B23.8 + (N28.9)
DESCRIPTION
A number of kidney disorders are associated with HIV infection.
Acute kidney injury due to sepsis, dehydration or nephrotoxicity from medicines occurs commonly.
The commonest chronic kidney disorder is HIV-associated nephropathy (HIVAN).
Typical features of HIVAN are:
- Heavy proteinuria.
- Rapidly progressive chronic kidney disease with preserved kidney size on imaging.
- ART slows progression of chronic kidney disease.
Early detection of kidney disease is important in order to implement interventions that may slow kidney disease progression, and for adjusting the dose of relevant medicines.
Risk factors for HIV renal disease:
- CD4 count <200 cells/mm3.
- Use of nephrotoxic medications.
- Comorbidity such as diabetes mellitus, hypertension, or hepatitis C virus co-infection.
Screening for renal disease in HIV
- Tests should include:
- Urine dipstick for haematuria and proteinuria (request urine protein:creatinine ratio if proteinuria is detected; if this is >0.15 g/mmol discuss with a specialist).
- Serum creatinine and eGFR.
Dose adjustment of ART in renal impairment: Refer to table: Dosing of ART for renal adjusted doses in Antiretroviral therapy.