AP-HP (Assistance Publique-Hôpitaux de Paris), Service de Néphrologie et de Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Hôpital Henri-Mondor/Albert-Chenevier, F-94000, Créteil, France.
Université Paris-Est Créteil (UPEC), UMR-S955, F-94000, Créteil, France.
BMC Nephrol. 2018 Nov 20;19(1):331. doi: 10.1186/s12882-018-1132-x.
Human immunodeficiency virus (HIV) is associated with diverse glomerular diseases. Characteristics of minimal change nephrotic syndrome (MCNS) in this setting have been little studied, and the specific features of this uncommon association remain to be determined.
We conduct a retrospective study. Clinical, biological and pathological characteristics of patients with MCNS and HIV infection were assessed. We evaluated HIV infection by in situ hybridization and CMIP expression by immunochemistry on kidney biopsies and compared it to HIV-associated nephropathy (HIVAN) and idiopathic MCNS.
Eight patients were identifies. In all but one of these cases, MCNS occurred after HIV diagnosis (mean of 9.5 years). Acute kidney injury was detected in three cases. Mean CD4 lymphocyte count was 733/mm and three patients had a detectable HIV viral load. In situ hybridization for HIV-1 RNA detection yielded a positive signal in a few tubular cells in the renal parenchyma in two of four patients with HIV infection associated with MCNS. Podocytes of these patients presented strong positive immunostaining for CMIP (4/4). Three patients suffered steroid-dependent nephrotic syndrome, and another two patients had at least one relapse. Rituximab treatment was initiated in four cases. After a median follow-up of 20 months, all patients were in remission (complete in 5 cases).
In patients with MCNS occurring in a context of HIV infection, podocyte injury seems to be associated with CMIP induction rather than renal HIV infection but further studies are needed to determine the molecular link between these two conditions.
人类免疫缺陷病毒（HIV）与多种肾小球疾病相关。在此背景下，微小病变肾病综合征（MCNS）的特征研究甚少，这种不常见关联的具体特征仍有待确定。
我们进行了一项回顾性研究。评估了 MCNS 合并 HIV 感染患者的临床、生物学和病理学特征。我们通过原位杂交检测 HIV 感染，通过免疫组化检测 CMIP 表达，并将其与 HIV 相关性肾病（HIVAN）和特发性 MCNS 进行比较。
共发现 8 例患者。除 1 例患者外，所有患者的 MCNS 均发生在 HIV 诊断后（平均 9.5 年）。3 例患者出现急性肾损伤。平均 CD4 淋巴细胞计数为 733/mm，3 例患者可检测到 HIV 病毒载量。4 例 HIV 感染合并 MCNS 的患者中，有 2 例肾实质的肾小管细胞中 HIV-1 RNA 原位杂交检测呈阳性信号。这 4 例患者的足细胞均对 CMIP 呈强阳性免疫染色（4/4）。3 例患者患有激素依赖型肾病综合征，另 2 例患者至少有 1 次复发。4 例患者接受了利妥昔单抗治疗。中位随访 20 个月后，所有患者均缓解（完全缓解 5 例）。
在 HIV 感染背景下发生 MCNS 的患者中，足细胞损伤似乎与 CMIP 诱导有关，而与肾脏 HIV 感染无关，但仍需要进一步研究来确定这两种情况之间的分子联系。
