Gonzalez Corina, Ariceta G, Langman C B, Zibaoui P, Escalona L, Dominguez L F, Rosas M A
Department of Pediatric Infectology, Hospital Doctor Enrique Tejera, University of Carabobo, Valencia, Venezuela.
Eur J Pediatr. 2008 May;167(5):509-15. doi: 10.1007/s00431-007-0538-4. Epub 2007 Jun 26.
Kidney involvement in children with Human Immunodeficiency Virus (HIV) infection is increasing in prevalence in parallel with the longer survival of HIV-infected patients and the side-effects of new antiretroviral drugs. However, there are only a few reports describing renal tubular disorders in HIV+ children. This is a cross-sectional, case series study evaluating kidney disease in 26 Venezuelan HIV-infected children. The study cohort consisted of 15 girls and 11 boys, with a median age of 5.9 years (25-75th percentile: 3.6-7.8), who had been treated with antiretrovirals for 2.8 +/- 0.4 years, Overall, the patients were short for their age and gender (Z-height: -3.1; 25-75th percentile: -4.94 to -1.98), and 15 showed signs of mild to moderate malnutrition. All of the children had a normal estimated glomerular filtration rate (136 +/- 22.6 ml/min/1.73 m2), and glomerular involvement was only observed in one patient with isolated proteinuria. None had nephromegaly. In contrast, tubular disorders were commonly found. Hypercalciuria was detected in 16 of the patients (UCa/Cr = 0.28; 25-75th percentile: 0.17-0.54 mg/mg), with five of these showing crystalluria. Eight children showed hyperchloremia, and three had frank metabolic acidosis. Kidney stones were absent in all, but one boy had bilateral medullary nephrocalcinosis. Conclusion, in Venezuelan children, HIV infection per se, or its specific treatment, was commonly associated with renal tubular dysfunction, especially hypercalciuria and acidosis, potentially leading to nephrocalcinosis and growth impairment. We recommend renal tubular evaluation during the follow-up of children with HIV infection.
随着感染人类免疫缺陷病毒（HIV）的患者生存期延长以及新型抗逆转录病毒药物的副作用，HIV感染儿童肾脏受累的患病率正在上升。然而，仅有少数报告描述了HIV阳性儿童的肾小管疾病。这是一项横断面病例系列研究，评估了26名委内瑞拉HIV感染儿童的肾脏疾病。研究队列包括15名女孩和11名男孩，中位年龄为5.9岁（第25至75百分位数：3.6 - 7.8岁），接受抗逆转录病毒治疗2.8±0.4年。总体而言，这些患者按年龄和性别计算身材矮小（身高Z值：-3.1；第25至75百分位数：-4.94至-1.98），15名患者有轻度至中度营养不良的迹象。所有儿童的估计肾小球滤过率均正常（136±22.6 ml/min/1.73 m²），仅1例孤立性蛋白尿患者出现肾小球受累。无人有肾肿大。相比之下，肾小管疾病较为常见。16名患者检测到高钙尿症（尿钙/肌酐 = 0.28；第25至75百分位数：0.17 - 0.54 mg/mg），其中5名出现结晶尿。8名儿童出现高氯血症，3名有明显的代谢性酸中毒。所有人均无肾结石，但1名男孩有双侧髓质肾钙质沉着症。结论，在委内瑞拉儿童中，HIV感染本身或其特定治疗通常与肾小管功能障碍相关，尤其是高钙尿症和酸中毒，可能导致肾钙质沉着症和生长发育受损。我们建议在HIV感染儿童的随访过程中进行肾小管评估。
