II. Epidemiology
- HIV Nephropathy is associated with increased mortality in HIV
III. Risk Factors
- Black race
- Older age
- Advanced Immunosuppression
- CD4 Count <200 cells/mm3
- HIV Viral Loads high
- Hepatitis C Virus coninfection
- Injection drug use
IV. Signs
- Proteinuria
- Nephrotic Syndrome
- Azotemia (Rapidly progressive, irreversible)
V. Course
- End Stage Renal Disease develops in 4-16 weeks
VI. Differential Diagnosis:
-
Heroin-associated nephropathy
- HIV Nephropathy lacks:
VII. Diagnosis
- Renal Ultrasound
- Kidneys are usually enlarged in HIV Nephropathy
- Renal Biopsy confirms diagnosis
VIII. Management
- No known treatment
- Antiretroviral therapy for HIV
-
ACE Inhibitor or Angiotensin Receptor Blocker
- See ACE Inhibitors and ARBs in Diabetic Nephropathy
- Indicated for persistent Proteinuria
IX. Prevention
- Screen for renal disease at time of HIV diagnosis and then every 6 months (more frequently if high risk)
- Avoid Nephrotoxic Drugs