目的：分析人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染合并慢性肾病患者的病理类型、临床特征及转归,以指导临床治疗。方法：收集上海市公共卫生临床中心2016年6月至2021年4月收治的HIV感染合并肾病并行超声引导下肾穿刺活检的病例32例,分析慢性肾病病理类型、临床情况以及转归。结果：32例患者中,男28例,女4例,平均年龄为（43.5±12.3）岁,CD4⁺T淋巴细胞计数为（425.9±240.4）个/μL,肾刺穿活检前26例（81.3%）已采用抗逆转录病毒治疗,治疗中位时间为24（1,72）个月。病理类型中,膜性肾病（8例,25.0%）和IgA肾病（6例,18.8%）占比居前;其次为糖尿病性肾病（5例,15.6%）,未见经典HIV相关性肾病。随访3个月~5年,肾病缓解率达84.4%（完全缓解13例,部分缓解14例）,未缓解率为9.4%（3例,包括1例狼疮样免疫复合物介导的增生性肾小球肾炎,1例糖尿病肾病,1例高血压肾病）,病死率6.3%（2例,均为微小病变）。结论：HIV感染合并肾病患者的病理类型多样,主要病理类型为膜性肾病、IgA肾病、糖尿病性肾病,而经典HIV相关性肾病并不常见。根据肾活检病理结果,在抗逆转录病毒治疗基础上给予肾病相关治疗,能够较好地缓解肾病或延缓肾病进展,但微小病变型肾病患者可能预后欠佳。

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.