Gerntholtz T E, Goetsch S J W, Katz I
Dumisani Mzamane African Institute of Kidney Disease, Nephrology Department of Chris Hani Baragwanath Hospital, Soweto, South Africa.
Kidney Int. 2006 May;69(10):1885-91. doi: 10.1038/sj.ki.5000351.
Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is an important cause of renal failure in those of African origin. A number of other kidney diseases occur in HIV-positive patients. We conducted a retrospective review of renal biopsies in HIV-positive Black African patients to determine the prevalence of both 'classic HIVAN' and non-HIVAN pathologies in this group. Clinical and laboratory data from HIV-positive patients who underwent renal biopsy from 1st January 2003 to 31st December 2004 were collected. Similar information on HIV-negative patients biopsied during the same period was also recorded by way of comparison to try and assess the influence of the virus on renal histologic patterns. HIV-positive group - 99 biopsies were suitable for study. The main histologic categories were 'classic HIVAN' (27%) and HIV immune complex kidney disease ('HIVICK') (21%). The subepithelial immune deposits in 'HIVICK' induced a newly described 'ball-in-cup' basement membrane reaction. Other glomerulonephritides included membranous, post-infectious disease, mesangial hyperplasia, and immunoglobulin A nephropathy. Overlapping clinical presentations prevented pre-biopsy histologic predictions. HIV-negative group - There were no examples of collapsing focal segmental glomerulosclerosis or nonspecific immune complex disease, but increased numbers of minimal change and membranoproliferative disease. 'Classic HIVAN' accounted for less than a third of the nephropathies occurring in HIV-positive Black South Africans. 'HIVICK' is another important cause of chronic kidney disease in this group. Future research is needed into the earlier detection and treatment of these diseases, which have a high mortality in our context.
人类免疫缺陷病毒（HIV）相关性肾病（HIVAN）是非洲裔人群肾衰竭的重要病因。HIV阳性患者还会出现许多其他肾脏疾病。我们对HIV阳性的非洲黑人患者的肾活检进行了回顾性研究，以确定该组中“典型HIVAN”和非HIVAN病理的患病率。收集了2003年1月1日至2004年12月31日接受肾活检的HIV阳性患者的临床和实验室数据。同期对HIV阴性患者进行活检的类似信息也进行了记录，以作比较，试图评估病毒对肾脏组织学模式的影响。HIV阳性组——99例活检标本适合研究。主要组织学类型为“典型HIVAN”（27%）和HIV免疫复合物肾病（“HIVICK”）（21%）。“HIVICK”中的上皮下免疫沉积物引发了一种新描述的“杯状球”基底膜反应。其他肾小球肾炎包括膜性、感染后疾病、系膜增生和免疫球蛋白A肾病。重叠的临床表现使得活检前无法进行组织学预测。HIV阴性组——没有塌陷性局灶节段性肾小球硬化或非特异性免疫复合物疾病的病例，但微小病变和膜增生性疾病的数量增加。“典型HIVAN”在HIV阳性的南非黑人中发生的肾病中占比不到三分之一。“HIVICK”是该组慢性肾病的另一个重要病因。需要对这些在我们这种情况下死亡率很高的疾病进行早期检测和治疗的进一步研究。
