Méry J P
Hôpital Bichat, Paris, Francia.
Rev Med Chil. 1997 Jan;125(1):95-8.
Renal involvement in AIDS may be specific or unspecific. Unspecific lesions, the most common, are usually an acute tubular necrosis produced by hemodynamic, infectious or electrolytic alterations that lead to an acute renal failure or drug nephrotoxicity. Specific lesions are segmental and focal hyalinosis, immune complex glomerulonephritis and thrombotic microangiopathy. Focal and segmental hyalinosis is observed almost exclusively in black people and produces a rapidly progressive renal failure. Lesions are a consequence of HIV stimulation of TGF beta in mesangial cells. Immune complex glomerulonephritis, formed by HIV antigens and anti HIV antibodies, is observed in white and black people. The glomerular lesion in this condition is less severe than in the former. Thrombotic microangiopathy could be a consequence of a pathogenic effect of the virus over glomerular capillaries and arterioles. It is clinically expressed as a hemolytic uremic syndrome. This paper reports briefly the renal pathological study of 46 patients infected with HIV-1, seen at the Nephrology Service of the Bichat Hospital in Paris.
艾滋病患者的肾脏受累情况可能是特异性的，也可能是非特异性的。非特异性病变最为常见，通常是由血流动力学、感染或电解质改变引起的急性肾小管坏死，可导致急性肾衰竭或药物性肾毒性。特异性病变包括节段性和局灶性玻璃样变性、免疫复合物性肾小球肾炎和血栓性微血管病。局灶性和节段性玻璃样变性几乎仅见于黑人，可导致快速进展性肾衰竭。病变是HIV刺激系膜细胞中转化生长因子β的结果。由HIV抗原和抗HIV抗体形成的免疫复合物性肾小球肾炎在白人和黑人中均有观察到。这种情况下的肾小球病变不如前者严重。血栓性微血管病可能是病毒对肾小球毛细血管和小动脉产生致病作用的结果。临床上表现为溶血尿毒综合征。本文简要报告了在巴黎比沙医院肾病科就诊的46例HIV-1感染患者的肾脏病理研究。
