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Chronic Kidney Disease in HIV-Infected Patients

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Key Points Î The risk of chronic kidney disease (CKD) is increased in individuals infected with human immunodeficiency virus (HIV) compared with the general population. Î In African Americans, HIV infection imparts a risk for end-stage renal disease (ESRD) that is of similar magnitude to that of diabetes. Î A constellation of potential factors contributes to excess kidney disease in HIV-infected patients, including direct effects by HIV infection, HIV-associated immune activation, drug toxicity, coinfection with hepatitis C virus, and a high prevalence of traditional kidney disease risk factors. Diagnosis Monitoring Î IDSA recommends monitoring creatinine-based estimated glomerular filtration rate (GFR) when antiretroviral therapy (ART) is initiated or changed, and at least twice yearly in stable HIV-infected patients using the same estimation method to track trends over time. More frequent monitoring may be appropriate for patients with additional kidney disease risk factors (S-L). Î IDSA suggests monitoring kidney damage with urinalysis or a quantitative measure of albuminuria/proteinuria at baseline, when ART is initiated or changed, and at least annually in stable HIV-infected patients. More frequent monitoring may be appropriate for patients with additional kidney disease risk factors (W-L). Evaluation Î IDSA recommends that the evaluation of new-onset or newly discovered kidney disease in HIV-infected persons include serum chemistry panel; complete urinalysis; quantitation of albuminuria (albumin-to-creatinine ratio (ACR) from spot sample or total albumin from 24-hour collection); assessment of temporal trends in estimated GFR, blood pressure, and blood glucose control (in patients with diabetes); markers of proximal tubular dysfunction ( particularly if treated with tenofovir); a renal sonogram; and review of prescription and over-the-counter medications for agents that may cause kidney injury or require dose modification for decreased kidney function (S-L).

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