HIV-associated immune complex glomerulonephritis with "lupus-like" features: A clinicopathologic study of 14 cases
HIV-associated immune complex glomerulonephritis with "lupus-like" features: A clinicopathologic study of 14 cases
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DOI：
10.1111/j.1523-1755.2005.00215.x
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发表时间：
2005-04-01
影响因子：
19.6
通讯作者：
Eustace, JA
中科院分区：
文献类型：
--
作者：
Haas, M;Kaul, S;Eustace, JA
背景。虽然与人类免疫缺陷病毒 (HIV) 感染相关的最常见肾小球病变是塌陷性局灶节段性肾小球硬化症 (FSGS) [HIV 相关肾病 (HIVAN)]，但免疫复合物介导的肾小球肾炎的报道也越来越多。 HIV感染人群中描述的一种肾小球肾炎是具有“狼疮样”特征的免疫复合物肾小球肾炎，其组织学、免疫组织学和超微结构特征类似于狼疮性肾炎，但发生在没有系统性红斑狼疮（SLE）证据的患者中。有关这种形式的肾小球肾炎患者临床结果的数据非常有限。方法。我们回顾了 1999 年 1 月至 2003 年 12 月在我们中心处理的所有 HIV 阳性患者的天然肾活检标本的病理报告。在 77 份标本中，14 份符合以下狼疮样肾小球肾炎标准：（1）免疫荧光显微镜检查显示 IgG、IgA、IgM、C3 和 C1q 颗粒状肾小球染色，C1q 染色≥1+（0 至 4+ 等级）； (2) 患者血清抗核抗体 (ANA) 呈阴性，或弱阳性（效价 3.0 mg/dL。除 1 名外，其余均为非裔美国人。组织学上，7 名活检显示弥漫性增生性肾小球肾炎，6 名局灶性增生性肾小球肾炎和 1 名膜性肾病。除 2 名活检外，所有活检均显示中度或重度慢性变化，3 名同时显示 HIVAN。14 名患者中有 10 名出现了 HIVAN活检后 1 年内出现终末期肾病 (ESRD)，这 10 名患者中有 9 名出现蛋白尿 > 5.0 g/24 小时和肾病综合征，而未发生 ESRD 的 4 名患者中有 3 名出现蛋白尿。
Background. While the most common glomerular lesion associated with human immunodeficiency virus (HIV) infection is collapsing focal segmental glomerulosclerosis (FSGS) [HIV-associated nephropathy (HIVAN)], immune complex-mediated forms of glomerulonephritis have been increasingly reported. One form of glomerulonephritis that has been described in the HIV-infected population is immune complex glomerulonephritis with "lupus-like" features, characterized by histologic, immunohistologic, and ultrastructural features resembling lupus nephritis, but occurring in patients without evidence of systemic lupus erythematosus (SLE). Data regarding clinical outcomes in patients with this form of glomerulonephritis are very limited.Methods. We reviewed pathology reports for all native renal biopsy specimens from HIV-positive patients processed at our center from January 1999 through December 2003. Of 77 total specimens, 14 met the following criteria for lupus-like glomerulonephritis: (1) immunofluorescence microscopy showed granular glomerular staining for IgG, IgA, IgM, C3 and C1q, with >= 1+ (0 to 4+ scale) staining for C1q; and (2) the patient's serum was negative for antinuclear antibodies (ANA), or weakly positive (titer 3.0 mg/dL. All but one were African American. Histologically, seven biopsies showed diffuse proliferative glomerulonephritis, six focal proliferative glomerulonephritis, and one membranous nephropathy. All but two biopsies showed moderate or severe chronic change, and three showed concurrent HIVAN. Ten of the 14 patients developed end-stage renal disease (ESRD) within 1 year of the biopsy. Nine of these ten patients presented with proteinuria > 5.0 g/24 hours and nephrotic syndrome, while three of four patients who did not develop ESRD had proteinuria