Acute Kidney Injury in HIV-Infected Patients

Kalim, Sahir; Szczech, Lynda A.; Wyatt, Christina M.

doi:10.1016/j.semnephrol.2008.08.008

Cited by 43 publications

(50 citation statements)

References 33 publications

(55 reference statements)

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“…Acute kidney injury (AKI) is a common, often reversible complication with an estimated incidence of 2.7 to 5.9 per 100 person-years in HIV-infected out-patients [1][2][3][4] [3,7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Acute kidney injury (AKI) is a common, often reversible complication with an estimated incidence of 2.7 to 5.9 per 100 person-years in HIV-infected out-patients [1][2][3][4]. Combination antiretroviral therapy (cART) is first-line therapy for HIV-associated nephropathy [3,5,6], but some antiretrovirals, including tenofovir (TFV), indinavir and atazanavir, have been associated with acute and chronic renal failure [3,7,8].…”

Section: Introductionmentioning

confidence: 99%

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Acute kidney injury caused by tenofovir disoproxil fumarate and diclofenac co‐administration

et al. 2013

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ObjectivesThe renal elimination of tenofovir (TFV) may be subject to renal drug−drug interactions that may increase the risk of kidney injury. Case reports indicated that diclofenac might increase TFV-associated nephrotoxicity via a drug−drug interaction, leading to an increased intracellular TFV concentration in proximal tubular cells. MethodsA retrospective analysis of data for all patients from the Frankfurt HIV Cohort (FHC) who had diclofenac prescriptions between January 2008 and June 2012 was carried out. ResultsAmong 89 patients with diclofenac use, 61 patients (68.5%) were treated with tenofovir disoproxil fumarate (TDF) and 28 patients (31.5%) were treated with TDF-sparing combination antiretroviral therapy (cART). Thirteen patients (14.6%) developed acute kidney injury (AKI) shortly after initiating diclofenac treatment. AKI occurred exclusively in TDF-treated patients, although all had previously stable renal function. All cases were accompanied by new onset of at least two parameters indicating proximal tubular damage, such as normoglycaemic-glucosuria and hypophosphataemia. TFV-associated nephrotoxicity was demonstrated by renal biopsy in four cases. Additionally, 11.5% of patients on TDF treatment developed new-onset proximal tubular damage, while having a preserved glomerular filtration rate. In contrast, diclofenac did not affect renal function in patients with TDF-sparing cART, as only one case of isolated hypophataemia was observed in these patients. In univariate analysis, risk factors for AKI were TDF-containing cART (P = 0.0076) and pre-existing hypophosphataemia (P = 0.0086). ConclusionsDrug−drug interaction caused by diclofenac could exacerbate TFV-associated nephrotoxicity. Diclofenac should be used with caution in patients on TDF therapy, especially in those with hypophosphataemia. Our findings need to be confirmed in larger studies.Keywords: acute kidney injury, drug−drug interaction, Fanconi syndrome, HIV, nonsteroidal anti-inflammatory drugs, tenofovir IntroductionAcute kidney injury (AKI) is a common, often reversible complication with an estimated incidence of 2.7 to 5.9 per 100 person-years in HIV-infected out-patients [1][2][3][4] [3,7,8].Renal toxicity related to TFV is caused by proximal tubular injury that may present with various manifestations (hypophosphataemia, normoglycaemic-glucosuria, hypouricaemia, proteinuria and/or metabolic acidosis, including partial or complete Fanconi syndrome) attributable to impaired reabsorption of glomerular filtrate and nephrogenic diabetes insipidus, as well as AKI [9][10][11][12]. Tenofovir disoproxil fumarate (TDF) is a prodrug which is rapidly metabolized to TFV in plasma. TFV is eliminated unchanged by glomerular filtration (70-80%) as well as proximal tubular secretion (20-30%). TFV enters the proximal renal tubular cells via human organic anion transporter 1 (hOAT1) and is then actively secreted into the urine by the multidrug-resistance protein (MRP), mainly MRP4 [10,11,13,14].Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit dru...

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“…Acute kidney injury (AKI) is a common, often reversible complication with an estimated incidence of 2.7 to 5.9 per 100 person-years in HIV-infected out-patients [1][2][3][4] [3,7,8].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute kidney injury caused by tenofovir disoproxil fumarate and diclofenac co‐administration

et al. 2013

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“…With the advent of highly active antiretroviral therapy (HAART), the survival of HIV patients has improved, with an increase in the incidence of comorbidities, including AKI (14). In a study performed in London, the incidence of renal disease among HIV patients was 0.36 cases per 100 patients per year (12).…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury in AIDS: frequency, RIFLE classification and outcome

Júnior¹,

Libório

Mota

et al. 2010

Braz J Med Biol Res

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“…An important entity HIV Associated Nephropathy (HIVAN) can result from direct kidney infection with HIV or from the adverse effects of antiretroviral drugs [18] [19]. Further, patients with HIV disease are at risk for developing prerenal azotemia due to volume depletion resulting from salt wasting or vomiting.…”

Section: Form Non-invasive Inexpensive and Safe Imaging Technique Tmentioning

confidence: 99%

Correlation between Abdominal Ultrasonographic Findings and CD4 Cell Count in Adult Patients with HIV/AIDS in Jos, Nigeria

Eze¹,

Chom²,

Igoh³

et al. 2017

AMI

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CD + counts were studied. Two hundred (40%) of the patients had normal abdominal ultrasound, while 60% (300) had various abnormalities. The common abnormalities included increased liver parenchymal echogenicity in 25.0%, hepatomegaly in 23.4%, splenomegaly in 6.6%, increased splenic echogenicity in 6.2% and thickened gallbladder wall in 12.6%, elevated renal parenchymal echogenicity in 6.4%, enlarged kidneys in 2.6%, lymphadenopathy in 6.0%, and ascites in 2.4%. Pelvic abscess was the least pathology in 0.2%.Most of the findings did not correlate with the patients' 4 CD + count except for lymphadenopathy and ascites. Although abdominal ultrasound examination is invaluable in the management of these patients, however, it has not shown to be useful in predicting the patients' immune status.

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Acute Kidney Injury in HIV-Infected Patients

Cited by 43 publications

References 33 publications

Acute kidney injury caused by tenofovir disoproxil fumarate and diclofenac co‐administration

Acute kidney injury caused by tenofovir disoproxil fumarate and diclofenac co‐administration

Acute kidney injury in AIDS: frequency, RIFLE classification and outcome

Correlation between Abdominal Ultrasonographic Findings and CD4 Cell Count in Adult Patients with HIV/AIDS in Jos, Nigeria

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