Association of Urinary Biomarkers of Kidney Injury with Estimated GFR Decline in HIV-Infected Individuals following Tenofovir Disoproxil Fumarate Initiation

Abstract

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Kidney disease risk factors associate with urine biomarkers concentrations in HIV-positive persons; a cross-sectional study

“…In contrast, novel urinary biomarkers are emerging as valid markers of early kidney injury [16]. These biomarkers have been demonstrated to predict longitudinal kidney function as well as other adverse outcomes in specific clinical scenarios, such as following major cardiac surgery [17], among kidney transplant recipients [18, 19], and among HIV-positive and negative ambulatory populations [20–26]. However, CKD pathogenesis often involves multiple risk factors that may cause injury at diverse parts of the nephron and contribute to progressive loss of kidney function.…”

Comparison of viral control between two tenofovir dose reduction regimens (300 mg every 48 hours versus 300 mg every 72 hours) in chronic hepatitis B patients with moderate renal impairment from tenofovir‐induced renal dysfunction

“…Approximately 15% of our patients had high normal proteinuria or glycosuria and 56.5% had TmP/GFR less than 2.4 mg/dL that indicated tubular injury. These abnormal renal parameters were lower than other TDF‐induced renal toxicity studies 28,29 . Although the main mechanism of TDF‐induced nephrotoxicity is tubular dysfunction via mitochondrial injury, other possible mechanisms of TDF‐induced nephrotoxicity such as intense renal vasoconstriction, reduction in endothelial nitric oxide synthase capacity and decreased nitric oxide concentration in a dose‐dependent manner have been proposed 30 .…”

Tenofovir disoproxil fumarate initiation and changes in urinary biomarker concentrations among HIV-infected men and women

“…[45,46] In another study using this cohort of new TDF users, we have demonstrated that 6 of these 14 biomarkers, including β2M, KIM-1, clusterin, UMOD, cystatin C, and IL-18, were independently associated with eGFR decline during follow-up. [47] The recent introduction of tenofovir alafenamide fumarate (TAF), a less nephrotoxic alternative to TDF, has eased some concerns regarding tenofovir-associated nephrotoxicity. However, TAF has not completely replaced TDF nor the need for novel kidney function diagnostic methods.…”