerosis (FSGS) is most common and frequently leads to end-stage renal disease. Although the precise mechanisms of HIV-associated FSGS remain to be elucidated, it appears that host genetic susceptibility, direct infection of the renal epithelium, and toxicity of one or more viral accessory protein contribute. Therapy for HIV-associated FSGS includes control of blood pressure and the use of angiotensin antagonist therapy. A randomized trial of angiotensin receptor blocker will be initiated shortly. Drug-related nephropathies are also common, manifesting as acute renal failure, nephrolithiasis, and interstitial nephritis. Tenofovir, a newer nucleoside analogue, has recently been implicated in causing tubular toxicity, although the incidence is low. Appropriate screening for renal dysfunction can minimize the likelihood of progressive renal injury in all patients with HIV-1 infection.
1984年首次发现了HIV-1感染与肾脏疾病之间的关联，在过去20年里人们对此有了很多了解。近年来，针对HIV-1感染及其相关机会性感染的更有效疗法提高了患者的生存率。然而，随着生存期延长，与肾脏疾病相关的发病率也有所增加。在可影响HIV患者的多种肾小球病中，局灶节段性肾小球硬化（FSGS）最为常见，且常导致终末期肾病。尽管HIV相关FSGS的确切机制仍有待阐明，但似乎宿主遗传易感性、肾上皮细胞的直接感染以及一种或多种病毒辅助蛋白的毒性都起了作用。HIV相关FSGS的治疗包括控制血压和使用血管紧张素拮抗剂治疗。一项关于血管紧张素受体阻滞剂的随机试验即将启动。药物相关性肾病也很常见，表现为急性肾衰竭、肾结石和间质性肾炎。替诺福韦是一种较新的核苷类似物，最近被认为可导致肾小管毒性，尽管发病率较低。对所有HIV-1感染患者进行适当的肾功能筛查可将进行性肾损伤的可能性降至最低。
