Winston J, Klotman P E
Mount Sinai School of Medicine, New York, NY 10029, USA.
Mt Sinai J Med. 1998 Jan;65(1):27-32.
Patients with HIV-1 infection are at risk for developing renal diseases with diverse etiologies. Acute renal failure occurs in up to 20% of hospitalized patients with HIV infection, and chronic renal disease of diverse etiology has been reported. The single most common cause of chronic renal insufficiency in HIV-1+ patients is HIV-associated nephropathy (HIVAN). Typical morphologic features include enlarged kidneys, microcystic tubule dilatation, tubulointerstitial inflammation, and focal and segmental glomerulosclerosis.
The pathogenesis, epidemiology, and treatment options for HIVAN are discussed. In studying the epidemiology of the disease, we reviewed several renal disease databases, including the United States Renal Data Systems and New York State End Stage Renal Disease Network. We have previously reported our experience with HIVAN at Mount Sinai Medical Center.
The exact cause of the renal disease remains unknown. The importance of a direct effect of HIV-1 viral protein(s) or renal HIV-1 gene expression in disease pathogenesis is supported in the murine model of HIVAN, but definitive proof of renal cell infection in humans is lacking. Further study is required to clarify this issue. We estimate that HIVAN is the fourth leading cause of end-stage renal disease (ESRD) among Blacks between the ages of 20 and 64 years, only slightly behind hypertension, diabetes, and chronic glomerulonephritis. At Mount Sinai Hospital HIVAN accounts for 20% of newly diagnosed ESRD in young black adults. It has become the third leading cause of ESRD in this group, after hypertension and diabetes.
In seropositive patients with renal disease, renal biopsies should be performed to confirm the diagnosis and determine the true incidence. Special attention should be directed toward understanding the underlying cause(s) of HIVAN. A multicenter trial to explore the potential for antiviral therapy in this disease should be initiated.
HIV-1感染患者有发生多种病因所致肾脏疾病的风险。急性肾衰竭在高达20%的住院HIV感染患者中出现，且已报道了多种病因的慢性肾脏疾病。HIV-1阳性患者慢性肾功能不全最常见的单一病因是HIV相关性肾病（HIVAN）。典型的形态学特征包括肾脏增大、微囊性肾小管扩张、肾小管间质炎症以及局灶节段性肾小球硬化。
讨论了HIVAN的发病机制、流行病学及治疗选择。在研究该疾病的流行病学过程中，我们查阅了多个肾脏疾病数据库，包括美国肾脏数据系统和纽约州终末期肾病网络。我们之前已报告了在西奈山医学中心对HIVAN的诊治经验。
肾脏疾病的确切病因仍不清楚。在HIVAN的小鼠模型中，支持HIV-1病毒蛋白或肾脏HIV-1基因表达在疾病发病机制中的直接作用的重要性，但缺乏人类肾细胞感染的确切证据。需要进一步研究来阐明这个问题。我们估计HIVAN是20至64岁黑人中终末期肾病（ESRD）的第四大主要病因，仅次于高血压、糖尿病和慢性肾小球肾炎。在西奈山医院，HIVAN占年轻黑人成年人新诊断ESRD的20%。它已成为该组中ESRD的第三大主要病因，仅次于高血压和糖尿病。
对于血清学阳性的肾病患者，应进行肾脏活检以确诊并确定真实发病率。应特别关注了解HIVAN的潜在病因。应启动一项多中心试验以探索该疾病抗病毒治疗的潜力。
