PATOGENIA, TRATAMIENTO Y PREVENCION DE LA NEFROPATIA INFANTIL ASOCIADA AL VIH

La infección por VIH-1, al igual que factores genéticos y ambientales, parecen desempeñar un papel importante en la patogenia de la nefropatía infantil asociada al VIH. La TARGA está considerada un tratamiento promisorio para evitar su progresión.

Autor:
Pingato Tang
Columnista Experto de SIIC
Artículos publicados por Pingato Tang

Coautor
Patricio E Ray*
George Washington University School of Medicine and Health Sciences, Washington D.C., EE.UU.*

Recepción del artículo
30 de Enero, 2007

Aprobación
1 de Marzo, 2007

Primera edición
26 de Junio, 2007

Segunda edición, ampliada y corregida
7 de Junio, 2021

PATOGENIA, TRATAMIENTO Y PREVENCION DE LA NEFROPATIA INFANTIL ASOCIADA AL VIH

Resumen
Los afroamericanos infectados por el virus de la innmunodeficiencia humana (VIH-1) corren riesgo de presentar un síndrome renal denominado nefropatía asociada al VIH. Esta nefropatía se caracteriza por la presencia de proteinuria importante y por la rápida progresión hasta la enfermedad renal terminal. Estudios renales de necropsia y biopsia mostraron riñones grandes y edematosos con una combinación de glomeruloesclerosis focal y segmentaria, y lesiones tubulointersticiales con dilatación tubular microquística. Este artículo examinará los conceptos relevantes relacionados con la patogenia de la nefropatía infantil asociada al VIH. La infección por VIH-1 parece desempeñar un papel clave en la patogenia de la nefropatía asociada al VIH, al menos parcialmente, al afectar el crecimiento y la diferenciación de las células epiteliales renales y al aumentar el reclutamiento de las células inflamatorias y los factores de crecimiento circulantes que fijan la heparina. Sin embargo, hasta la fecha no se conoce totalmente el papel exacto que desempeña el VIH-1 en la patogenia de la nefropatía asociada al VIH. Varios factores genéticos y ambientales, además del VIH-1, parecen desempeñar un papel clave en este proceso. Se necesita más investigación para dilucidar la contribución clave de cada uno de estos factores. La terapia antirretroviral de gran actividad (TARGA) parece ser la alternativa más promisoria para prevenir la progresión de la nefropatía infantil asociada al VIH. Es de esperar que mejores programas de prevención y tratamiento conduzcan a la erradicación de esta enfermedad renal en los niños.

Palabras clave
nefropatía por VIH, niños, FGF-2, proteoglucanos heparansulfatos, infección por VIH 1

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Pathogenesis of Childhood HIV Associated Nephropathy

Abstract
African Americans infected with the human immunodeficiency virus (HIV-1) are at risk of developing a renal syndrome named HIV-associated nephropathy (HIVAN). HIVAN is characterized by the presence of heavy proteinuria and rapid progression to end stage renal disease. Renal autopsy and biopsy studies showed large edematous kidneys with a combination of focal segmental glomerulosclerosis (FSGS) and tubulointerstitial lesions with microcystic tubular dilatation. This article will discuss relevant concepts related to the pathogenesis of childhood HIVAN. HIV-1 infection appears to play a key role in the pathogenesis of HIVAN, at least partially by affecting the growth and differentiation of renal epithelial cells, and by enhancing the renal recruitment of inflammatory cells and circulating heparin binding growth factors. However, to date, the exact role that HIV-1 plays in the pathogenesis of HIVAN is not completely understood. Several genetic and environmental factors, in addition to HIV-1, seem to play a key role in this process. More research is needed to elucidate the relative contribution of each of these factors. Highly active anti-retroviral therapy (HAART) appears to be the most promising treatment to prevent the progression of childhood HIVAN. Hopefully, better prevention and treatment programs will lead to the eradication of this renal disease in children.

Key words
HIV-nephropathy, children, FGF-2, heparan sulfate proteoglycans, HIV-1 infection

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Especialidades
Principal: Infectología, Pediatría
Relacionadas: Medicina Interna, Nefrología y Medio Interno

Enviar correspondencia a:
Patricio E Ray, Children's Research Institute, Children's National Medical Center , 111 Michigan Av, Room 5111,, Washington D.C., EE.UU.

Patrocinio y reconocimiento:
Este estudio fue financiado por los subsidios de los National Institutes of Health R0-1 DK-49419 y RO-1 HL 55605 y la Fundación Argentina para el Desarrollo Infantil, Buenos Aires, Argentina.

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