Szczech Lynda Anne, Anderson Albert, Ramers Christian, Engeman John, Ellis Matthew, Butterly David, Howell David N
Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, NC 27710, USA.
Am J Kidney Dis. 2006 Oct;48(4):e55-9. doi: 10.1053/j.ajkd.2006.06.007.
Glomerular lesions that complicate patients with human immunodeficiency virus (HIV) infection include HIV-associated nephropathy, membranous glomerulopathy, and immune-complex glomerulonephritides. This case series presents 3 patients with clinically significant renal disease and positive test results for anti-glomerular basement membrane (anti-GBM) antigen. Characteristic histological findings that would suggest anti-GBM antibodies have a significant role in the pathological state of each patient's kidney disease were absent. In addition, each patient recovered without specific treatment for anti-GBM disease. This case series suggests that anti-GBM antibodies likely are related to the B-cell expansion previously described in patients with HIV infection. We propose that clinicians interpret results of anti-GBM antibody tests carefully for patients with HIV infection, considering biopsy before empiric therapy, particularly in a clinical presentation that is atypical for Goodpasture disease.
使人类免疫缺陷病毒（HIV）感染患者病情复杂化的肾小球病变包括HIV相关性肾病、膜性肾小球病和免疫复合物性肾小球肾炎。本病例系列报告了3例患有具有临床意义的肾脏疾病且抗肾小球基底膜（anti-GBM）抗原检测结果呈阳性的患者。未发现提示anti-GBM抗体在每位患者肾脏疾病病理状态中起重要作用的特征性组织学表现。此外，每位患者未经针对anti-GBM疾病的特异性治疗即康复。本病例系列提示，anti-GBM抗体可能与先前在HIV感染患者中描述的B细胞扩增有关。我们建议临床医生在对HIV感染患者进行anti-GBM抗体检测结果解读时要谨慎，在经验性治疗前考虑进行活检，尤其是在临床表现不典型的Goodpasture病患者中。
