da Silva D R, Gluz I C, Kurz J, Thomé G G, Zancan R, Bringhenti R N, Schaefer P G, Dos Santos M, Barros E J G, Veronese F V
Serviço de Nefrologia, Hospital de Clínicas de Porto Alegre, RS, Porto Alegre, Brasil.
Serviço de Patologia, Hospital de Clínicas de Porto Alegre, RS, Porto Alegre, Brasil.
Braz J Med Biol Res. 2016;49(4):e5176. doi: 10.1590/1414-431X20165176. Epub 2016 Mar 18.
HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥ 200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥ 200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003). In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥ 200 cells/mm3 was associated with better renal function after 2 years of follow-up.
HIV感染有广泛的肾脏表现。本研究检查了HIV相关肾病的临床和组织学表现，以及肾脏预后的预测因素。对61例（64%为男性，平均年龄45岁）HIV患者进行了回顾性评估。评估了临床表现和肾脏组织病理学，以及CD4 T细胞计数和病毒载量。使用Cox回归模型确定组织学病变、基线CD4细胞计数和病毒载量对终末期肾病（ESRD）或死亡的预测价值。通过基线CD4细胞计数评估慢性肾脏病（CKD）和ESRD或死亡的结局。初始临床表现时的百分比分布为非肾病性蛋白尿（54%）、急性肾损伤（28%）、肾病综合征（23%）和慢性肾脏病（22%）。局灶节段性肾小球硬化（28%），主要是塌陷型（HIVAN）、急性间质性肾炎（AIN）（26%）和免疫复合物介导的肾小球肾炎（ICGN）（25%）是主要的肾脏组织学类型。基线CD4细胞计数≥200个细胞/mm3是预防CKD的保护因素（风险比=0.997；95%CI=0.994-0.999；P=0.012）。在末次随访时，基线CD4≥200个细胞/mm3的患者中有64%的估算肾小球滤过率（eGFR）>60 mL·min-1·(1.73 m2)-1，而基线CD4<200个细胞/mm3的其他35%患者则不然（对数秩检验=9.043，P=0.003）。总之，HIV相关肾病的主要组织学病变是HIVAN型，其次是AIN和ICGN。这些发现强化了对有肾脏损害和/或蛋白尿的HIV患者进行肾活检的必要性。随访2年后，基线CD4细胞计数≥200个细胞/mm3与更好的肾功能相关。
