The performance of HIV infection - Urinary system

Renal dysfunction, renal structural damage are very common complication of HIV infection, about 5 ~ 10% of HIV patients suffering from a pathological unique kidney disease, known as HIV nephropathy. Such rapid progress is usually in need of kidney dialysis to sustain life by the end of the period of renal disease. Many HIV-related kidney abnormalities, including HIV nephropathy, can occur in any stage of HIV disease, one from the early asymptomatic infection to advanced AIDS, including kidney failure and electrolyte disorders more common in people with AIDS in the. HIV nephropathy HIV can also be an early or only performance in some cases even before the birth of anti-HIT7 antibodies, HIV nephropathy can also be born in serology-positive mothers of infants, one of the important clinical manifestations.


1.HIV-associated nephropathy (HIV AN) HIV's addicted organization is based on the complex, not just because the surface of susceptible cells with CD4 receptors, HIV replication in cells in general have a toxicity. In the kidney, the renal tubular cells, glomerular epithelial cells were seriously damaged, resulting in filtering protein "leakage" producing nephrotic syndrome. Heavy proteinuria is a prelude to HIV nephropathy. Urea, hyperlipidemia, proteinuria, or both occurred in 90% of simultaneous HIV-infected patients, the majority of patients (89%), urinary protein of more than 1 g per day or more. http://www.tcmwell.com

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Focal segmental glomerulosclerosis (FSGS) is the HIV AN patients show a typical kidney disease, HIV disease after renal damage occurs the rapid progress of the discovery of more than 16 weeks after renal injury deaths increased renal pathology can be seen , the cortical surface is smooth. Early kidney damage under a microscope showed diffuse glomerular membrane increased, with minimal glomerular sclerosis. The number of occurrence ranging from segmental glomerular sclerosis, which is characterized by a thick cytoplasm containing vacuoles of epithelial cell proliferation, capillary wall collapse, or because of protein deposition (hyaline degeneration) and to the capillaries disappear, cavity foam cells (lipid filled with mononuclear cells). Glomerular cysts are usually expanded, tubular damage is extensive.

Clinical manifestations of HIV nephropathy summarized as follows: severe proteinuria, azotemia, water, electrolyte disorder, gross hematuria, normal blood pressure, kidney, normal or increased, rapid-progressive renal insufficiency. HIV nephropathy with normal blood pressure to become a distinctive feature, the reason difficult to explain. Urine sediment examination often showed severe proteinuria, oval body fat and fat urine. A large number of mega-wax-like tube is HIV nephropathy is characterized by. The increase may be due to kidney:
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① rapid progress of the disease, there is not enough time for all of glomerular sclerosis are, fibrosis;

② different from other chronic renal failure, HIV nephropathy showed significant glomerular expansion and numerous micro-like vesicles; ③ interstitial edema, a sharp reduction in serum albumin, with moderate proteinuria (<10mg / day) not a the ratio may be related to malnutrition or liver function abnormalities produce albumin. HIV nephropathy When it happens, will rapidly deteriorate into end-stage renal disease progress in different research reports on time is not uniform, but mostly 6 to 12 months, an average of 9 months.

2. Water, electrolyte and acid-base balance disorders in patients with advanced AIDS, water and electrolyte disorders are common. HIV infection in patients with hyponatremia are the most common dielectric disorder inpatients hyponatremia were up 36% a 56%. In these patients, fluid loss from the gastrointestinal tract caused by low blood volume is the most common causes of hyponatremia. Adrenal insufficiency is caused by another reason for hyponatremia. While the autopsy report is often adrenal pathological changes, but clinically less than 5% of patients showed significant adrenal dysfunction. Hyponatremia, hyperkalemia, non-anion gap metabolic acidosis, low blood volume, renal salt loss, as well as the performance of mild renal insufficiency often mixed there.
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HIV infected persons in the course of treatment, drugs is another cause of water and electrolyte disorders an important reason, and adrenal insufficiency can cause similar abnormalities. Has been found to accept the administration of parenteral pentamidine in patients with hyperkalemia may occur and non-anion gap metabolic acidosis. Amphotericin B and high hypernatremia, hypokalemia, hypomagnesemia, renal tubular acidosis and renal insufficiency related to. With AIDS-related cancer chemotherapy drugs, it can directly through the renal toxicity or persistent vomiting, diarrhea caused by gastrointestinal fluid loss caused by water and electrolyte disturbance.

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3. Acute renal failure with acute renal failure occurred in 20% ~ 40% of AIDS, this is one of the complications of HIV infection. May be secondary to inadequate fluid intake or excessive fluid loss of the gastrointestinal tract caused by prerenal azotemia. Hypertension, sepsis or application of drug-induced nephrotoxicity renal ischemia can lead to renal tubular necrosis. Acute interstitial nephritis is HIV-related illness caused by drug therapy is another complication.

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Opportunistic infections, lymphoma, or Kaposi's sarcoma of the kidney substance abuse and abuse of narcotic induced subcutaneous amyloidosis may also lead to interstitial nephritis. Other kidney diseases, such as hepatitis B induced membranous glomerulonephritis, secondary bacterial infection of acute glomerulonephritis, from CMV, fungi, Mycobacterium direct result of renal parenchymal infection and hemolytic uremic a comprehensive Zheng, are related to HIV infection related to renal insufficiency. http://www.tcmwell.com

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