南非一家大型城市公立医院肾小球疾病的模式——HIV感染的影响

Lazarus Yvette, Davies Malcolm, Nana Mitan, Paget Graham
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摘要

肾小球疾病是导致肾功能衰竭的重要原因。我们试图描述2001-2010年期间在南非一家大型城市公立医院接受原生肾活检的患者肾小球疾病的模式。方法回顾性回顾研究期间进行的所有本地肾活检。我们进一步描述和比较肾小球病理之间的临床、实验室和人口统计学数据。结果大多数接受活检的患者是年轻人(中位年龄34岁)和非洲黑人后裔(83%)。蛋白尿是活检最常见的指征。继发性肾小球疾病比原发性肾小球疾病更常见。hiv相关肾小球疾病是最常见的继发性肾小球疾病,局灶节段性肾小球硬化(FSGS)是最常见的原发性肾小球疾病。微小改变肾病(MCN)在年轻患者中更为常见,膜性肾病(MN)在老年患者中更为常见。FSGS和膜增生性肾小球疾病患者肾功能较差。结论HIV是继发性肾小球疾病高发的重要因素。原发性肾小球病变在南非表现出地理差异,FSGS在约翰内斯堡占主导地位。尽管临床参数可能提示潜在的肾小球病变,但准确诊断以促进指导治疗并防止进展为肾衰竭需要肾活检。
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Patterns of Glomerular Disease at a Large Urban Public Hospital in South Africa- Impact of HIV Infection
Abstract Introduction Glomerular disease is an important cause of renal failure. We sought to describe the patterns of glomerular disease in patients undergoing native kidney biopsy at a large urban public hospital in South Africa during the period 2001–2010. Methods We retrospectively reviewed all native kidney biopsies undertaken during the study period. We further characterised and compared clinical, laboratory and demographic data between glomerular pathologies. Results The majority of patients undergoing biopsy were young (median age 34 years) and of Black African descent (83%). Proteinuria was the most common indication for biopsy. Secondary glomerular disease was more common than primary glomerular disease. HIV-associated glomerular diseases were the most common secondary glomerulopathies Focal segmental glomerulosclerosis (FSGS) was the most frequent primary glomerulopathy. Minimal change nephropathy (MCN) was more frequent in younger patients and membranous nephropathy (MN) more common in older patients. Renal function was poorer in FSGS and membranoproliferative glomerular disease. Conclusions HIV is an important contributor to the high rates of secondary glomerular disease. Primary glomerulopathy demonstrates geographic variation in South Africa with FSGS being dominant in Johannesburg. Although clinical parameters may suggest underlying glomerulopathy, an accurate diagnosis to facilitate directed treatment and prevent progression to renal failure requires a renal biopsy.
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