How is renal disease treated in HIV infection?

Updated: Sep 07, 2018
  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

This can occur either as a primary or as a secondary disease. Some known risk factors include CD4 count less than 200 cells/µL; HIV viremia, particularly RNA levels greater than 4,000 copies/mL; African-American race; family history of kidney disease; and use of nephrotoxins.

Screening studies at initial HIV documentation should include urine analysis and serum creatinine. If abnormal values are detected, these should be evaluated further. Of note, selective drugs can cause acute or chronic kidney injury. These include tenofovir (can cause acute tubular necrosis, Fanconi syndrome), indinavir (acute interstitial nephritis [AIN] and crystalluria), atazanavir (AIN and nephrolithiasis), and abacavir (AIN). Special consideration regarding dosing of their ARVs should be given to patients who have chronic kidney disease or are undergoing hemodialysis.


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