Berggren Ruth, Batuman Vecihi
Nephrology Section-SL45, Tulane Medical School, 1430 Tulane Avenue, New Orleans, LA 70112-2632, USA.
Curr HIV/AIDS Rep. 2005 Aug;2(3):109-15. doi: 10.1007/s11904-005-0002-x.
Renal electrolyte disorders, acute renal failure, and a variety of chronic renal diseases are common in HIV-infected patients. Glomerular disorders include IgA nephropathy, cryoglobulinemia, amyloidosis, and a lupus-like immune complex glomerulopathy. The most attention has been focused on collapsing glomerulopathy associated with nephrotic syndrome and progressive renal failure, which appears to be unique for patients with HIV/AIDS, called HIV-associated nephropathy (HIVAN), and it occurs predominantly in African American patients. Investigations in humans and in a transgenic mouse model reveal direct infection of renal epithelial cells by HIV and toxic cellular and immunologic processes mediated by HIV glycoproteins as the principal pathophysiology of HIVAN. Highly active antiretroviral treatment may be associated with an improved renal outcome and even reversal of kidney disease in some patients. Treatment with angiotensin-converting enzyme inhibitors may avert progression of HIVAN to end-stage kidney disease and result in superior patient and kidney survival as compared with untreated patients.
肾电解质紊乱、急性肾衰竭以及各种慢性肾病在HIV感染患者中很常见。肾小球疾病包括IgA肾病、冷球蛋白血症、淀粉样变性以及狼疮样免疫复合物肾小球病。最受关注的是与肾病综合征和进行性肾衰竭相关的塌陷性肾小球病，这似乎是HIV/AIDS患者所特有的，称为HIV相关性肾病（HIVAN），主要发生在非裔美国患者中。对人类和转基因小鼠模型的研究表明，HIV直接感染肾上皮细胞以及HIV糖蛋白介导的毒性细胞和免疫过程是HIVAN的主要病理生理学机制。高效抗逆转录病毒治疗可能与改善肾脏预后相关，甚至在一些患者中可使肾病逆转。与未治疗的患者相比，使用血管紧张素转换酶抑制剂治疗可能避免HIVAN进展至终末期肾病，并使患者和肾脏的存活率更高。
