Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes, Digestive, and Kidney Diseases, Bethesda, MD 20892, USA.
Adv Chronic Kidney Dis. 2010 Jan;17(1):83-93. doi: 10.1053/j.ackd.2009.09.001.
A spectrum of kidney diseases in HIV-infected patients has been reported both before and after the introduction of highly active antiretroviral therapy (HAART). Kidney syndromes affecting HIV-infected patients include CKD as well as proteinuria, nephrotic syndrome, and acute nephritic syndrome. Thrombotic microangiopathy should be considered in patients with kidney disease and typical clinical characteristics. As the HIV-infected population ages, there is increased concern regarding the incidence of vascular and metabolic disease, leading to an increased burden of CKD. Although HIV-associated nephropathy is still the major cause of nephrotic syndrome in HIV-infected patients, immune complex glomerulonephritis (ICGN) still comprises a substantial proportion of the disease burden, especially in people of European origin. Genetic investigations into the underpinnings of the various histologic expressions of HIV-associated kidney disease hold great promise. The single most important diagnostic test to differentiate various forms of kidney disease in HIV-infected patients is a kidney biopsy. The results of treating kidney disease in HIV-infected patients remain unclear, and properly designed randomized controlled trials of the treatment of ICGN with HAART and other approaches are desperately needed.
在引入高效抗逆转录病毒疗法 (HAART) 之前和之后，报告了感染 HIV 的患者的一系列肾脏疾病。影响 HIV 感染患者的肾脏综合征包括慢性肾脏病以及蛋白尿、肾病综合征和急性肾炎综合征。在具有典型临床特征的肾脏疾病患者中应考虑血栓性微血管病。随着 HIV 感染人群的老龄化，对血管和代谢疾病的发病率的担忧增加，导致慢性肾脏病的负担增加。尽管 HIV 相关性肾病仍然是 HIV 感染患者肾病综合征的主要原因，但免疫复合物肾小球肾炎 (ICGN) 仍然构成了疾病负担的很大一部分，尤其是在欧洲血统的人群中。对 HIV 相关性肾脏疾病各种组织学表现的基础的遗传研究具有巨大的潜力。区分 HIV 感染患者各种肾脏疾病的唯一最重要的诊断测试是肾活检。治疗 HIV 感染患者肾脏疾病的结果尚不清楚，迫切需要设计针对 ICGN 用 HAART 和其他方法进行治疗的适当的随机对照试验。
