Drugs

, Volume 68, Issue 7, pp 963–980 | Cite as

Renal Disease in Patients with HIV Infection

Epidemiology, Pathogenesis and Management
  • Derek M. Fine
  • Mark A. Perazella
  • Gregory M. Lucas
  • Mohamed G. Atta
Review Article

Abstract

With the introduction of highly active antiretroviral therapy, we have witnessed prolonged survival with the potential for normal life expectancy in HIV-infected individuals. With improved survival and increasing age, HIV-infected patients are increasingly likely to experience co-morbidities that affect the general population, including kidney disease. Although HIV-associated nephropathy, the most ominous kidney disease related to the direct effects of HIV, may be prevented and treated with antiretrovirals, kidney disease remains an important issue in this population. In addition to the common risk factors for kidney disease of diabetes mellitus and hypertension, HIV-infected individuals have a high prevalence of other risk factors, including hepatitis C, cigarette smoking and injection drug use. Furthermore, they have exposures unique to this population, including antiretrovirais and other medications. Therefore, the differential diagnosis is vast.

Early identification (through efficient screening) and definitive diagnosis (by kidney biopsy when indicated) of kidney disease in HIV-infected individuals are critical to optimal management. Earlier interventions with disease-specific therapy, often with the help of a nephrologist, are likely to lead to better outcomes. In those with chronic kidney disease, interventions, such as aggressive blood pressure control with the use of ACE inhibitors or angiotensin receptor antagonists where tolerated, tight blood glucose control in those with diabetes, and avoidance of potentially nephrotoxic medications, can slow progression and prevent end-stage renal disease. Only with greater awareness of kidney-disease manifestations and their implications in this particularly vulnerable population will we be able to achieve success in confronting this growing problem.

Keywords

Chronic Kidney Disease Glomerular Filtration Rate Proteinuria Acute Renal Failure Tenofovir 

Notes

Acknowledgements

Dr Lucas is supported by the National Institute on Drug Abuse (K23 Grant-DA15616).

Dr Fine has received speaking honoraria and consulting fees from GlaxoSmithKline. Dr Atta has received speaking honoraria from GlaxoSmithKline and consulting fees from Gilead Sciences. Drs Perazella and Lucas have no conflicts of interest that are directly relevant to the content of this review.

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Copyright information

© adis data information BV 2008

Authors and Affiliations

  • Derek M. Fine
    • 1
  • Mark A. Perazella
    • 2
  • Gregory M. Lucas
    • 3
  • Mohamed G. Atta
    • 1
  1. 1.Division of Nephrology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Section of Nephrology, Department of Internal MedicineYale University School of MedicineNew HavenUSA
  3. 3.Division of Infectious Diseases, Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA

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