인간면역결핍 바이러스 관련 신장병증

인간면역결핍 바이러스 관련 신장병증
진료과신장내과

인간면역결핍 바이러스 관련 신장병증 (HIVAN, HIV-associated nephropathy)은 후천면역결핍증후군을 유발하는 인간면역결핍 바이러스 감염에 수반하여 진행하는 콩팥병이다. 주로 국소분절성토리굳음증(FSGS, focal segmental glomerulosclerosis)으로 진행하나, 다른 양상의 콩팥병으로 진행할 수도 있다.[1] 기저의 조직학적 특성과 상관없이, HIV 양성 환자의 콩팥병은 사망 위험 증가와 연관된다.[2]

병리

네프론(nephron)의 모든 구성요소에서 비정상적인 조직학이 관찰된다. 국소분절성토리굳음증으로 빠르게 진행하며, 발세포(podocyte)의 증식과 과형성으로 인해 사구체가 붕괴된다.[3] 고활성 항바이러스 요법(highly active anti-retroviral therapy, 이하 HAART 요법) 등장 이전까지는 만성신부전으로의 진행이 빠르고 예후가 불량했으나, 치료법 등장 이후로 예후가 극적으로 개선되었다.[4]

치료

현재 HAART 요법으로 HIV 감염을 조절함과 함께, 스테로이드제나 ACEI를 이용해 HIVAN의 진행을 막고 신장 기능을 개선한다. 스테로이드제는 HIVAN 환자의 신장 기능에 유익한 효과를 나타내는 것으로 밝혀졌다.[5] 또한, ACE 억제제는 신장 보호 효과를 나타내어 신장의 생존을 연장하였다.[6]

각주

  1. ↑ Kimmel PL, Barisoni L, Kopp JB (August 2003). “Pathogenesis and treatment of HIV-associated renal diseases: lessons from clinical and animal studies, molecular pathologic correlations, and genetic investigations”. 《Annals of Internal Medicine》 139 (3): 214–26. doi:10.7326/0003-4819-139-3-200308050-00019. PMID 12899589. 
  2. ↑ Szczech LA, Hoover DR, Feldman JG, 외. (October 2004). “Association between renal disease and outcomes among HIV-infected women receiving or not receiving antiretroviral therapy”. 《Clinical Infectious Diseases》 39 (8): 1199–206. doi:10.1086/424013. PMID 15486845. 
  3. ↑ Christina M. Wyatt, Paul E. Klotman, and Vivette D. D’Agati (2009 Nov 1.). “HIV-Associated Nephropathy: Clinical Presentation, Pathology, and Epidemiology in the Era of Antiretroviral Therapy”. 《Seminars in Nephrology》. 
  4. ↑ R. K. Wali, C. I. Drachenberg, J. C. Papadimitriou, S. Keay, and E. Ramos (1998 Sep 5). “HIV-1-associated nephropathy and response to highly-active antiretroviral therapy”. 《Lancet》. 
  5. ↑ J. A. Eustace, E. Nuermberger, M. Choi, P. J. Scheel Jr., R. Moore, W. A. Briggs. “Cohort study of the treatment of severe HIV-associated nephropathy with corticosteroids”. 《Kidney International》. 
  6. ↑ Alice Wei, Godfrey C Burns, Brent A Williams, Nazim B Mohammed, Paul Visintainer, Steven L Sivak (2003 Oct). “Long-term renal survival in HIV-associated nephropathy with angiotensin-converting enzyme inhibition”. 《Kidney International》. 

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