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).
