HIV and kidney diseases: 35 years of history and consequences

Abstract

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.

Kidney Lesions in Hiv-Infected Patients

“…There are numerous experiments on the study of a number of renal diseases in the HIVinfected individuals worldwide [4,8,9]. For instance, the studies conducted in the United Sta tes have revealed that, according to the re nal biopsy, 52.7% of the patients with ne phrotic PU were diagnosed with HIV-associated ne ph ropathy.…”

“…A screening study to identify the kidney lesion markers (permanent proteinuria, reduction in GFR that was detected for 3 or more months) in HIV-infected patients was conducted in accordance with the recommendations of the Kidney Disease Outcome Quality Initiative, K / DOQI, 2002, and Infectious Diseases Society of America, IDSA, 2005 [4,7]. Among the surveyed patients there were 105 (36.0%) people with markers of kidney lesion: albuminuria/ proteinuria.…”

“…In tubulointerstitial diseases, in comparison with the glomerular pathology of kidneys, the renal function impairment was diagnosed much less frequently (32.3±8. 4 notes: * -significant difference between the groups of patients with glomerular and tubulointerstitial diseases (p<0.05-0.001). min/1.73 m 2 (p<0.05).…”

“…The kidneys lesion, which is often characterized by severe clinical manifestations, can significantly affect the life expectancy in hivinfected patients [3,4]. Considering the increasing number of HIV-infected people in the world and a rise in the life expectancy of such patients, an increase in the number of HIVinfected people in need of expensive substitution renal therapy as well as kidney transplantation is expected.…”

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

“…HIV-infected patients have an increased risk of developing AKI [5][6][7][8][9]. In HIV-infected patients, kidney disease has become an important cause of mortality [8,10]. The development of combination antiretroviral therapy (cART) has prolonged patient survival and modified the spectrum of renal diseases in HIV-infected patients, with a decrease in the prevalence of glomerular diseases and an increase in the prevalences of nephrotoxicity and comorbidities [10][11][12][13].…”