Röling J, Schmid H, Fischereder M, Draenert R, Goebel F D
Department of Infectious Diseases, Medizinische Poliklinik, Ludwig Maximilians Universitat, University of Munich, Munich, Germany.
Clin Infect Dis. 2006 May 15;42(10):1488-95. doi: 10.1086/503566. Epub 2006 Apr 11.
Renal disease is becoming an increasingly prevalent entity in human immunodeficiency virus (HIV)-infected patients; it occurs in a variety of clinical settings and is associated with histopathological changes. HIV-related renal impairment can present as acute or chronic kidney disease; it can be caused directly or indirectly by HIV and/or by drug-related effects that are directly nephrotoxic or lead to changes in renal function by inducing metabolic vaculopathy and renal damage. Acute renal failure is frequently caused by the toxic effects of antiretroviral therapy or nephrotoxic antimicrobial substances used in the treatment of opportunistic infections. Chronic renal disease can be caused by multiple pathophysiological mechanisms, leading to HIV-associated nephropathy, a form of collapsing focal glomerulosclerosis, thrombotic microangiopathy, and various forms of immune complex glomerulonephritis. The increase in life expectancy and alteration of lipid metabolism due to receipt of highly active antiretroviral therapy are expected to result in an increased prevalence of diabetes and hypertension and, thus, to secondary diabetic and hypertensive renal damage. Antiretroviral agents, such as indinavir and tenofovir, have been associated with nephrotoxic drug effects that have been shown to be reversible in most cases. In this article, we review the current knowledge about acute and chronic HIV-associated renal disease, metabolic alterations and related nephropathies, and toxic drug effects of combination antiretroviral pharmacotherapy.
在人类免疫缺陷病毒（HIV）感染患者中，肾脏疾病正变得越来越普遍；它发生在多种临床情况下，并与组织病理学变化相关。HIV相关的肾功能损害可表现为急性或慢性肾病；它可由HIV直接或间接引起，和/或由具有直接肾毒性或通过诱导代谢性血管病变和肾损害而导致肾功能改变的药物相关作用引起。急性肾衰竭常由抗逆转录病毒疗法的毒性作用或用于治疗机会性感染的肾毒性抗菌物质引起。慢性肾病可由多种病理生理机制引起，导致HIV相关性肾病，这是一种塌陷性局灶性肾小球硬化、血栓性微血管病以及各种形式的免疫复合物肾小球肾炎。由于接受高效抗逆转录病毒疗法导致的预期寿命延长和脂质代谢改变，预计会导致糖尿病和高血压患病率增加，进而导致继发性糖尿病和高血压性肾损害。抗逆转录病毒药物，如茚地那韦和替诺福韦，已被证明与肾毒性药物作用有关，在大多数情况下这些作用是可逆 的。在本文中，我们综述了关于急性和慢性HIV相关性肾病、代谢改变及相关肾病以及联合抗逆转录病毒药物治疗的毒性药物作用的现有知识。
