Immunodeficiency and renal impairment are risk factors for HIV-associated acute renal failure

Ibrahim, Fowzia; Naftalin, Claire M.; Cheserem, Emily; Roe, Jennifer; Campbell, Lucy; Bansi, Loveleen; Hendry, Bruce M.; Sabin, Caroline; Post, Frank A.

doi:10.1097/qad.0b013e32833c85d6

Cited by 52 publications

(62 citation statements)

References 24 publications

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“…Several authors showed a significant relationship between CD4 count at initiation of ARV treatment and the occurrence of chronic kidney failure [3,9,20,23]. The severe immunosuppression generally favors the occurrence of opportunistic events (infectious, diarrhea, tuberculosis) that can be a source of renal impairment.…”

Section: Prevalence Of Chronic Kidney Failure In People With Hivmentioning

confidence: 99%

Prevalence of Chronic Kidney Failure and Associated Factors in Patients Treated by Antiretroviral in the National Teaching Hospital of Cotonou

Dm¹,

Vigan²,

Azon-Kouanou³

et al. 2015

J Nephrol Ther

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Section: Prevalence Of Chronic Kidney Failure In People With Hivmentioning

confidence: 99%

Prevalence of Chronic Kidney Failure and Associated Factors in Patients Treated by Antiretroviral in the National Teaching Hospital of Cotonou

Dm¹,

Vigan²,

Azon-Kouanou³

et al. 2015

J Nephrol Ther

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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%

“…Moreover, no patient with AKI had been on angiotensin conversion enzyme inhibitor or angiotensin-1 receptor blocker therapy, which is known to increase the nephrotoxic potential of diclofenac. It therefore appears unlikely that the numbers of patients with AKI after diclofenac prescription were attributable to other nephrotoxic drug effects than that of TDF.AKI under cART has also been associated with prior CKD, AIDS, lower CD4 cell count, HCV coinfection and liver disease in HIV-infected out-patients [1][2][3] and also with malignancies and traditional risk factors, such as older age, African descent, hypertension and diabetes, in hospitalized patients [11,25,26]. However, these risk factors did not differ between HIV-infected patients with and without AKI.…”

mentioning

confidence: 99%

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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“…1 In addition, HIV-infected patients often have unique risk factors for AKI, either associated with immunodeficiency, immune reconstitution or nephrotoxic effects of antiretroviral therapy (ART). [2][3][4] It is common for AKI to reflect the multifactorial effects of these renal 'stressors', and careful evaluation of the patient's pre-morbid condition, immunovirological status, current clinical condition and recent nephrotoxic exposures is required for an accurate diagnosis and to individualise treatment. The 'STOP' (sepsis, toxins, obstruction, parenchymal disease) mnemonic remains a useful aide memoire for considering contributing factors of AKI in HIV, as per the general population.…”

Section: Introductionmentioning

confidence: 99%

HIV and the kidney in the acute medical unit

Booth

Post

2015

Clinical Medicine

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Immunodeficiency and renal impairment are risk factors for HIV-associated acute renal failure

Abstract: Current levels of immunodeficiency and renal function were independent predictors of HIV-associated ARF.

Cited by 52 publications

References 24 publications

Prevalence of Chronic Kidney Failure and Associated Factors in Patients Treated by Antiretroviral in the National Teaching Hospital of Cotonou

Prevalence of Chronic Kidney Failure and Associated Factors in Patients Treated by Antiretroviral in the National Teaching Hospital of Cotonou

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

HIV and the kidney in the acute medical unit

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