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HIV感染中的肾脏:超越HIV相关性肾病

The kidney in HIV infection: beyond HIV-associated nephropathy.

作者信息

Wyatt Christina M

机构信息

Mount Sinai School of Medicine, New York, NY, USA.

出版信息

Top Antivir Med. 2012 Aug-Sep;20(3):106-10.

Abstract

Acute kidney injury (AKI) and chronic kidney disease (CKD) are more common in HIV-infected persons than in the general population. AKI is associated with poor health outcomes, including increased risk of heart failure, cardiovascular events, end-stage renal disease (ESRD), and mortality. The most common causes of AKI in HIV-infected persons are systemic infections and adverse drug effects. The prevalence of CKD is rising in the HIV-infected population and CKD is increasingly likely to be caused by comorbid conditions, such as diabetes and hypertension, that frequently cause CKD in the general population. Guidelines for CKD screening in HIV-infected patients are being revised. It is currently recommended that all patients be screened for creatinine-based estimates of glomerular filtration rate and for urine protein at the time of HIV diagnosis. Annual screening is recommended for high-risk patients. Hemodialysis, peritoneal dialysis, and kidney transplantation are all options for treating ESRD in HIV-infected patients. Hemodialysis and peritoneal dialysis offer similar survival in HIV-infected patients with ESRD. In selected patients with well-controlled HIV infection, kidney transplantation is associated with survival intermediate between that in the overall transplant population and that among transplant recipients older than 65 years. This article summarizes a presentation by Christina M. Wyatt, MD, at the IAS-USA continuing medical education program held in Chicago in May 2012, describing AKI and CKD using case illustrations.

摘要

急性肾损伤(AKI)和慢性肾脏病(CKD)在HIV感染者中比在普通人群中更为常见。AKI与不良健康结局相关,包括心力衰竭、心血管事件、终末期肾病(ESRD)和死亡风险增加。HIV感染者中AKI最常见的病因是全身感染和药物不良反应。CKD在HIV感染人群中的患病率正在上升,CKD越来越可能由合并症引起,如糖尿病和高血压,这些疾病在普通人群中也经常导致CKD。针对HIV感染患者的CKD筛查指南正在修订。目前建议在HIV诊断时对所有患者进行基于肌酐的肾小球滤过率估计值和尿蛋白筛查。建议高危患者每年进行筛查。血液透析、腹膜透析和肾移植都是治疗HIV感染患者ESRD的选择。血液透析和腹膜透析在HIV感染的ESRD患者中生存率相似。在HIV感染得到良好控制的特定患者中,肾移植的生存率介于总体移植人群和65岁以上移植受者之间。本文总结了医学博士克里斯蒂娜·M·怀亚特于2012年5月在芝加哥举行的IAS-USA继续医学教育项目上的一次演讲,通过病例说明描述了AKI和CKD。

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