Yanagisawa Naoki, Ando Minoru, Suganuma Akihiko, Akifumi Imamura, Ajisawa Atsushi
Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital.
Kansenshogaku Zasshi. 2010 Jan;84(1):28-32. doi: 10.11150/kansenshogakuzasshi.84.28.
Kidney disease is a significant cause of morbidity and mortality among persons infected with the human immunodeficiency virus (HIV). However, epidemiologic and clinical variables regarding kidney disease have not been determined among HIV-infected patients in Japan.
A cross-sectional study of 788 HIV-infected outpatients including 706 men was conducted in 2009. The patient's mean age and CD4+ T cell count were 46.2 +/-11.8 years and 418 +/- 202/microL, respectively. Of them, 677 patients (86%) had an undetectable HIV-RNA level (<50 copies/mL). Random urine and blood samples were collected to study the coexistence of chronic kidney disease (CKD). In addition, serum cystatin C was measured since it is considered to be an alternative marker of early kidney dysfunction in the HIV population. The estimated glomerular filtration rate (eGFR) based on serum creatinine was calculated using the 3-variable equation, proposed by the Japanese Society of Nephrology [eGFR (mL/ min/1.73m2) = 194 x Serum creatinine (-1.094) x Age (-0.287 x 0.739 (if female)]. CKD stages were classified based on the National Kidney Foundation guidelines.
The prevalence of CKD and that of CKD > or = stage 3 was 14.9% and 9.4%, respectively. The pro-portion of each stage was as follows: stage 1, 15 patients (1.9%); stage 2, 28 patients (3.6%); stage 3, 66 patients (8.4%); stage 4, 1 patient (0.1%); stage 5, 1 patient (0.1%); and stage 5D, 6 patients (0.8%). Elevation of serum cystatin C (> or = 0.9 mg/L) was found in 23.3%. Comorbidities such as hypertension and diabetes were found in 55.4% and 27.0% in patients with CKD > or = stage 3, respectively. Urinalysis showed 71 patients (9.1%) with proteinuria and 44 patients (5.6%) with hematuria.
CKD has become an important comorbidity for HIV-infected patients in Japan, a point that should be given more emphasis from public health perspective.
肾脏疾病是人类免疫缺陷病毒（HIV）感染者发病和死亡的重要原因。然而，日本HIV感染患者中有关肾脏疾病的流行病学和临床变量尚未确定。
2009年对788名HIV感染门诊患者进行了一项横断面研究，其中包括706名男性。患者的平均年龄和CD4 + T细胞计数分别为46.2±11.8岁和418±202/μL。其中，677名患者（86%）的HIV-RNA水平检测不到（<50拷贝/mL）。收集随机尿液和血液样本以研究慢性肾脏病（CKD）的共存情况。此外，检测血清胱抑素C，因为它被认为是HIV人群早期肾功能障碍的替代标志物。根据日本肾脏病学会提出的三变量方程，基于血清肌酐计算估计肾小球滤过率（eGFR）[eGFR（mL/min/1.73m2）=194×血清肌酐（-1.094）×年龄（-0.287×0.739（女性时）]。根据美国国立肾脏基金会指南对CKD分期进行分类。
CKD的患病率以及CKD≥3期的患病率分别为14.9%和9.4%。各期比例如下：1期，15例患者（1.9%）；2期，28例患者（3.6%）；3期，66例患者（8.4%）；4期，1例患者（0.1%）；5期，1例患者（0.1%）；5D期，6例患者（0.8%）。血清胱抑素C升高（≥0.9mg/L）的比例为23.3%。CKD≥3期患者中，高血压和糖尿病等合并症的发生率分别为55.4%和27.0%。尿液分析显示，71例患者（9.1%）有蛋白尿，44例患者（5.6%）有血尿。
在日本，CKD已成为HIV感染患者的一种重要合并症，从公共卫生角度应给予更多关注。
