Clinical characteristics and outcomes of HIV-associated immune complex kidney disease

Booth, John; Hamzah, Lisa; José, Sophie; Horsfield, Catherine; O’Donnell, Patrick; McAdoo, Stephen P; Kumar, Emil; Turner‐Stokes, Tabitha; Khatib, Nadia; Das, Partha; Naftalin, Claire M.; Mackie, Nicola; Kingdon, Ed; Williams, Debbie; Hendry, Bruce M.; Sabin, Caroline; Jones, Rachael; Levy, Jeremy; Hilton, Rachel; Connolly, John; Post, Frank A.

doi:10.1093/ndt/gfv436

Cited by 64 publications

(80 citation statements)

References 20 publications

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“…The patients receiving cART over a 3-year period showed stabilization in eGFR and an improvement in proteinuria, but these findings were not statistically significant. Booth et al 46 recently reported an observed significant reduction in proteinuria and improvement in eGFR in patients with HIVICD initiated on cART.…”

Section: Antiretroviral Therapymentioning

confidence: 96%

“…18,34,35 HIVICD has not been extensively studied, and the direct role of HIV infection in its pathogenesis is not known. 44,45 Booth et al 46 recently reported on a multicentre study describing the clinical characteristics and outcomes of HIVICD in renal biopsies between 1998 and 2012. Of 265 biopsies, 92 revealed immune complex disease (ICD).…”

Section: Spectrum Of Hiv-associated Ckdmentioning

confidence: 99%

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Update on current management of chronic kidney disease in patients with HIV infection

Diana¹,

Naicker²

2016

IJNRD

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The prevalence of HIV-associated chronic kidney disease (CKD) varies geographically and depends on the definition of CKD used, ranging from 4.7% to 38% globally. The incidence, however, has decreased with the use of effective combined antiretroviral therapy (cART). A wide variety of histological patterns are seen in HIV-associated kidney diseases that include glomerular and tubulointerstitial pathology. In resource-rich settings, there has been a plateau in the incidence of end-stage renal disease secondary to HIV-associated nephropathy (HIVAN). However, the prevalence of end-stage renal disease in HIV-positive individuals has risen, mainly due to increased longevity on cART. There is a disparity in the occurrence of HIVAN among HIV-positive individuals such that there is an 18- to 50-fold increased risk of developing kidney disease among HIV-positive individuals of African descent aged between 20 and 64 years and who have a poorer prognosis compared with their European descent counterparts, suggesting that genetic factors play a vital role. Other risk factors include male sex, low CD4 counts, and high viral load. Improvement in renal function has been observed after initiation of cART in patients with HIV-associated CKD. Treatment with an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker is recommended, when clinically indicated in patients with confirmed or suspected HIVAN or clinically significant albuminuria. Other standard management approaches for patients with CKD are recommended. These include addressing other cardiovascular risk factors (appropriate use of statins and aspirin, weight loss, cessation of smoking), avoidance of nephrotoxins, and management of serum bicarbonate and uric acid, anemia, calcium, and phosphate abnormalities. Early diagnosis of kidney disease by screening of HIV-positive individuals for the presence of kidney disease is critical for the optimal management of these patients. Screening for the presence of kidney disease upon detection of HIV infection and annually thereafter in high-risk populations is recommended.

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Section: Antiretroviral Therapymentioning

confidence: 96%

Section: Spectrum Of Hiv-associated Ckdmentioning

confidence: 99%

Update on current management of chronic kidney disease in patients with HIV infection

Diana¹,

Naicker²

2016

IJNRD

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“…HIVICK is associated with immune complex formation and renal deposition attributable to the presence of viral antigens and polyclonal immunoglobulin expansion associated with recurrent infections in these patients . Immunoglobulin A (IgA) nephropathy, post‐infectious glomerulonephritis, lupus‐like glomerulonephritis, cryoglobulinemia and membranoproliferative glomerulonephritis are the most frequent immune complex‐mediated glomerulonephritis in HIV‐infected patients .…”

Section: Pathogenesismentioning

confidence: 99%

“…HIVAN and HIV immune complex disease of the kidney (HIVICK) are the most common HIV-related nephropathies, resulting from the exposure of renal cells of a genetically susceptible host to viral antigens [82]. HIVAN results from direct cytotoxicity leading to podocyte proliferation and dedifferentiation, apoptosis of tubular epithelial cells and tubulointerstitial inflammation [82,83] HIVICK is associated with immune complex formation and renal deposition attributable to the presence of viral antigens and polyclonal immunoglobulin expansion associated with recurrent infections in these patients [84]. Immunoglobulin A (IgA) nephropathy, post-infectious glomerulonephritis, lupus-like glomerulonephritis, cryoglobulinemia and membranoproliferative glomerulonephritis are the most frequent immune complexmediated glomerulonephritis in HIV-infected patients [84].…”

Section: Pathogenesismentioning

confidence: 99%

Acute kidney injury in HIV‐infected patients: a critical review

et al. 2018

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Acute kidney injury (AKI) is characterized by a rapid decline of renal function associated with worse outcomes. The purpose of the authors is to perform a critical review of the incidence, risk factors, pathogenesis and outcome of AKI in HIV‐infected patients. Human immunodeficiency virus (HIV)‐infected patients have an increased risk of developing AKI, to which contribute both HIV‐dependent and HIV‐independent factors as well as the nephrotoxicity of drugs used. The increased risk of AKI in HIV‐infected patients and its negative impact on prognosis highlights the need for identification of patients at risk, creation of prevention strategies and management. HIV‐infected patients have an increased risk of developing AKI, to which both HIV‐dependent and HIV‐independent factors contribute, as well as the nephrotoxicity of drugs used. The increased risk of AKI in HIV‐infected patients and its negative impact on prognosis highlight the need for identification of patients at risk, creation of prevention strategies and management.

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“…Compared with HIVAN, HIVICK patients have more antiretroviral therapy exposure, lower viral loads, and higher CD4 and eGFR [10, 15, 18, 19]. Indeed, HIVICK is far less likely to progress to ESRD than HIVAN [15].…”

Section: Introductionmentioning

confidence: 99%

HIV and kidney diseases: 35 years of history and consequences

2016

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Kidney diseases in human immunodeficiency virus (HIV)-infected patients are often misdiagnosed. Despite reductions in morbidity and mortality owing to widespread use of highly effective combination antiretroviral therapy (cART), acute kidney injury (AKI) and chronic kidney disease (CKD) are still more common in these patients than in the general population, and are associated with poor health outcomes. HIV-associated nephropathy and HIV immune complex kidney diseases are the more recognizable HIV-related kidney diseases. However, a broad spectrum of kidney disorders related or not directly related with HIV infection can be observed, including cART-induced AKI, CKD, proximal tubular dysfunction, crystalluria and urolithiasis, among others. This review summarizes the major epidemiologic studies of kidney diseases in HIV-infected patients, discusses novel approaches that may potentially limit nephrotoxicity such as the use of tenofovir alafenamide, and outlines current screening measures for early diagnosis of kidney dysfunction or tubular damage, and for accurate detection of increased risk for acute or chronic kidney diseases.

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Clinical characteristics and outcomes of HIV-associated immune complex kidney disease

Cited by 64 publications

References 20 publications

Update on current management of chronic kidney disease in patients with HIV infection

Update on current management of chronic kidney disease in patients with HIV infection

Acute kidney injury in HIV‐infected patients: a critical review

HIV and kidney diseases: 35 years of history and consequences

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