Mount Sinai School of Medicine, New York, NY 10029, USA.
Adv Chronic Kidney Dis. 2010 Jan;17(1):19-25. doi: 10.1053/j.ackd.2009.08.006.
Nephrologists can serve many important functions for HIV-infected patients, including identifying risks for developing kidney disease, detecting and diagnosing kidney disease, distinguishing antiretroviral-induced kidney injury from kidney disease in the setting of antiretroviral therapy, comanaging the clinical course and complications of CKD, and preparing patients for dialysis and/or transplantation. The epidemiology of kidney disease in HIV informs us for these functions by describing the natural history of disease, its frequent occurrence in high-risk communities, and its potential causes. Risk factors that drive CKD in HIV are black race, hypertension, diabetes, HIV viral replication with low CD4 cell counts, high viral load or acquired immune deficiency syndrome-defining conditions, and antiretroviral agents with nephrotoxic potential. The prevalence of these risk factors in any population determines the magnitude of the problem, which can range from as low as 2% to as high as 30%. Recent research focuses on kidney health in HIV. Important links between HIV viral replication and glomerular filtration rate, even in patients with normal kidney function, are now being reported. A review of these data provides the foundation for a better understanding of kidney disease and, hopefully, better treatment for patients with HIV.
肾病学家可以为感染 HIV 的患者提供多种重要的服务，包括识别发生肾脏疾病的风险、检测和诊断肾脏疾病、将抗逆转录病毒治疗中因抗逆转录病毒药物引起的肾脏损伤与肾脏疾病相区分、共同管理慢性肾脏病的临床病程和并发症，以及为患者进行透析和/或移植做准备。HIV 相关肾脏疾病的流行病学通过描述疾病的自然史、其在高危人群中的频繁发生以及其潜在原因，为这些功能提供了信息。导致 HIV 患者发生慢性肾脏病的危险因素包括：黑人种族、高血压、糖尿病、HIV 病毒载量高且 CD4 细胞计数低、高病毒载量或获得性免疫缺陷综合征定义的条件，以及具有潜在肾毒性的抗逆转录病毒药物。在任何人群中，这些危险因素的流行程度决定了问题的严重程度，范围可低至 2%，高至 30%。最近的研究重点关注 HIV 患者的肾脏健康。现在有报道称，HIV 病毒复制与肾小球滤过率之间存在重要联系，即使在肾功能正常的患者中也是如此。对这些数据的回顾为更好地了解肾脏疾病，并希望为 HIV 患者提供更好的治疗提供了基础。
