UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

HIV感染者肾脏疾病概述

Authors
Christina M Wyatt, MD
Paul E Klotman, MD
Section Editors
Richard J Glassock, MD, MACP
Fernando C Fervenza, MD, PhD
Deputy Editor
John P Forman, MD, MSc
Translators
弓孟春, 主治医师

引言

在高效抗逆转录病毒治疗(highly active antiretroviral therapy, HAART)的时代，随着人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者生存情况和疾病进展情况的大幅改善，并发症(例如，肾脏疾病、肝脏疾病和心脏疾病)很大程度上已取代机会性感染成为HIV感染者死亡的主要原因[1]。HIV感染者存在继发于药物肾毒性、HIV相关性肾病(HIV-associated nephropathy, HIVAN)[2-5]、免疫复合物肾病[5-9]以及血栓性微血管病性肾病[10,11]的急性肾损伤(acute kidney injury, AKI)和慢性肾脏疾病(chronic kidney disease, CKD)的风险。此外，HIV感染者的老化队列(aging cohort)发生与乙型肝炎病毒(hepatitis B virus, HBV)或丙型肝炎病毒(hepatitis C virus, HCV)共感染[5,12,13]相关的肾脏疾病的风险可能增高，发生共病性糖尿病和高血压或治疗相关性糖尿病和高血压的风险也可能增高。

急性肾损伤

HIV感染者中发生AKI的流行病学 — 在引入HAART之前，AKI通常由败血症、血容量不足或是药物毒性所导致[14,15]。

AKI的发病率 — HIV感染者中的AKI发病率高于非HIV感染者。HIV感染者中的AKI发病率也已随着时间而增加。一项对纽约州住院成年HIV感染者的研究，对比了1995年(HAART引入之前)和2003年(HAART引入之后)的管理数据，并证明了这一点[16]。同非HIV感染的住院患者相比，在1995年(2.9% vs 1%)和2003年(6% vs 2.7%)的数据中，感染HIV的住院患者被证实患AKI的比例均显著更高。在HIV感染者中，证实患AKI的患者比例在2003年比1995年高出2倍，但是住院死亡率更低。

一项纳入754例在单个医疗中心随访的门诊HIV感染者的前瞻性研究显示，两年期间(2000-2002年，HAART引入之后)有71例(9.4%)患者出现了至少1次AKI发作[17]。

AKI的危险因素 — HIV感染者发生AKI的某些危险因素与普通人群相似，例如年龄较大、糖尿病、既往存在CKD以及急性或慢性肝病[16]。但是，某些危险因素是HIV特有的。例如，在上述纳入754例HIV感染者的研究中，AKI更多见于接受HAART者(12% vs 4%)和存在获得性免疫缺陷综合征(acquired immune deficiency syndrome, AIDS)相关性疾病(AIDS-defining illness)者(30% vs 7%)[17]。其他的AKI预测因子还包括CD4计数较低、高病毒载量，以及在HIV感染患者中较为常见的HCV共感染。

             

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2017-04-27.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Selik RM, Byers RH Jr, Dworkin MS. Trends in diseases reported on U.S. death certificates that mentioned HIV infection, 1987-1999. J Acquir Immune Defic Syndr 2002; 29:378.
  2. Gardenswartz MH, Lerner CW, Seligson GR, et al. Renal disease in patients with AIDS: a clinicopathologic study. Clin Nephrol 1984; 21:197.
  3. Pardo V, Aldana M, Colton RM, et al. Glomerular lesions in the acquired immunodeficiency syndrome. Ann Intern Med 1984; 101:429.
  4. Rao TK, Filippone EJ, Nicastri AD, et al. Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome. N Engl J Med 1984; 310:669.
  5. D'Agati V, Appel GB. Renal pathology of human immunodeficiency virus infection. Semin Nephrol 1998; 18:406.
  6. Casanova S, Mazzucco G, Barbiano di Belgiojoso G, et al. Pattern of glomerular involvement in human immunodeficiency virus-infected patients: an Italian study. Am J Kidney Dis 1995; 26:446.
  7. Kimmel PL, Phillips TM, Ferreira-Centeno A, et al. HIV-associated immune-mediated renal disease. Kidney Int 1993; 44:1327.
  8. Balow JE. Nephropathy in the context of HIV infection. Kidney Int 2005; 67:1632.
  9. Kimmel PL, Phillips TM, Ferreira-Centeno A, et al. Brief report: idiotypic IgA nephropathy in patients with human immunodeficiency virus infection. N Engl J Med 1992; 327:702.
  10. Boccia RV, Gelmann EP, Baker CC, et al. A hemolytic-uremic syndrome with the acquired immunodeficiency syndrome. Ann Intern Med 1984; 101:716.
  11. Bachmeyer C, Blanche P, Séréni D, et al. Thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome in HIV-infected patients. AIDS 1995; 9:532.
  12. Stokes MB, Chawla H, Brody RI, et al. Immune complex glomerulonephritis in patients coinfected with human immunodeficiency virus and hepatitis C virus. Am J Kidney Dis 1997; 29:514.
  13. Lai KN, Li PK, Lui SF, et al. Membranous nephropathy related to hepatitis B virus in adults. N Engl J Med 1991; 324:1457.
  14. Peraldi MN, Maslo C, Akposso K, et al. Acute renal failure in the course of HIV infection: a single-institution retrospective study of ninety-two patients and sixty renal biopsies. Nephrol Dial Transplant 1999; 14:1578.
  15. Rao TK, Friedman EA. Outcome of severe acute renal failure in patients with acquired immunodeficiency syndrome. Am J Kidney Dis 1995; 25:390.
  16. Wyatt CM, Arons RR, Klotman PE, Klotman ME. Acute renal failure in hospitalized patients with HIV: risk factors and impact on in-hospital mortality. AIDS 2006; 20:561.
  17. Franceschini N, Napravnik S, Eron JJ Jr, et al. Incidence and etiology of acute renal failure among ambulatory HIV-infected patients. Kidney Int 2005; 67:1526.
  18. Choi AI, Li Y, Parikh C, et al. Long-term clinical consequences of acute kidney injury in the HIV-infected. Kidney Int 2010; 78:478.
  19. Wikman P, Safont P, Del Palacio M, et al. The significance of antiretroviral-associated acute kidney injury in a cohort of ambulatory human immunodeficiency virus-infected patients. Nephrol Dial Transplant 2013; 28:2073.
  20. Zaidan M, Lescure FX, Brochériou I, et al. Tubulointerstitial nephropathies in HIV-infected patients over the past 15 years: a clinico-pathological study. Clin J Am Soc Nephrol 2013; 8:930.
  21. Schwartz EJ, Szczech LA, Ross MJ, et al. Highly active antiretroviral therapy and the epidemic of HIV+ end-stage renal disease. J Am Soc Nephrol 2005; 16:2412.
  22. Szczech LA, Gange SJ, van der Horst C, et al. Predictors of proteinuria and renal failure among women with HIV infection. Kidney Int 2002; 61:195.
  23. Laurinavicius A, Hurwitz S, Rennke HG. Collapsing glomerulopathy in HIV and non-HIV patients: a clinicopathological and follow-up study. Kidney Int 1999; 56:2203.
  24. German P, Liu HC, Szwarcberg J, et al. Effect of cobicistat on glomerular filtration rate in subjects with normal and impaired renal function. J Acquir Immune Defic Syndr 2012; 61:32.
  25. Koteff J, Borland J, Chen S, et al. A phase 1 study to evaluate the effect of dolutegravir on renal function via measurement of iohexol and para-aminohippurate clearance in healthy subjects. Br J Clin Pharmacol 2013; 75:990.
  26. Eitner F, Cui Y, Hudkins KL, et al. Thrombotic microangiopathy in the HIV-2-infected macaque. Am J Pathol 1999; 155:649.
  27. Segerer S, Eitner F, Cui Y, et al. Cellular injury associated with renal thrombotic microangiopathy in human immunodeficiency virus-infected macaques. J Am Soc Nephrol 2002; 13:370.
  28. Becker S, Fusco G, Fusco J, et al. HIV-associated thrombotic microangiopathy in the era of highly active antiretroviral therapy: an observational study. Clin Infect Dis 2004; 39 Suppl 5:S267.
  29. Jotwani V, Li Y, Grunfeld C, et al. Risk factors for ESRD in HIV-infected individuals: traditional and HIV-related factors. Am J Kidney Dis 2012; 59:628.
  30. Estrella MM, Parekh RS, Astor BC, et al. Chronic kidney disease and estimates of kidney function in HIV infection: a cross-sectional study in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr 2011; 57:380.
  31. Cailhol J, Nkurunziza B, Izzedine H, et al. Prevalence of chronic kidney disease among people living with HIV/AIDS in Burundi: a cross-sectional study. BMC Nephrol 2011; 12:40.
  32. Peters L, Grint D, Lundgren JD, et al. Hepatitis C virus viremia increases the incidence of chronic kidney disease in HIV-infected patients. AIDS 2012; 26:1917.
  33. Mocroft A, Neuhaus J, Peters L, et al. Hepatitis B and C co-infection are independent predictors of progressive kidney disease in HIV-positive, antiretroviral-treated adults. PLoS One 2012; 7:e40245.
  34. Lucas GM, Jing Y, Sulkowski M, et al. Hepatitis C viremia and the risk of chronic kidney disease in HIV-infected individuals. J Infect Dis 2013; 208:1240.
  35. Kalayjian RC, Lau B, Mechekano RN, et al. Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care. AIDS 2012; 26:1907.
  36. Mocroft A, Kirk O, Reiss P, et al. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AIDS 2010; 24:1667.
  37. Scherzer R, Estrella M, Li Y, et al. Association of tenofovir exposure with kidney disease risk in HIV infection. AIDS 2012; 26:867.
  38. Ryom L, Mocroft A, Kirk O, et al. Association between antiretroviral exposure and renal impairment among HIV-positive persons with normal baseline renal function: the D:A:D study. J Infect Dis 2013; 207:1359.
  39. Gerntholtz TE, Goetsch SJ, Katz I. HIV-related nephropathy: a South African perspective. Kidney Int 2006; 69:1885.
  40. Katz A, Bargman JM, Miller DC, et al. IgA nephritis in HIV-positive patients: a new HIV-associated nephropathy? Clin Nephrol 1992; 38:61.
  41. Foy MC, Estrella MM, Lucas GM, et al. Comparison of risk factors and outcomes in HIV immune complex kidney disease and HIV-associated nephropathy. Clin J Am Soc Nephrol 2013; 8:1524.
  42. Szczech LA, Gupta SK, Habash R, et al. The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection. Kidney Int 2004; 66:1145.
  43. Cheng JT, Anderson HL Jr, Markowitz GS, et al. Hepatitis C virus-associated glomerular disease in patients with human immunodeficiency virus coinfection. J Am Soc Nephrol 1999; 10:1566.
  44. Gupta SK, Eustace JA, Winston JA, et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2005; 40:1559.
  45. Inker LA, Wyatt C, Creamer R, et al. Performance of creatinine and cystatin C GFR estimating equations in an HIV-positive population on antiretrovirals. J Acquir Immune Defic Syndr 2012; 61:302.
  46. Vrouenraets SM, Fux CA, Wit FW, et al. A comparison of measured and estimated glomerular filtration rate in successfully treated HIV-patients with preserved renal function. Clin Nephrol 2012; 77:311.
  47. Piédrola G, Casado JL, López E, et al. Clinical features of adrenal insufficiency in patients with acquired immunodeficiency syndrome. Clin Endocrinol (Oxf) 1996; 45:97.
  48. Shah GM, Alvarado P, Kirschenbaum MA. Symptomatic hypocalcemia and hypomagnesemia with renal magnesium wasting associated with pentamidine therapy in a patient with AIDS. Am J Med 1990; 89:380.
  49. Gradon JD, Fricchione L, Sepkowitz D. Severe hypomagnesemia associated with pentamidine therapy. Rev Infect Dis 1991; 13:511.