Campos Pedro, Ortiz Alberto, Soto Karina
Nephrology Department, Hospital Fernando Fonseca, Lisbon, Portugal.
IIS-Fundación Jiménez Díaz, School of Medicine, UAM and IRSIN, Madrid, Spain; Iberoamerican CKD Research Network (IBERERC), Madrid, Spain.
Clin Kidney J. 2016 Dec;9(6):772-781. doi: 10.1093/ckj/sfw104. Epub 2016 Oct 25.
Kidney diseases in human immunodeficiency virus (HIV)-infected patients are often misdiagnosed. Despite reductions in morbidity and mortality owing to widespread use of highly effective combination antiretroviral therapy (cART), acute kidney injury (AKI) and chronic kidney disease (CKD) are still more common in these patients than in the general population, and are associated with poor health outcomes. HIV-associated nephropathy and HIV immune complex kidney diseases are the more recognizable HIV-related kidney diseases. However, a broad spectrum of kidney disorders related or not directly related with HIV infection can be observed, including cART-induced AKI, CKD, proximal tubular dysfunction, crystalluria and urolithiasis, among others. This review summarizes the major epidemiologic studies of kidney diseases in HIV-infected patients, discusses novel approaches that may potentially limit nephrotoxicity such as the use of tenofovir alafenamide, and outlines current screening measures for early diagnosis of kidney dysfunction or tubular damage, and for accurate detection of increased risk for acute or chronic kidney diseases.
人类免疫缺陷病毒（HIV）感染患者的肾脏疾病常常被误诊。尽管由于广泛使用高效抗逆转录病毒联合疗法（cART），发病率和死亡率有所降低，但急性肾损伤（AKI）和慢性肾脏病（CKD）在这些患者中仍比普通人群更为常见，且与不良健康结局相关。HIV相关性肾病和HIV免疫复合物性肾脏疾病是更易识别的HIV相关肾脏疾病。然而，可以观察到一系列与HIV感染相关或不直接相关的肾脏疾病，包括cART引起的AKI、CKD、近端肾小管功能障碍、结晶尿和尿路结石等。本综述总结了HIV感染患者肾脏疾病的主要流行病学研究，讨论了可能潜在限制肾毒性的新方法，如使用替诺福韦艾拉酚胺，并概述了目前用于早期诊断肾功能障碍或肾小管损伤以及准确检测急性或慢性肾脏疾病风险增加的筛查措施。
