Berliner Adam R, Fine Derek M, Lucas Gregory M, Rahman M Hafizur, Racusen Lorraine C, Scheel Paul J, Atta Mohamed G
Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Am J Nephrol. 2008;28(3):478-86. doi: 10.1159/000112851. Epub 2008 Jan 4.
This study aims to explore the spectrum of renal disease in HIV-infected patients, identify clinical predictors of HIV-associated nephropathy (HIVAN), and investigate the performance of renal biopsy in HIV-infected patients.
Of 263 HIV-infected patients with renal disease evaluated between 1995 and 2004, 152 had a renal biopsy, while 111 had not. A group comparison was performed.
The leading biopsy diagnoses were HIVAN (35%), noncollapsing focal segmental glomerulosclerosis (22%), and acute interstitial nephritis (7.9%), amongst over a dozen others. There was a trend of decreasing yearly incidence of HIVAN diagnoses, paralleling the use of antiretroviral therapy. By multivariate logistic regression, CD4 counts >200 cells/mm(3) and higher estimated glomerular filtration rate were strong negative predictors of HIVAN. HIVAN patients were more likely to require dialysis (p < 0.0001) and had worse overall survival (p = 0.02). Younger age and lower estimated glomerular filtration rate were significant predictors of renal biopsy in multivariate regression analysis. More biopsied patients progressed to dialysis (51 vs. 25%, p = 0.001) and death (15 vs. 5.4%, p = 0.001), despite more frequent corticosteroid treatment (29 vs. 3.6%, p = 0.001).
These findings may reflect more severe acute and/or chronic disease at the time of biopsy and suggests that earlier renal biopsy may be warranted in HIV-infected patients, especially in light of the changing spectrum of renal disease in this group.
本研究旨在探索HIV感染患者的肾病谱，确定HIV相关性肾病（HIVAN）的临床预测因素，并研究肾活检在HIV感染患者中的应用情况。
在1995年至2004年间评估的263例患有肾病的HIV感染患者中，152例行肾活检，111例未行肾活检。进行了组间比较。
活检诊断的主要类型为HIVAN（35%）、非塌陷性局灶节段性肾小球硬化（22%）和急性间质性肾炎（7.9%），还有其他十几种类型。HIVAN诊断的年发病率呈下降趋势，与抗逆转录病毒疗法的使用情况平行。通过多因素逻辑回归分析，CD4细胞计数>200个/立方毫米和较高的估计肾小球滤过率是HIVAN的强负性预测因素。HIVAN患者更有可能需要透析（p<0.0001），总体生存率更差（p=0.02）。在多因素回归分析中，年龄较小和估计肾小球滤过率较低是肾活检的显著预测因素。尽管活检患者接受皮质类固醇治疗更频繁（29%对3.6%，p=0.001），但更多活检患者进展为透析（51%对25%，p=0.001）和死亡（15%对5.4%，p=0.001）。
这些发现可能反映了活检时更严重的急性和/或慢性疾病，并表明HIV感染患者可能需要更早进行肾活检，尤其是考虑到该组肾病谱的变化。
