Prakash J, Ganiger V, Prakash S, Sivasankar M, Sunder S, Singh U
Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Department of Medicine, TNMC, Mumbai, Maharashtra, India.
Indian J Nephrol. 2017 Jul-Aug;27(4):271-276. doi: 10.4103/0971-4065.202400.
Human immunodeficiency virus (HIV) infection can cause a broad spectrum of renal diseases. However, there is paucity of Indian data on the patterns of renal lesions in HIV-seropositive patients. The aim of the present study was to delineate the spectrum of renal lesions in HIV/acquired immunodeficiency syndrome patients. In this prospective study, all HIV-positive patients of both genders aged >18 years were screened for renal disease. Patients with proteinuria of more than 1 g/24 h were subjected to renal biopsy. A total of 293 HIV-positive patients were screened; of these, 136 (46.4%) patients found to have renal involvement. Dipstick-positive proteinuria of 1+ or more was observed in 112 (38.2%) patients, and 16 (14.2%) patients had proteinuria of more than 1 g/24 h. Renal biopsy in 14 cases revealed glomerulonephritis (GN) in 12 (85.7%) (isolated GN in 4 [28.5%] and GN mixed with chronic TIN in 8 [57.1%]) patients. These include mesangioproliferative GN in 5 (35.7%), membranoproliferative GN in 2 (14.2%), focal segmental glomerulosclerosis in 2 (14.2%), diffuse proliferative GN in 2 (14.2%), and diabetic nephropathy in 1 (7.1%) patients. Chronic interstitial nephritis was noted in 10 (71.42%) (superimposed on GN in 8 [57.1%], isolated in 2 [14.2%]) patients. Granulomatous interstitial nephritis was seen in 3 (24.1%) cases. GN and chronic interstitial nephritis were noted in 85.7% and 71.42% of patients, respectively, mostly superimposed on each other. Mesangioproliferative GN was the most common glomerular lesion, but classical HIV-associated nephropathy was not observed.
人类免疫缺陷病毒(HIV)感染可引发一系列广泛的肾脏疾病。然而,关于HIV血清阳性患者肾脏病变模式的印度数据较为匮乏。本研究的目的是描绘HIV/获得性免疫缺陷综合征患者的肾脏病变范围。在这项前瞻性研究中,对所有年龄大于18岁的HIV阳性男女患者进行了肾脏疾病筛查。蛋白尿超过1 g/24小时的患者接受了肾活检。共筛查了293例HIV阳性患者;其中,136例(46.4%)患者被发现有肾脏受累。112例(38.2%)患者尿试纸检测蛋白尿呈1+或更高阳性,16例(14.2%)患者蛋白尿超过1 g/24小时。14例患者的肾活检显示,12例(85.7%)患者患有肾小球肾炎(GN)(4例[28.5%]为孤立性GN,8例[57.1%]为GN合并慢性肾小管间质性肾炎)。这些包括5例(35.7%)系膜增生性GN、2例(14.2%)膜增生性GN、2例(14.2%)局灶节段性肾小球硬化、2例(14.2%)弥漫性增生性GN以及1例(7.1%)患者患有糖尿病肾病。10例(71.42%)患者出现慢性间质性肾炎(8例[57.1%]叠加于GN,2例[14.2%]为孤立性)。3例(24.1%)病例出现肉芽肿性间质性肾炎。分别有85.7%和71.42%的患者出现GN和慢性间质性肾炎,且大多相互叠加。系膜增生性GN是最常见的肾小球病变,但未观察到典型的HIV相关性肾病。