II. Epidemiology

  1. HIV Nephropathy is associated with increased mortality in HIV

III. Risk Factors

  1. Black race
  2. Older age
  3. Advanced Immunosuppression
    1. CD4 Count <200 cells/mm3
    2. HIV Viral Loads high
  4. Hepatitis C Virus coninfection
  5. Injection drug use

IV. Signs

  1. Proteinuria
  2. Nephrotic Syndrome
  3. Azotemia (Rapidly progressive, irreversible)

V. Course

  1. End Stage Renal Disease develops in 4-16 weeks

VI. Differential Diagnosis:

  1. Heroin-associated nephropathy
    1. HIV Nephropathy lacks:
      1. Severe Hypertension
      2. Peripheral Edema
      3. Anasarca

VII. Diagnosis

  1. Renal Ultrasound
    1. Kidneys are usually enlarged in HIV Nephropathy
  2. Renal Biopsy confirms diagnosis

VIII. Management

IX. Prevention

  1. Screen for renal disease at time of HIV diagnosis and then every 6 months (more frequently if high risk)
  2. Avoid Nephrotoxic Drugs
    1. See Renal Manifestations of HIV
    2. See Nephrotoxic Drugs

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