ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE IN HIV PATIENTS IN THE ERA OF ANTIRETROVIRAL THERAPY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 9
Abstract
BACKGROUND HIV/AIDS may have renal involvement as a direct consequence of HIV infection, due to opportunistic infections, neoplasm or related to drug toxicity. The present study was done to determine etiological factors, biochemical profile and outcome of patients of HIV with acute kidney injury (AKI) and chronic kidney disease (CKD) separately. MATERIALS AND METHODS In this descriptive study, HIV positive patients aged >18 years who were admitted or seen on OPD basis were screened for renal involvement Patients who were positive on screening were classified as AKI or CKD, underwent investigations for cause including kidney biopsy if indicated and followed up prospectively. RESULTS Total 116 patients were observed of which 82 had AKI, and 34 patients had CKD. Infectious diseases causing AKI was the most prevalent cause especially in patients not on ART followed by tenofovir (TDF) use causing AKI. 74/82 (90.24%) had CD4 count of < 500 cells/mm3. CKD group comprised of only CKD in 5 patients, TDF nephrotoxicity overlapping with CKD in 19 patients and AKI on CKD in 10 patients. 32/34 (94.11%) had CD4 count of < 500 cells/mm3. In total 84 (72.41%) patients with renal failure comprising 54 (65.85%) from AKI group and 30 (88.24%) patients from CKD group were on TDF based ART regimen. In 5 (6%) patients with TDF induced AKI had the partial recovery with high creatinine values at the time of discharge and 3 months follow up suggesting progression to CKD. CONCLUSION Prerenal AKI due to various opportunistic infections was a significant cause of AKI particularly in patients not on ART. Tenofovir was leading cause of renal failure causing AKI as well as contributing to nephrotoxicity in CKD cases. Thus, our study shows that drug-induced nephrotoxicity mainly due to TDF is a very important cause of morbidity in HIV. Our study showed a strong correlation between advanced immunosuppression and renal failure.
Authors and Affiliations
Priya V. Patil, Jyoti B Bansode, Manoj C. Kore, Kashmira Hajare
Keywords
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- EP ID EP411172
- DOI 10.14260/jemds/2018/246
- Views 77
- Downloads 0
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