Renal Manifestations of HIV

Aka: Renal Manifestations of HIV, HIV Related Renal Complications, HIV-Relared Kidney Disease, Kidney Disease Associated with AIDS, Chronic Kidney Disease in HIV

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II. Causes: Chronic Kidney Disease

  1. See Prevention of Kidney Disease Progression
  2. Chronic Kidney Disease (CKD) is common in HIV patients
    1. Most common cause of Kidney disease in HIV
    2. Contrast with Classic HIV Nephropathy (far less common with modern Antiretroviral therapy)
  3. Risk Factors
    1. See Chronic Kidney Disease
    2. Hepatitis BVirus coinfection
    3. Hepatitis CVirus coinfection
    4. Diabetes Mellitus
    5. Hypertension
  4. Manage Chronic Kidney Disease via the same guidelines as for non-HIV patients
    1. See Prevention of Kidney Disease Progression
    2. Screen Renal Function yearly
    3. Avoid Nephrotoxic Drugs (including those more specific for HIV, as below)

III. Causes: Glomerular Disease

  1. See Glomerulonephritis
  2. See Glomerulonephritis Causes
  3. HIV Nephropathy (AIDS associated Nephropathy, HIVAN)
  4. HIV Associated Immune Complex Kidney Disease (HIVICK)
  5. Membranoproliferative Glomerulonephritis
  6. Membranous Nephropathy
  7. Thrombotic Microangiopathy

IV. Causes: Renal Tubular Disease

  1. Acute Kidney Injury
  2. Fanconi's Syndrome (Proximal Tubule Injury)
  3. Diabetes Insipidus
  4. Crystal Nephropathy

V. Causes: Medications

  1. Drugs that increase Serum Creatinine without decreasing glomerular function
    1. Bictegravir
    2. Cobicistat
  2. Drug induced Renal toxicity
    1. See Nephrotoxic Drug
    2. Amphotericin B
    3. Foscarnet
    4. Pentamidine
    5. Trimethoprim Sulfamethoxazole
    6. NSAIDs
    7. Atazanavir
    8. Tenofovir disoproxil Fumarate (TDF)
      1. Causes proximal tubule dysfunction (e.g. Hypophosphatemia) and decreased Renal Function
      2. Avoid if GFR <60 ml/min and discontinue if GFR falls more than 25% or <60 ml/min
      3. May safely use Tenofovir Alafenamide as alternative (less nephrotoxic)

VI. Causes: Other HIV Related Renal Disorders

  1. Interstitial Nephritis
  2. Fluid and Electrolyte abnormalities
    1. SIADH and Hyponatremia common due to occult infection

VII. Prevention

  1. See Prevention of Kidney Disease Progression

VIII. References

  1. Baloor (2018) Exam Preparatory Manual for Undergraduates Medicine, Jaypee Brothers, India, p. 240
  2. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]
  3. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]

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