论文部分内容阅读
人类免疫缺陷病毒相关性肾病(HIVAN)主要表现为蛋白尿和进行性肾衰竭,是HIV感染的常见并发症。从组织学上来看,肾脏通常表现为塌陷性、局灶性、节段性肾小球硬化,并且伴有中度增大,CD4细胞计数较少的HIV长期感染者多发,急性HIV感染者偶见。研究对象不同,该疾病的发生率也不一样,如在临床检出有蛋白尿的患者中,为3.5%,而尸检中为12%。该疾病在非裔及西班牙裔中发病率高。据调查,824例HIVAN患者中,94%的为非裔。糖皮质激素、ACEI和高效抗逆转录病毒治疗(HARRT)均能改善其预后。在使用HAART之前,该病预后不佳,2年存活率为36%。有报道称HAART能改善肾功能,但是尚未有前瞻性研究对其证实,而且肌酐水平好转所需要的时间无记载。本例所述为1例经肾组织活检确诊为HIVAN的患者在接受HAART治疗后其终末期肾衰竭快速逆转的案例。
Human immunodeficiency virus associated nephropathy (HIVAN) is mainly manifested as proteinuria and progressive renal failure, and is a common complication of HIV infection. Histologically, the kidneys usually show collapsed, focal, segmental glomerulosclerosis and are associated with moderate increases in CD4 counts and few HIV long-term infections, and those with acute HIV infection see. Different subjects, the incidence of the disease is not the same, as clinically detected in patients with proteinuria was 3.5%, while autopsy was 12%. The disease has a high prevalence among Afro-Hispanics. According to the survey, 94% of 824 HIVAN patients are of African descent. Glucocorticoids, ACEI, and high-potency antiretroviral therapy (HARRT) all improved their prognosis. The disease had a poor prognosis before using HAART with a 2-year survival of 36%. It has been reported that HAART can improve renal function, but no prospective study has confirmed it, and the time required for the improvement of creatinine level is not documented. This case describes the rapid reversal of end-stage renal failure in 1 patient diagnosed with HIVAN by renal biopsy after receiving HAART.