10 Interesting Facts of HIV associated kidney disorders
1. HIVAN results from direct HIV infection of podocytes and tubular cells.
2. HIVICK results from the development of peripheral immune complexes containing HIV antigens that deposit in the glomerulus.
3. Patients with HIV are frequently co-infected with HCV and/or HBV and may develop glomerulonephritis from these infections.
4. Patients with HIVAN are unexpectedly normotensive, often demonstrating large echogenic kidneys on ultrasound.
5. In cART, proteosome inhibitors cause ATN by stone formation and intratubular precipitation and by interstitial nephritis, and directly inhibit the P450 system in the liver.
6. In cART, NRTIs, like tenofovir, cause Fanconi’s syndrome and ATN through proximal tubular injury.
7. In cART, integrase strand inhibitors reduce the secretion of creatinine leading to a false diagnosis of AKI.
8. Dialysis and transplantation are viable options for patients with cART controlled HIV.
9. AKI is extremely common in patients with HIV because of cART.
10. Guidelines require all patients with HIV to be regularly screened for kidney disease with a GFR and urinalysis for proteinuria.
