The spectrum of renal histologies seen in HIV with outcomes, prognostic indicators and clinical correlations
The spectrum of renal histologies seen in HIV with outcomes, prognostic indicators and clinical correlations
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DOI：
10.1093/ndt/gfr702
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发表时间：
2012-11-01
影响因子：
6.1
通讯作者：
Rayner, Brian L.
中科院分区：
文献类型：
--
作者：
Wearne, Nicola;Swanepoel, Charles R.;Rayner, Brian L.
[...] HIVAN可能成为“APOL-1相关肾脏疾病”谱的一部分，其影响不同的全身和内在肾细胞类型。[...].我们分析了Groote Schuur医院221例HIV阳性的肾活检标本，根据组织学和临床特征确定结果和预后指标，并将组织学结果与患者人口统计学、临床和肾脏参数、死亡率、CD 4计数和开始联合抗逆转录病毒治疗（cART）的日期进行比较。随访1 ~ 3.5年，我们发现HIV阳性患者的肾脏组织学类型多样，其中HIV相关性肾病（HIVAN）是最常见的组织学类型。cART将具有任何HIVAN特征的患者的死亡率降低了57 [校正风险比（AHR）0.43，95置信区间（CI）0.220.85]。在死亡的艾滋病毒/艾滋病患者中，79人死于死亡证明上登记的肾衰竭。蛋白尿和微囊肿显示为不良预后指标（AHR 1.36：1.091.70和2.04：1.243.37）。在接受cART治疗长达2年的单纯HIVAN患者中，估计的肾小球滤过率保持稳定，并且有蛋白尿减少的趋势。cART改善了孤立性免疫复合物疾病患者的生存率。由于具有任何HIVAN或孤立性免疫复合物疾病特征的患者的死亡率有所改善，因此一旦确定了任何这些组织学特征，就应该开始cART。我们认为，构成艾滋病毒/艾滋病的疾病谱需要更具体地界定。最终结果可能由组织学亚型决定。
[...] HIVAN may become part of a spectrum of "APOL-1 associated renal diseases" that affect different systemic and intrinsic renal cell types. [...].Two hundred and twenty-one HIV-positive renal biopsies were analysed from Groote Schuur Hospital to determine outcomes and prognostic indicators based on histology and clinical features.The histology findings were compared with patient demographics, clinical and renal parameters, mortality, CD4 count and date of commencing combined anti-retroviral therapy (cART). Follow-up was between 1 and 3.5 years.We found a spectrum of renal histologies in HIV-positive patients of which HIV-associated nephropathy (HIVAN) was the most common histology. cART reduced the mortality in those with any feature of HIVAN by 57 [adjusted hazard ratio (AHR) 0.43, 95 confidence interval (CI) 0.220.85]. Of those patients with HIVAN who died, 79 died of renal failure as registered on their death certificate. Proteinuria and microcysts were shown to be poor prognostic indicators (AHR 1.36: 1.091.70 and 2.04: 1.243.37). In patients with HIVAN alone followed for up to 2 years on cART, estimated glomerular filtration rate remained stable and there was a trend towards decreased proteinuria. cART improved survival in patients with isolated immune complex disease.As mortality is improved in patients with any feature of HIVAN or isolated immune complex disease, cART should be initiated once any of these histological features are established. We believe the spectrum of disease that constitutes HIVAN needs to be more specifically defined. The ultimate outcome may be determined by the histological subtype.