人类免疫缺陷病毒感染合并肾脏疾病患者的肾脏病理和临床特征

Renal Pathology and clinical features of patients with human immunodeficiency virus infection complicated with kidney diseases

目的分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染合并肾脏疾病患者的病理类型、临床特点和治疗转归。方法回顾性分析2016年6月至2019年11月在上海复旦大学附属公共卫生临床中心行肾穿刺活组织检查的21例HIV感染合并肾脏疾病患者的临床特征、肾脏病理类型、治疗和转归。结果21例患者中,男19例,女2例,年龄为(45.4±11.0)岁。CD4+T淋巴细胞计数为(473.7±218.4)/μL。20例患者检测病毒载量,其中13例(65.0%)HIV RNA<40拷贝/mL。肾穿刺前18例(85.7%)患者已启动抗反转录病毒治疗,治疗时间为12(1,47)个月。临床表现为肾病综合征14例(66.7%),肾炎综合征7例(33.3%)。肾脏病理提示HIV相关免疫复合物性肾病为最常见病理类型,占42.9%(9/21),其次为足细胞病和糖尿病肾病,各占23.8%(5/21)。HIV相关免疫复合物性肾病以IgA肾病多见(23.8%,5/21),而足细胞病以微小病变型肾病最常见(19.0%,4/21)。未见经典HIV相关性肾病。随访时间为(12.5±9.2)个月,9例病情好转,8例稳定,2例恶化,2例死亡。结论HIV感染合并肾脏疾病病理类型以IgA肾病、微小病变型肾病和糖尿病肾病常见,大部分治疗后预后良好。对于HIV感染合并显著肾脏损伤者,应积极行肾脏活组织检查明确病理类型,以指导临床治疗和判断预后。

Objective To analyze the pathological patterns,clinical features,and prognosis in patients with human immunodeficiency virus(HIV)infection complicated with kidney disease.Methods A retrospective analysis of 21 renal damage cases in HIV-infected patients undergoing renal biopsy from June 2016 to November 2019 in Shanghai Public Health Clinical Center,Fudan University was conducted.The clinical features,renal pathological patterns,therapies and outcomes were summarized and analyzed.Results The age of 21 patients was(45.4±11.0)years.There were 19 men and two women.The CD4+T lymphocyte count was(473.7±218.4)cells/μL.The HIV RNA levels were measured in 20 patients,and 13 cases(65.0%)were less than 40 copies/mL.A total of 18 cases(85.7%)had initiated antiretroviral therapy before renal biopsy,and the treatment time was 12(1,47)months.As for the clinical diagnosis,14 cases(66.7%)were nephrotic syndrome and seven cases(33.3%)were nephritic syndrome.Renal pathology reports showed that HIV immune-complex kidney disease was the most common pathology pattern,accounting for 42.9%(9/21),followed by podocytopathy and diabetic nephropathy,both accounting for 23.8%(5/21),respectively.The IgA nephropathy(23.8%,5/21)was the most common subtype of HIV immune-complex kidney disease,while minimal change disease(19.0%,4/21)was the most common one of podocytopathy.However,classic HIV-associated nephropathy was not found in the study.The follow-up period was(12.5±9.2)months.During this period,the nephropathy conditions of nine patients were improved,eight were stable,two deteriorated,and two died.Conclusions IgA nephropathy,minimal change disease and diabetic nephropathy are the top three patterns of renal pathology in patients with HIV infection.Most cases have good prognosis after treatments.For HIV-infected patients with serious renal damage,timely kidney biopsy is vital to determine pathological pattern,and to subsequently guide the clinical treatment and evaluate the prognosis.