Kumar Neelja, Perazella Mark A
Section of Nephrology, Department of Medicine, Yale University School of Medicine, BB 114, 330 Cedar Street, New Haven, CT, 06520-8029, USA.
Curr HIV/AIDS Rep. 2014 Sep;11(3):202-11. doi: 10.1007/s11904-014-0209-9.
With the introduction of potent combination antiretroviral therapy (cART) into clinical practice, HIV-infected patients have garnered much benefit. However, kidney disease continues to be a potential complication in this group. Whereas HIV-associated nephropathy (HIVAN) was the major renal complication prior to cART, co-morbid diseases and adverse renal effects of various drugs, in particular cART, now complicate the landscape. Clinicians now must differentiate HIVAN from cART nephrotoxicity. While sometimes this is easy and relatively straightforward, often the clinician faces a difficult challenge distinguishing these two etiologies of kidney disease. This review will discuss HIVAN and cART-related kidney disease and review the clinical and laboratory data that may be useful in differentiating these processes. Often, however, kidney biopsy may be required to differentiate HIVAN from cART nephrotoxicity as well as other kidney lesions associated with concurrent co-morbidities, both infectious and non-infectious.
随着强效联合抗逆转录病毒疗法（cART）引入临床实践，感染HIV的患者已获得诸多益处。然而，肾脏疾病仍是该群体的一个潜在并发症。在cART出现之前，HIV相关性肾病（HIVAN）是主要的肾脏并发症，而如今，合并疾病以及各种药物（尤其是cART）的不良肾脏影响使情况变得复杂。临床医生现在必须区分HIVAN和cART肾毒性。虽然有时这很容易且相对简单，但临床医生常常面临区分这两种肾病病因的艰巨挑战。本综述将讨论HIVAN和与cART相关的肾脏疾病，并回顾可能有助于区分这些病程的临床和实验室数据。然而，通常可能需要进行肾活检来区分HIVAN与cART肾毒性，以及与并发的合并症（包括感染性和非感染性）相关的其他肾脏病变。
