Kidney disease in children and adolescents with perinatal HIV-1 infection.
Kidney disease in children and adolescents with perinatal HIV-1 infection.
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DOI：
10.7448/ias.16.1.18596
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发表时间：
2013-06-18
影响因子：
6
通讯作者：
Kala, Udai
中科院分区：
文献类型：
--
作者：
Bhimma, Rajendra;Purswani, Murli Udharam;Kala, Udai
简介：围产期(HIV-1)感染的儿童和青少年的肾脏受累可发生在儿童一生中的任何阶段，各种诊断，从急性肾损伤、儿童尿路感染(UTIs)、电解质失衡和药物所致的肾毒性，到肾小球疾病。后者包括各种免疫介导的慢性肾脏疾病(CKD)和HIV相关肾病(HIVAN)。讨论：高效抗逆转录病毒疗法(HAART)的引入极大地降低了HIVAN的发生率，HIVAN曾是感染HIV的非洲裔儿童最常见的CKD形式，并将其预后从最终进展为终末期肾脏疾病改变为与长期生存相适应的预后。HAART对该人群中看到的其他形式的肾脏疾病的结果的影响并不是那么令人印象深刻。越来越重要的是，由于长期使用抗逆转录病毒药物而产生的继发性肾毒性，以及与艾滋病毒感染或其治疗无关的共病肾病的发生。随着艾滋病毒专家和肾病学家协调这些患者的临床护理，对与艾滋病毒相关的肾脏疾病的分子发病机制和遗传学的了解将导致更好的筛查、预防和治疗努力。血液透析(HD)和腹膜透析(PD)在HIV感染的终末期肾病患者中都是有效的肾脏替代疗法，其中PD在资源有限的情况下更受欢迎。肾移植曾经是这一人群的禁忌，但只要符合严格的标准，现在已经成为最有效的肾脏替代疗法。鉴于HIV感染的儿童和青少年肾脏疾病的发病率和死亡率，建议在资源允许的情况下进行肾脏疾病的常规筛查。结论：本综述重点介绍围产期HIV-1感染的儿童和青少年肾脏疾病的发病机制和遗传学、临床表现和处理。
INTRODUCTION: Involvement of the kidney in children and adolescents with perinatal (HIV-1) infection can occur at any stage during the child's life with diverse diagnoses, ranging from acute kidney injury, childhood urinary tract infections (UTIs), electrolyte imbalances and drug-induced nephrotoxicity, to diseases of the glomerulus. The latter include various immune-mediated chronic kidney diseases (CKD) and HIV-associated nephropathy (HIVAN).DISCUSSION: The introduction of highly active anti-retroviral therapy (HAART) has dramatically reduced the incidence of HIVAN, once the commonest form of CKD in children of African descent living with HIV, and also altered its prognosis from eventual progression to end-stage kidney disease to one that is compatible with long-term survival. The impact of HAART on the outcome of other forms of kidney diseases seen in this population has not been as impressive. Increasingly important is nephrotoxicity secondary to the prolonged use of anti-retroviral agents, and the occurrence of co-morbid kidney disease unrelated to HIV infection or its treatment. Improved understanding of the molecular pathogenesis and genetics of kidney diseases associated with HIV will result in better screening, prevention and treatment efforts, as HIV specialists and nephrologists coordinate clinical care of these patients. Both haemodialysis (HD) and peritoneal dialysis (PD) are effective as renal replacement therapy in HIV-infected patients with end-stage kidney disease, with PD being preferred in resource-limited settings. Kidney transplantation, once contraindicated in this population, has now become the most effective renal replacement therapy, provided rigorous criteria are met. Given the attendant morbidity and mortality in HIV-infected children and adolescents with kidney disease, routine screening for kidney disease is recommended where resources permit.CONCLUSIONS: This review focuses on the pathogenesis and genetics, clinical presentation and management of kidney disease in children and adolescents with perinatal HIV-1 infection.