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Том 23 №1 - Приложение 2021 год - Нефрология и диализ

Гломерулярные болезни почек при ВИЧ-инфекции: Современные представления об этиологии, классификации, патогенезе


Волгина Г.В. Томилина Н.А. Гаджикулиева М.М. Фролова Н.Ф.

DOI: 10.28996/2618-9801-2021-1suppl-42-61

Аннотация: В эпоху комбинированной антиретровирусной терапии (кAРT) ВИЧ-инфекция стала управляемым хроническим заболеванием, а не острой патологией, которая может быстро прогрессировать в синдром приобретенного иммунодефицита (СПИД). Одновременно с широким применением кАРТ распространенность заболеваний почек у людей, инфицированных вирусом иммунодефицита человека (ВИЧ-1), возросла и, как ожидается, будет расти и дальше в результате старения населения и повышения выживаемости пациентов. Несмотря на успехи в борьбе с ВИЧ-инфекцией, заболевание почек является одной из причин заболеваемости и смертности у людей, инфицированных ВИЧ. Спектр заболеваний почек, описанных в настоящее время у ВИЧ-позитивных пациентов, включает ВИЧ-ассоциированную нефропатию (ВИЧ-АН), иммунокомплексные заболевания почек в условиях ВИЧ (ВИЧ-ИКГН), тромботическую микроангиопатию и различные заболевания, связанные с нарушениями иммунной системы и суперинфекциями. ВИЧ-ассоциированная нефропатия является одной из наиболее важных причин терминальной стадии почечной недостаточности (ТПН) в этой группе населения. Такие факторы, как афроамериканское происхождение, полиморфизм APOL1, сопутствующие заболевания, высокая вирусная нагрузка, низкий уровень CD4, прогрессирующее заболевание почек и протеинурия нефротического уровня, являются факторами риска развития ВИЧ-АН и ее прогрессирования до ТПН. ВИЧ-АН характеризуется гистопатологически коллапсирующей гломерулопатией с гипертрофией и пролиферацией подоцитов, тубулоретикулярными включениями в эндотелиальных клетках, канальцевыми микрокистами и тубулоинтерстициальным инфильтратом, состоящим в основном из CD8+ T-лимфоцитов. Иммуннокомплексные гломерулярные заболевания, описанные у пациентов в условиях ВИЧ-инфекции, представляют собой группу гломерулонефритов, которые включают IgA нефропатию, волчаночно-подобный нефрит с отрицательной серологией и отсутствием других клинических проявлений волчанки, мембранозную нефропатию и мембранопролиферативный гломерулонефрит. В обзоре описаны современные тенденции развития, патофизиология, классификация и клиническая картина ВИЧ-АН и ВИЧ-ИКГН, представлен анализ литературы по заболеваниям почек, развивающихся в условиях ВИЧ-инфекции.

Для цитирования: Волгина Г.В., Томилина Н.А., Гаджикулиева М.М., Фролова Н.Ф. Гломерулярные болезни почек при ВИЧ-инфекции: Современные представления об этиологии, классификации, патогенезе. Нефрология и диализ. 2021. 23(1):42-61. doi: 10.28996/2618-9801-2021-1suppl-42-61

Весь текст



Ключевые слова: вирус иммунодефицита человека, ВИЧ-инфекция, ВИЧ-ассоциированная нефропатия, иммунокомплексный гломерулонефрит, Human immunodeficiency virus (HIV), HIV-infection, HIV-associated nephropathy, immune complex glomerulonephritis

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