Veränderungen im Spektrum der Nierenerkrankungen bei HIV-Infektion

 

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Zusammenfassung

Hintergrund und Fragestellung: Chronische Nierenerkrankungen sind eine zunehmend häufige und relevante Komplikation bei HIV-Infizierten. Das Spektrum der zugrunde liegenden Ursachen ist vielfältig und umfasst sowohl HIV-assoziierte als auch HIV-unabhängige Ursachen. Ziel der Studie war, den Einfluss der antiretroviralen Therapie (ART) auf das Spektrum der Nierenerkrankungen bei HIV-Infektion zu untersuchen.

Patienten und Methodik: Retrospektive Analyse aller Patienten der Frankfurter HIV-Kohorte (FHC), bei denen zwischen 1989 und 2012 aufgrund unklarer progressiver Niereninsuffizienz eine Nierenpunktion durchgeführt wurde. Es wurden 2 Perioden definiert, um Veränderungen über die Zeit zu beschreiben (frühe Periode: 1989–2000, späte Periode: 2001–2012).

Ergebnisse: Insgesamt wurde bei 69 Patienten (meist männliche Kaukasier) eine Nierenpunktion durchgeführt. Im Gesamtzeitraum waren Immunkomplex-vermittelte Glomerulonephritiden (26,1 %), hypertensive (20,3 %) und diabetische Nephropathie (20,3 %) die häufigsten Ursachen für eine chronische Niereninsuffizienz. Während HIV-assoziierte Nierenerkrankungen die frühe Periode dominierten, waren hypertensive und diabetische Nephropathie für etwa 50 % aller Fälle von Niereninsuffizienz nach dem Jahr 2000 verantwortlich. Weitere häufige Nierenerkrankungen in der späten Periode waren renale AA-Amyloidosen und Tenofovir(TDF)-bedingte Nierenschäden.

Folgerung: Das Spektrum der Nierenerkrankungen bei HIV-Infizierten ist sehr breit und hat sich in den letzten zwei Jahrzehnten gewandelt. Seit Einführung der ART sind die häufigsten Nierenerkrankungen bei HIV-Infizierten, wie hypertensive Nephropathie, nicht direkt durch das HI-Virus bedingt. Dies spiegelt die wachsende Bedeutung von traditionellen Risikofaktoren, wie Diabetes und Hypertonie, auch in dieser alternden Population wider.

Abstract

Background and objective: Renal disease is a common complication in HIV-infected patients. The causes and spectrum of kidney disease among these patients is extensive, including HIV-related and HIV unrelated causes. Our objective was to assess the changes in distribution of renal disease under antiretroviral therapy (ART).

Patients and methods: Retrospective analysis of all patients from the Frankfurt HIV Cohort (FHC) who underwent renal biopsy because of chronic, progressive renal disease between 1989 and 2012. Two time periods were defined: 1989–2001 (early period) and 2000–2012 (late period).

Results: 69 HIV-infected patients, mostly Caucasian and male, underwent renal biopsy (early period: 22 patients, late period: 47 patients). During the total observation time immuncomplex-mediated glomerulonephritis (26.1 %), hypertensive (20.3 %) and diabetic nephropathy (20.3 %) were the most frequent causes of chronic renal disease. HIV-associated renal diseases were predominant in the first period, whereas hypertensive and diabetic kidney disease accounted for almost 50 % of cases diagnosed in the late period. Other types of renal disease frequently encountered during the late period include renal AA-amyloidosis and tenofovir-related kidney disease.

Conclusion: The underlying pathology of renal disease in HIV-infected patients is highly variable and evolving. Since the introduction of HAART, renal disease not directly related to HIV has become the predominant cause, reflecting the growing burden of co-morbidities in this aging population.

• Literatur

• 1 Berliner AR, Fine DM, Lucas GM et al. Observations on a cohort of HIV-infected patients undergoing native renal biopsy. Am J Nephrol 2008; 28: 478-486
  CrossrefPubMedGoogle Scholar
• 2 Bickel M, Marben W, Betz C et al. End-stage renal disease and dialysis in HIV-positive patients: observations from a long-term cohort study with a follow-up of 22 years. HIV Med 2013; 14: 127-135
  CrossrefPubMedGoogle Scholar
• 3 Brown TT, Cole SR, Li X et al. Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the multicenter AIDS cohort study. Arch Intern Med 2005; 165: 1179-1184
  CrossrefPubMedGoogle Scholar
• 4 Casanova S, Mazzucco G, Barbiano di Belgiojoso G et al. Pattern of glomerular involvement in human immunodeficiency virus-infected patients: an Italian study. Am J Kidney Dis 1995; 26: 446-453
  CrossrefPubMedGoogle Scholar
• 5 Fernandez-Fernandez B, Montoya-Ferrer A, Sanz AB et al. Tenofovir nephrotoxicity: 2011 update. AIDS Res Treat 2011; 2011: 354908
  PubMedGoogle Scholar
• 6 Fine DM, Garg N, Haas M et al. Cocaine use and hypertensive renal changes in HIV-infected individuals. Clin J Am Soc Nephrol 2007; 2: 1125-1130
  CrossrefPubMedGoogle Scholar
• 7 George E, Lucas GM, Nadkarni GN et al. Kidney function and the risk of cardiovascular events in HIV-1-infected patients. AIDS 2010; 24: 387-394
  CrossrefPubMedGoogle Scholar
• 8 George E, Nadkarni GN, Estrella MM et al. The impact of hepatitis C coinfection on kidney disease related to human immunodeficiency virus (HIV): a biopsy study. Medicine (Baltimore) 2011; 90: 289-295
  PubMedGoogle Scholar
• 9 Gerntholtz TE, Goetsch SJ, Katz I. HIV-related nephropathy: a South African perspective. Kidney Int 2006; 69: 1885-1891
  CrossrefPubMedGoogle Scholar
• 10 Gupta SK, Mamlin BW, Johnson CS et al. Prevalence of proteinuria and the development of chronic kidney disease in HIV-infected patients. Clin Nephrol 2004; 61: 16
  PubMedGoogle Scholar
• 11 Gupta SK, Eustace JA, Winston JA et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2005; 40: 1559-1585
  CrossrefPubMedGoogle Scholar
• 12 Haas M, Kaul S, Eustace JA. HIV-associated immune complex glomerulonephritis with "lupus-like" features: a clinicopathologic study of 14 cases. Kidney Int 2005; 67: 1381-1390
  CrossrefPubMedGoogle Scholar
• 13 Herlitz LC, Mohan S, Stokes MB et al. Tenofovir nephrotoxicity: acute tubular necrosis with distinctive clinical, pathological, and mitochondrial abnormalities. Kidney Int 2010; 78: 1171-1177
  CrossrefPubMedGoogle Scholar
• 14 Izzedine H, Sene D, Cacoub P et al. Kidney diseases in HIV/HCV-co-infected patients. AIDS 2009; 23: 1219-1226
  CrossrefPubMedGoogle Scholar
• 15 Jung O, Haack HS, Buettner M et al. Renal AA-amyloidosis in intravenous drug users – a role for HIV-infection?. BMC Nephrol 2012; 13: 151
  CrossrefPubMedGoogle Scholar
• 16 Lescure FX, Flateau C, Pacanowski J et al. HIV-associated kidney glomerular diseases: changes with time and HAART. Nephrol Dial Transplant 2012; 27: 2349-2355
  CrossrefPubMedGoogle Scholar
• 17 Lucas GM, Eustace JA, Sozio S et al. Highly active antiretroviral therapy and the incidence of HIV-1associated nephropathy: a 12-year cohort study. AIDS 2004; 18: 541-546
  CrossrefPubMedGoogle Scholar
• 18 Mocroft A, Kirk O, Reiss P et al. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AIDS 2010; 24: 1667-1678
  CrossrefPubMedGoogle Scholar
• 19 Nebuloni M, Barbiano di Belgiojoso G, Genderini A et al. Glomerular lesions in HIV-positive patients: a 20-year biopsy experience from Northern Italy. Clin Nephrol 2009; 72: 38-45
  PubMedGoogle Scholar
• 20 Nochy D, Glotz D, Dosquet P et al. 63 Renal disease associated with HIV infection: a multicentric study of 60 patients from Paris hospitals. Nephrol Dial Transplant 1993; 8: 11-19
  PubMedGoogle Scholar
• 21 Onen NF, Overton ET, Seyfried W et al. Aging and HIV infection: a comparison between older HIV-infected persons and the general population. HIV Clin Trials 2010; 11: 100-109
  CrossrefPubMedGoogle Scholar
• 22 Rachakonda AK, Kimmel PL. CKD in HIV-infected patients other than HIV-associated nephropathy. Adv Chronic Kidney Dis 2010; 17: 83-93
  CrossrefPubMedGoogle Scholar
• 23 Robert Koch Institut (RKI). Aktuelle Daten und Informationen zu Infektionskrankheiten und public health. Epidem Bull 2011; 46: 415-428
  PubMedGoogle Scholar
• 24 Schwartz EJ, Szczech LA, Ross MJ et al. Highly active antiretroviral therapy and the epidemic of HIV+ end-stage renal disease. J Am Soc Nephrol 2005; 16: 2412-2420
  CrossrefPubMedGoogle Scholar
• 25 Szczech LA, Gupta SK, Habash R et al. The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection. Kidney Int 2004; 66: 1145-1152
  CrossrefPubMedGoogle Scholar
• 26 Weiner NJ, Goodman JW, Kimmel PL. The HIV-associated renal diseases: Current insight into pathogenesis and treatment. Kidney Int 2003; 63: 1618-1631
  CrossrefPubMedGoogle Scholar
• 27 Wyatt CM, Malvestutto C, Coca SG et al. The impact of hepatitis C virus coinfection on HIV-related kidney disease: a systematic review and meta-analysis. AIDS 2008; 22: 1799-1807
  CrossrefPubMedGoogle Scholar
• 28 Zaidan M, Lescure FX, Brochériou I et al. Tubulointerstitial Nephropathies in HIV-Infected Patients over the Past 15 Years: A Clinico-Pathological Study of 59 Patients. Clin J Am Soc Nephrol 2013; 8: 930-938
  CrossrefPubMedGoogle Scholar