Renal

HIV Nephropathy

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HIV Nephropathy, AIDS associated Nephropathy

  • Epidemiology
  1. HIV Nephropathy is associated with increased mortality in HIV
  • Risk Factors
  1. Black race
  2. Older age
  3. Advanced Immunosuppression
    1. CD4 Count <200 cells/mm3
    2. HIV Viral Loads high
  4. Hepatitis C Virus coninfection
  5. Injection drug use
  • Signs
  1. Proteinuria
  2. Nephrotic Syndrome
  3. Azotemia (Rapidly progressive, irreversible)
  • Course
  1. End Stage Renal Disease develops in 4-16 weeks
  • Differential Diagnosis
  1. Heroin-associated nephropathy
    1. HIV Nephropathy lacks:
      1. Severe Hypertension
      2. Peripheral Edema
      3. Anasarca
  • Diagnosis
  1. Renal Ultrasound
    1. Kidneys are usually enlarged in HIV Nephropathy
  2. Renal Biopsy confirms diagnosis
  • Management
  • Prevention
  1. Screen for renal disease at time of HIV diagnosis and then every 6 months (more frequently if high risk)
  2. Avoid Nephrotoxic Drugs
    1. See Renal Manifestations of HIV
    2. See Nephrotoxic Drugs