Connolly J O, Weston C E, Hendry B M
Department of Medicine, King's College Hospital School of Medicine and Dentistry, London, UK.
QJM. 1995 Sep;88(9):627-34.
We report experience from London hospitals which further illustrates the heterogeneous nature of HIV-associated nephropathy (HIVAN). Nineteen HIV-positive patients underwent renal biopsy from 1992 to 1994. Fourteen were male, five female. Eleven were Afro-Caribbean, 7 Caucasian and 1 Asian. Eleven patients had classical HIVAN with proteinuria, rapidly progressive renal failure and features of focal and segmental glomerulosclerosis (FSGS) on renal biopsy, and three of these had associated tubulo-interstitial nephritis (TIN). One further patient had TIN and tubular changes suggestive of HIVAN but no glomeruli were present in the biopsy. Other biopsy findings were of focal proliferative glomerulonephritis and TIN (1 patient), pauci-immune crescentic glomerulonephritis and TIN (1 patient), membranous nephropathy (1 patient), membranoproliferative nephropathy (1 patient) and haemolytic uraemic syndrome (2 patients). Of 11 patients with FSGS, seven died with median survival of 8 months (range 23 days-46 months) and five are still alive after median follow-up of 18 months (range 10-22 months). Of patients with glomerular disease other than FSGS, five died, with median survival of 3 months (range 1-27 months) and two have survived (10 and 27 months, respectively). Thirteen patients had renal failure, 10 of whom had FSGS. In 10 cases renal failure was acute and in two was the presenting feature of HIV infection. Thirteen patients underwent renal replacement therapy. Four received haemodialysis, and all died within one month. Nine patients received CAPD. Two were able to discontinue dialysis. Of the remaining seven, five died with median survival of 8 months (range 1.3-40 months) and two are alive 1 and 10 months after beginning dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)
我们报告了来自伦敦多家医院的经验，这些经验进一步说明了HIV相关性肾病（HIVAN）的异质性。1992年至1994年期间，19名HIV阳性患者接受了肾活检。其中14名男性，5名女性。11名是非洲裔加勒比人，7名是白种人，1名是亚洲人。11名患者患有典型的HIVAN，伴有蛋白尿、快速进展性肾衰竭以及肾活检显示局灶节段性肾小球硬化（FSGS）特征，其中3例伴有肾小管间质性肾炎（TIN）。另有1例患者有TIN和提示HIVAN的肾小管改变，但活检中未见肾小球。其他活检结果包括局灶增生性肾小球肾炎和TIN（1例）、寡免疫性新月体性肾小球肾炎和TIN（1例）、膜性肾病（1例）、膜增生性肾病（1例）以及溶血尿毒综合征（2例）。11例FSGS患者中，7例死亡，中位生存期为8个月（范围23天至46个月），5例在中位随访18个月（范围10至22个月）后仍存活。在非FSGS的肾小球疾病患者中，5例死亡，中位生存期为3个月（范围1至27个月），2例存活（分别为10个月和27个月）。13例患者出现肾衰竭，其中10例为FSGS。10例肾衰竭为急性，2例是HIV感染的首发特征。13例患者接受了肾脏替代治疗。4例接受血液透析，均在1个月内死亡。9例接受持续性非卧床腹膜透析（CAPD）。2例能够停止透析。其余7例中，5例死亡，中位生存期为8个月（范围1.3至40个月），2例在开始透析后1个月和10个月仍存活。（摘要截选至250字）
