HIV感染伴膜性肾病一例并文献复习-东南大学学报医学版

HIV感染伴膜性肾病一例并文献复习

单位：南京中医药大学附属南京医院(南京市第二医院) 感染性疾病科, 江苏南京 210000

分类号：R512.91; R692

出版年·卷·期（页码）：2023·42·第六期（921-925）

摘要：

目的:报道人类免疫缺陷病毒(HIV)感染合并膜性肾病使用他克莫司治疗的效果。方法:回顾分析南京市第二医院感染性疾病科收治的1例HIV感染合并膜性肾病患者的临床、病理资料,并复习相关文献资料。结果:25岁男性,HIV合并隐球菌感染起病,两性霉素B抗感染,富马酸替诺福韦等抗病毒治疗后出现2次血肌酐升高,停药后改善。8个月后出现蛋白尿,肾活检诊断膜性肾病。他克莫司治疗后出现手抖、急性肾损伤等不良反应,他克莫司减量至0.5 mg·2周^-1,蛋白尿下降,肾功能稳定。结论:他克莫司治疗HIV相关膜性肾病有效,但须注意药物相关作用及他克莫司血药浓度监测。病程中抗逆转录病毒及抗感染药物的肾毒性临床中须高度重视。

Objective: To report the curative effect of tacrolimus treatment on human immunodeficiency virus(HIV) infection with membranous nephropathy. Methods: Clinical, pathological, and follow-up data of a patient with HIV infection with membranous nephropathy was reviewed, and the relevant literatures were reviewed. Results: A 25-year-old male diagnosed as HIV infection was complicated with cryptococcal infection, then he received amphotericin B anti cryptococcal, tenofovir anti-viral treatment. Serum creatinine increased twice and decreased following the discontinuation of amphotericin B and tenofovir. Eight months later proteinuria was revealed and the patient underwent renal biopsy. Membranous nephropathy was diagnosed, considering HIV-related. Tacrolimus was then administered. However, limb jitter and acute kidney injury was occurred. Tacrolimus was reduced to 0.5 mg·2 week^-1 after the closely monitoring drug blood concentration. Proteinuria decreased and renal function remained stable. Conclusion: Tacrolimus is effective in treating HIV associated membranous nephropathy, but side effects should be noticed and monitoring of tacrolimus blood concentration is needed. The nephrotoxicity of antiretroviral and anti-infective drugs should be highly cautious.

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