Chapter 52 - Human Immunodeficiency Virus Infection and Chronic Kidney Disease

https://doi.org/10.1016/B978-0-12-815876-0.00052-8Get rights and content

Abstract

The prevalence of chronic kidney disease (CKD) in human immunodeficiency virus (HIV)-infected patients has increased over the past two decades. Renal biopsy series show a variety of lesions associated with CKD in this patient population, including HIV-associated nephropathy (HIVAN), HIV-associated immune complex renal disease (HIVICD), thrombotic microangiopathy (TMA), tubulointerstitial renal diseases including some related to combination antiretroviral therapy (cART), diabetic nephropathy, arterionephrosclerosis, and diseases related to coinfection with hepatitis B and C virus. Screening for renal disease is recommended in all patients with newly diagnosed HIV infection. Approximately 10–15% of all HIV-infected patients have microalbuminuria. Estimating equations for glomerular filtration rate (GFR) have not been widely validated in patients with HIV infection. Serum creatinine concentration-based GFR estimating equations including the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease may have limited utility in patients with HIV infection who have decreased muscle mass, but equations are being evaluated in this population. Therapy for CKD in the setting of HIV infection focuses on reducing viral replication, and control of traditional risk factors for CKD progression, including hypertension, hyperglycemia, and hyperlipidemia. Use of cART may slow CKD progression, especially in patients with renal disease manifesting as classic HIVAN. Renin-angiotensin-aldosterone system inhibitors should be employed in all patients with proteinuria and CKD unless a contradiction exits, such as hyperkalemia. APOL1 genetic variants contribute to HIV nephropathy, but at this time do not influence choice of therapy. Future studies should focus on optimal screening tools to facilitate early detection of CKD in this patient population.

References (0)

View full text