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The spectrum of kidney biopsy findings in HIV-infected patients in the modern era.
Kidney International ( IF 19.6 ) Pub Date : 2020-02-04 , DOI: 10.1016/j.kint.2020.01.018
Satoru Kudose 1 , Dominick Santoriello 1 , Andrew S Bomback 2 , M Barry Stokes 1 , Ibrahim Batal 1 , Glen S Markowitz 1 , Christina M Wyatt 3 , Vivette D D'Agati 1
Affiliation  

HIV-associated kidney disease is evolving rapidly. Few North American studies have addressed modern trends and none has applied the 2018 Kidney Disease Improving Global Outcomes (KDIGO) pathologic classification. Therefore we performed a retrospective clinical-pathologic analysis of all HIV-positive patients with kidney biopsy interpreted at Columbia University from 2010-2018 using the KDIGO classification. The biopsy cohort of 437 HIV-positive patients had median age 53 years, including 66% males, 80% on anti-retroviral therapy, 57% with hypertension, 31% with diabetes, 27% with hepatitis C and 6% with hepatitis B co-infections. Race, known in 308 patients, included 58% black, 25% white and 17% Hispanic. Pathologic diagnoses were surprisingly diverse. Immune complex glomerulonephritis (ICGN) and diabetic nephropathy each outnumbered HIV-associated nephropathy, followed by tenofovir nephrotoxicity, FSGS- not otherwise specified (NOS) and global sclerosis (NOS). HIV-associated nephropathy was the most common disease in patients not on anti-retroviral therapy, and 94% were black. The association of FSGS (NOS) with black race (68%) and anti-retroviral therapy use (77%) suggests some cases may represent attenuated HIV-associated nephropathy. The most common ICGNs were IgA nephropathy and membranous glomerulopathy, both associating with anti-retroviral therapy (over 90%), followed by hepatitis C-associated proliferative ICGN. Among the 16 cases of uncharacterized ICGN lacking identifiable etiology, 69% were not on anti-retroviral therapy, possibly representing true HIV-associated immune complex kidney disease. Dual diseases occurred in 17% of patients, underscoring lesion complexity. Thus, anti-retroviral therapy has shifted the landscape of HIV-associated kidney disease toward diverse ICGN, diabetic nephropathy, and non-collapsing glomerulosclerosis, but has not eradicated HIV-associated nephropathy.

中文翻译:

在现代时代,HIV感染患者的肾脏活检发现范围很广。

与艾滋病毒相关的肾脏疾病正在迅速发展。北美的研究很少涉及现代趋势,也没有一项研究应用2018年肾脏疾病改善全球结局(KDIGO)病理分类。因此,我们使用KDIGO分类法对2010-2018年在哥伦比亚大学解释的所有HIV阳性肾活检患者进行了回顾性临床病理分析。437名HIV阳性患者的活检队列中位年龄为53岁,其中男性66%,抗逆转录病毒疗法80%,高血压57%,糖尿病31%,丙型肝炎27%,乙型肝炎6% -感染。308名患者中已知种族,其中58%的黑人,25%的白人和17%的西班牙裔。病理诊断令人惊讶地多样。免疫性复杂性肾小球肾炎(ICGN)和糖尿病性肾病的数量均超过了与HIV相关的肾病,其次是替诺福韦肾毒性,未另作说明的FSGS(NOS)和总体硬化(NOS)。在不接受抗逆转录病毒治疗的患者中,与艾滋病毒相关的肾病是最常见的疾病,其中94%是黑人。FSGS(NOS)与黑人种族(68%)和抗逆转录病毒疗法的使用(77%)的关联表明某些病例可能代表了与HIV相关的肾病减毒。最常见的ICGN是IgA肾病和膜性肾小球病,均与抗逆转录病毒疗法相关(超过90%),其次是丙型肝炎相关增生性ICGN。在16例缺乏特征性病因的特征性ICGN患者中,有69%未接受抗逆转录病毒治疗,可能代表了真正的HIV相关免疫复合物肾脏疾病。17%的患者发生了双重疾病,突出了病变的复杂性。因此,抗逆转录病毒疗法已使与艾滋病毒相关的肾脏疾病的领域转向了多种ICGN,糖尿病性肾病和非塌陷性肾小球硬化,但并未根除与艾滋病毒相关的肾病。
更新日期:2020-02-04
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