Can HIV affect the kidneys?

Hello,

Welcome to icliniq.com.

Well, I am deeply concerned about your worries, and I understand that you are going through tough times.

Let me explain that HIV is associated with nephropathy due to the widespread use of combined antiretroviral therapy (ART). It remains one of the leading causes of end-stage renal disease in HIV-1 seropositive patients, who typically present with low CD4 count, high viral load, and heavy proteinuria. Pathological findings often include collapsing focal segmental glomerulosclerosis. There is an increased susceptibility among individuals of African descent, largely due to polymorphisms in the APOL1 (apolipoprotein L1) gene.

Clinical risk factors include low CD4 count, advanced kidney disease, and nephrotic range proteinuria. Proteinuria has been associated with end-stage renal disease. Improvement in renal function has been observed after the initiation of combined ART. Other treatment options may be considered when clinically indicated, such as inhibitors of the renin-angiotensin system and corticosteroids.

I would advise the following investigations:

1. CBC (complete blood count).
2. Midstream urine sample.
3. Fasting blood sugar.
4. Viral markers.
5. Renal function tests.
6. Liver function tests.
7. CD4 count and viral load.
8. Ultrasound of the abdomen and pelvis.

Management:

1. This case requires a multidisciplinary team approach. You need to consult with an HIV specialist physician, a consultant nephrologist, a psychiatrist, and a psychotherapist.
2. You should monitor both fluid intake and output.
3. Combined active ART should be continued regardless of the CD4 count.
4. Corticosteroids are given to patients with HIV-associated nephropathy (HIVAN) when there is significant tubulointerstitial inflammation.
5. Renal replacement therapy, including kidney transplantation, may be considered in cases of advanced renal failure.

I hope I have clarified your query. Please do not hesitate to contact me if you have further questions.

Thank you.