Human Immunodeficiency Virus Book

Nephropathy

  • HIV Nephropathy

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HIV Nephropathy

Aka: HIV Nephropathy, AIDS associated Nephropathy
  1. See Also
    1. Nephropathy
    2. Renal Manifestations of HIV
    3. HIV Complications
  2. Epidemiology
    1. HIV Nephropathy is associated with increased mortality in HIV
  3. Risk Factors
    1. Black race
    2. Older age
    3. Advanced Immunosuppression
      1. CD4 Count <200 cells/mm3
      2. HIV Viral Loads high
    4. Hepatitis CVirus coninfection
    5. Injection drug use
  4. Signs
    1. Proteinuria
    2. Nephrotic Syndrome
    3. Azotemia (Rapidly progressive, irreversible)
  5. Course
    1. End Stage Renal Disease develops in 4-16 weeks
  6. Differential Diagnosis:
    1. Heroin-associated nephropathy
      1. HIV Nephropathy lacks:
        1. Severe Hypertension
        2. Peripheral Edema
        3. Anasarca
  7. Diagnosis
    1. Renal Ultrasound
      1. Kidneys are usually enlarged in HIV Nephropathy
    2. Renal Biopsy confirms diagnosis
  8. Management
    1. No known treatment
    2. Antiretroviral therapy for HIV
    3. ACE Inhibitor or Angiotensin Receptor Blocker
      1. See ACE Inhibitors and ARBs in Diabetic Nephropathy
      2. Indicated for persistent Proteinuria
  9. 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
  10. References
    1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]

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