HIV-associated kidney disease

Abstract

HIV infection is associated with increased risk for kidney disease, both in its acute and chronic forms, and prolonged exposure to antiretroviral therapy (ART) may cause or exacerbate kidney injury. Hospitalized HIV patients with sepsis or those taking nephrotoxic drugs are at increased risk for acute tubular necrosis and acute interstitial nephritis. The incidence of acute kidney injury (AKI) in HIV-infected patients is higher than in uninfected patients. The most common causes of AKI in the clinical setting of HIV infection include drug toxicity, especially antiretrovirals, volume depletion, sepsis, and liver disease. HIV-associated nephropathy (HIVAN) was originally described in 1984 as a focal and segmental glomerulosclerosis (FSGS) with a clinical presentation that included nephrotic proteinuria and rapid renal function decline. Some authors believe that the prevalence of kidney disease seems to increase in the HIV-infected population. The main risk factors to be evaluated include high blood pressure, diabetes, hepatitis C, potentially nephrotoxic drugs, family history of kidney disease, black ethnicity, advanced HIV disease, cardiovascular disease, smoking, and cocaine exposure. Morphologically, HIVAN is a variant of FSGS characterized by the collapse of glomerular tufts. Renal biopsy is recommended in cases where the cause of chronic kidney disease (CKD) is not well defined or accelerated disease progression is observed, or even when the prognosis needs to be defined. The implementation of ART in the treatment of HIV infection has a delicate risk-benefit relationship because, although it is associated with increased life expectancy, the renal effects of continuous use of these drugs require strict attention.