Human Immunodeficiency Virus Infection and Chronic Kidney Disease
Chronic Renal Disease
Epidemiology; HIV-associated immune complex kidney disease (HIVICK); HIV-associated nephropathy (HIVAN)
© 2015 Elsevier Inc. All rights reserved. The prevalence of CKD in human immunodeficiency virus (HIV)-infected patients has increased over the past two decades. Renal biopsy series show a variety of histologies associated with CKD in this patient population including HIV-associated nephropathy (HIVAN), HIV-associated immune complex renal disease (HIVICK), thrombotic microangiopathy (TMA), tubulointerstitial renal diseases including some related to combination antiretroviral therapy (cART), diabetic nephropathy, hypertensive nephrosclerosis, and diseases related to co-infection with hepatitis B and C virus. Screening for kidney disease is recommended in all patients with newly diagnosed HIV infection. Approximately 10-15% of HIV patients have microalbuminuria. Estimating equations for glomerular filtration rate (GFR) have not been widely validated in patients with HIV infection. Creatinine-based GFR estimating equations including the CKD-EPI and MDRD may have limited utility in patients with HIV infection who have decreased muscle mass. 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 help to slow CKD progression especially in patients with renal disease secondary to classic HIVAN. RAAS inhibitors should be employed in all patients with proteinuria and CKD unless a contradiction, such as hyperkalemia, exists. Future studies should focus on optimal screening tools to facilitate early detection of CKD in this at-risk patient population.
Cohen, S., Kopp, J., Cathro, H., & Kimmel, P. (2015). Human Immunodeficiency Virus Infection and Chronic Kidney Disease. Chronic Renal Disease, (). http://dx.doi.org/10.1016/B978-0-12-411602-3.00044-5