Ma Jie, Zheng Qingyue, Zhang Hanlin, Wen Yubing, Ye Wenling, Ye Wei, Zheng Ke, Gao Ruitong, Chen Limeng, Li Taisheng, Li Xuemei, Yu Yang, Lyu Wei
Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Eight-year MD Program, Peking Union Medical College, Beijing, China.
HIV Med. 2022 Mar;23 Suppl 1:23-31. doi: 10.1111/hiv.13246.
HIV-associated kidney disease is common but data on the pathology spectrum of kidney biopsy in China is lacking. This study aimed to illustrate the clinical presentation, laboratory findings and pathological spectrum of different subtypes of HIV-associated kidney disease in China.
Eighteen HIV patients with renal biopsy indications at the Peking Union Medical College Hospital from January 2002 to October 2021 were retrospectively enrolled. All had CD4 counts and HIV viral load measurements. Renal biopsies were examined with light microscopy, immunofluorescence, and electron microscopy. Shapiro-Wilk test was used to test whether the data was normally distributed. The data is presented as medians (interquartile range), number (%), or means (±SD) according to their distribution.
Seventeen patients had glomerular disease, and one patient had interstitial nephritis. Membranous nephropathy was present in eight patients (47.1%), and IgA nephropathy in four patients (23.5%). The difference in urine protein and serum albumin before and after treatment was statistically significant and no deaths or dialysis were observed to the end of follow-up.
This study found that classic HIV-associated nephropathy (HIVAN) was uncommon in Chinese HIV patients. HIV immune complex kidney (HIVICK) disease, such as membranous or IgA nephropathy, was more common, and associated with better prognosis. Antiretroviral therapy, ACE inhibitors, and angiotensin II receptor blockers were effective in decreasing proteinuria and preserving renal function. The use of corticosteroids and immunosuppressive agents seems safe. However, the nephrotoxic effect of antiretroviral agents and other medications should be carefully monitored.
HIV相关肾病很常见，但中国缺乏关于肾活检病理谱的数据。本研究旨在阐明中国HIV相关肾病不同亚型的临床表现、实验室检查结果及病理谱。
回顾性纳入2002年1月至2021年10月在北京协和医院有肾活检指征的18例HIV患者。所有患者均进行了CD4细胞计数和HIV病毒载量检测。肾活检标本进行了光镜、免疫荧光和电镜检查。采用Shapiro-Wilk检验来检验数据是否呈正态分布。数据根据其分布情况以中位数（四分位间距）、例数（%）或均值（±标准差）表示。
17例患者患有肾小球疾病，1例患者患有间质性肾炎。8例患者（47.1%）存在膜性肾病，4例患者（23.5%）存在IgA肾病。治疗前后尿蛋白和血清白蛋白的差异具有统计学意义，随访结束时未观察到死亡或透析情况。
本研究发现经典的HIV相关肾病（HIVAN）在中国HIV患者中并不常见。HIV免疫复合物肾病（HIVICK）疾病，如膜性或IgA肾病，更为常见，且预后较好。抗逆转录病毒疗法、血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂在降低蛋白尿和保护肾功能方面有效。使用糖皮质激素和免疫抑制剂似乎是安全的。然而，应仔细监测抗逆转录病毒药物和其他药物的肾毒性作用。
