Analysis on the clinicopathological characteristics and follow-up of 32 patients with human immunodeficiency virus infection and chronic kidney diseases

Abstract

Abstract:

Objective:To analyze the pathological types, clinical characteristics and outcomes of human immunodeficiency virus (HIV)-infected patients with chronic kidney diseases (CKD).Methods:Thirty-two cases of HIV infection combined with CKD who underwent ultrasound guided renal biopsy in Shanghai Public Health Clinical Center from June 2016 to April 2021 were enrolled. Pathological types, clinical conditions and outcomes were all analyzed.Results:Among the 32 patients, there were 28 male and 4 female, with an average age of (43.5±12.3) years. The CD4⁺T lymphocyte count was (425.9±240.4) cells/μL. Twenty-six patients (81.3%) had been treated with antiretroviral therapy before renal puncture biopsy, and the median treatment time was 24 (1, 72) months. Among the pathological types, membranous nephropathy (8 cases, 25.0%) and IgA nephropathy (6 cases, 18.8%) accounted for the most types, followed by diabetic nephropathy (5 cases, 15.6%). No classical HIV-related nephropathy was found. During the follow-up period of 3 months to 5 years, the remission rate of renal disease reached 84.4% (13 complete remissions, 14 partial remissions), and the unresponsive rate was 9.4% (3 cases, including 1 case of lupus like immune complex mediated proliferative glomerulonephritis, 1 case of diabetes nephropathy, and 1 case of hypertensive nephropathy). The mortality rate was 6.3%(2 cases, all minor lesions).Conclusions:This study shows that the pathological types of HIV infected patients with CKD are various. Membranous nephropathy is predominant pathological type, and followed by IgA nephropathy and diabetes nephropathy, but classical HIV related nephropathy is not common. According to the pathological results of renal biopsy, renal disease related treatment based on antiretroviral therapy can alleviate renal disease or delay the progression of renal disease, but the prognosis of patients with minimal change nephropathy may be poor.

Key words:Human immunodeficiency virus,Nephropathy,Kidney biopsy,Anti-retroviral therapy

CLC Number:

R692.6

SHI Xia, MA Xin, WANG Zhenyan, ZHANG Hui, LIU Shaojun. Analysis on the clinicopathological characteristics and follow-up of 32 patients with human immunodeficiency virus infection and chronic kidney diseases[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(04): 437-443.

Figures/Tables5

HIV感染合并肾病	病理分型	完全缓解	部分缓解	未缓解	死亡	总计	占比（%）
原发性肾小球疾病（免疫复合物介导）	膜性肾病	5	3			8	25.0
	IgA肾病	2	4			6	18.8
	增生性肾小球肾炎伴单克隆免疫球蛋白沉积	1				1	3.1
	狼疮样免疫复合物介导的增生性肾小球肾炎			1		1	3.1
	系膜增生性肾小球肾炎	1				1	3.1
	膜增生性肾小球肾炎	1				1	3.1
原发性肾小球疾病（足细胞病）	微小病变		1		2	3	9.4
	局灶节段性肾小球硬化症		1			1	3.1
	HIV相关性肾病					0	0.0
继发性肾小球疾病	糖尿病肾病	1	3	1		5	15.6
	高血压性肾病			1		1	3.1
	紫癜性肾炎	1				1	3.1
间质性肾炎	亚急性间质性肾炎		1			1	3.1
	慢性活动性小管间质性肾炎		1			1	3.1
肾穿刺组织不足	轻微病变	1				1	3.1
	总计	13	14	3	2	32

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