摘要
目的在国内首次报道人类免疫缺陷病毒（HIV）感染合并肾脏病2例。方法总结分析2例HIV感染合并肾脏病患者的临床和病理资料。结果例号1为69岁男性，临床表现为大量蛋白尿（肾病综合征），肾功能不全（Scr 142μmol／L），血清HIV-1抗体阳性。肾活检光镜下可见轻度局灶节段性肾小球硬化（FSGS），肾小管空泡变性，肾间质淋巴细胞浸润。免疫荧光全部阴性。电镜下足突基本融合，轻度节段硬化，足细胞未见明显肿胀、增生，肾小管轻度空泡变性，肾间质中可见吞噬细胞。诊断为HIV感染合并肾病综合征。由于诊断初期CD4大于200/μl，未行高效抗逆转录病毒治疗（HAART），只给予小剂量激素加免疫抑制剂治疗。经1年随访，CD4明显下降伴反复感染，遂停用激素和免疫抑制剂，开始HAART治疗。例号2为38岁男性，血友病甲（Ⅷ因子缺乏）患者，因输血同时感染HIV及HCV，临床以大量蛋白尿伴持续镜下血尿，难以控制的高血压和进展迅速的肾功能损害为主要表现。临床拟诊肾小球病变为主，考虑HIV感染合并肾脏损害。但由于该患者双肾已缩小，且合并血友病，无法行肾活检。HAART治疗3年后已进展至终末期肾功能衰竭，接受维持性腹膜透析治疗。结论应提高HIV感染合并肾损害的认识，必要时行肾活检对确诊病变类型及决定治疗方案有指导意义。
Objective To report 2 cases of HIV infection complicated with kidney disease for the first time in China. Methods The clinical manifestation of 2 HIV-seropositive male patients and pathological findings by renal biopsy were collected. Results The HIV-1 seropositive male patient was 69 years old. He was diagnosed as nephrotic syndrome （NS） complicated with renal insufficiency. Renal biopsy revealed characteristic focal segmental glomerular sclerosis （FSGS）, non-collapsing, tubulointerstitial prominent lymphocytic infiltration. These characteristics were partially compatible with human immunodeficiency virus-associated nephropathy （HIVAN）. According to NS and normal range of CD4, he was recommended with steroid and immunosuppressive therapy while absent of highly active anti-retroviral therapy （HAART）. During one-year followed up, he had experienced several episodes of severe infection without remission of NS. After immunosuppressive therapy withdrawal and counterchecked low level of CD4, he received HAART for HIV treatment. The other patient was a hemophile-infected AIDS complicated with chronic hepatitis C, haemophilia A（lack of factor vm）, and diabetes mellitus（DM）. Proteinuria and chronic renal failure occurred after 1 year of HAART. During the therapy period, the renal function was impaired progressively and irreversibly entered into ESRD at the 3rd year of HAART. Conclusions The clinical and pathological manifestation of HIV infection complicated with kidney disease shonld be known in China. For HIV-infected kidney impaired patients suspected of HIVAN or other pathological pattern, it is important to establish the diagnosis and treatment by renal biopsy.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2008年第1期8-12,共5页
Chinese Journal of Nephrology
