Acute Kidney Injury in HIV-Infected Patients

A Critical Review

J Gameiro; J Agapito Fonseca; S Jorge; JA Lopes

Disclosures

HIV Medicine. 2019;20(2):77-87. 

In This Article

Abstract and Introduction

Abstract

Acute kidney injury (AKI) is characterized by a rapid decline of renal function associated with worse outcomes. The purpose of the authors is to perform a critical review of the incidence, risk factors, pathogenesis and outcome of AKI in HIV-infected patients. Human immunodeficiency virus (HIV)-infected patients have an increased risk of developing AKI, to which contribute both HIV-dependent and HIV-independent factors as well as the nephrotoxicity of drugs used. The increased risk of AKI in HIV-infected patients and its negative impact on prognosis highlights the need for identification of patients at risk, creation of prevention strategies and management.

HIV-infected patients have an increased risk of developing AKI, to which both HIV-dependent and HIV-independent factors contribute, as well as the nephrotoxicity of drugs used.

The increased risk of AKI in HIV-infected patients and its negative impact on prognosis highlight the need for identification of patients at risk, creation of prevention strategies and management.

Introduction

Acute kidney injury (AKI) is characterized by a rapid decline of renal function of multiple aetiologies.[1] The negative impact of AKI on short- and long-term patient outcomes has been demonstrated in various studies reporting its association with increased health care costs, increased lengths of hospital stay, increased risk for developing chronic kidney disease (CKD), increased risk for cardiovascular events and increased mortality.[1–4] This highlights the importance of comprehending the epidemiology and aetiologies of AKI to improve the identification of patients at risk.

HIV-infected patients have an increased risk of developing AKI.[5–9] In HIV-infected patients, kidney disease has become an important cause of mortality.[8,10] The development of combination antiretroviral therapy (cART) has prolonged patient survival and modified the spectrum of renal diseases in HIV-infected patients, with a decrease in the prevalence of glomerular diseases and an increase in the prevalences of nephrotoxicity and comorbidities.[10–13]

Both HIV-dependent and HIV-independent factors as well as nephrotoxic drugs contribute to the increased risk of AKI and must be considered when managing HIV-infected patients.

Our purpose was to perform a critical review of the incidence, risk factors, pathogenesis and outcome of AKI in HIV-infected patients.

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