目的: 分析人类免疫缺陷病毒(HIV)感染合并肾脏疾病患者的肾脏病理类型、临床特征及预后。方法: 回顾性分析2016年1月至2023年1月在南京市第二医院感染性疾病科行肾穿刺组织检查的HIV感染合并肾脏疾病患者的临床资料。结果: 25例患者纳入本研究,平均年龄(45.0±12.1)岁,男23例(92%),4例(16%)合并糖尿病,5例(20%)合并高血压,4例(16%)合并乙肝,3例(12%)合并丙肝。肾穿刺病理5例(20%)为HIV相关肾损伤(HIVAN),9例(36%)为IgA肾病,7例(28%)为HIV相关免疫复合物肾病(HIVICK),2例(8%)为间质性肾炎,缺血性肾病、糖尿病肾病各1例(4%)。15例患者在抗逆转录病毒治疗(ART)前即出现肾脏损伤,其中5例表现为HIVAN,4例表现为IgA肾病,3例膜性肾病,2例免疫复合物沉积性肾病,1例肾小管间质损伤。接受ART后出现肾脏损伤患者中,5例为IgA肾病,膜增生性肾小球肾炎、缺血性肾病、免疫复合物沉积性肾病、间质性肾炎、糖尿病肾病各1例。20例(80%)患者肾活检时存在肾小球滤过率下降。平均随访36.5个月,末次随访时,14例患者获得肾脏缓解,其中9例获得完全缓解。与基线相比,末次随访尿蛋白显著下降,肾小球滤过率显著升高。3例(12%)患者进展为终末期肾病,无患者死亡。结论: HIV感染患者在ART前出现肾脏损伤病理改变以HIVAN、HIVICK为主,而ART后以IgA肾病为主。积极行ART及免疫抑制剂治疗能显著改善蛋白尿及肾功能。HIV合并肾脏损伤,就诊时肾功能受损较重,迫切需要早期发现、及时治疗。

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