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Charre C, Lemoine S, Icard V, Maud R, Tardy JC, Chiarello P, Godinot M, Avettand-Fenoel V. HIV-1-Associated Kidney Disease in an Elite Controller. AIDS Patient Care STDS 2022; 36:413-415. [PMID: 36301263 DOI: 10.1089/apc.2022.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Caroline Charre
- Université Paris Cité, Faculté de Médecine, Paris, France.,INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France.,Department of Virology, Hôpital Cochin, APHP, Paris, France
| | - Sandrine Lemoine
- Université de Lyon, Lyon, France.,Department of Nephrology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Vinca Icard
- Department of Virology, Institut de Agents Infectieux, Centre National de Référence des Virus des Infections Respiratoires, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Rabeyrin Maud
- Department of Anatomical Pathology, Centre de Biologie et de Pathologie Grand Est, Hospices Civils de Lyon, Lyon, France
| | - Jean-Claude Tardy
- Department of Virology, Institut de Agents Infectieux, Centre National de Référence des Virus des Infections Respiratoires, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Pierre Chiarello
- Department of Infectious Diseases, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Godinot
- Department of Infectious Diseases, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Véronique Avettand-Fenoel
- Université Paris Cité, Faculté de Médecine, Paris, France.,INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France.,Department of Virology, Hôpital Cochin, APHP, Paris, France
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Louis M, Cottenet J, Salmon-Rousseau A, Blot M, Bonnot PH, Rebibou JM, Chavanet P, Mousson C, Quantin C, Piroth L. Prevalence and incidence of kidney diseases leading to hospital admission in people living with HIV in France: an observational nationwide study. BMJ Open 2019; 9:e029211. [PMID: 31061062 PMCID: PMC6501953 DOI: 10.1136/bmjopen-2019-029211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/27/2019] [Accepted: 04/03/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To describe hospitalisations for kidney disease (KD) among people living with HIV (PLHIV) in France and to identify the factors associated with such hospitalisations since data on the epidemiology of KD leading to hospitalisation are globally scarce. DESIGN Observational nationwide study using the French Programme de Médicalisation des Systèmes d'Information database. SETTING France 2008-2013. PARTICIPANTS Around 10 862 PLHIV out of a mean of 5 210 856 patients hospitalised each year. All hospital admissions with a main diagnosis code indicating KD (International Classification of Diseases, 10th revision codes, N00 to -N39) were collected. MAIN OUTCOME MEASURES The prevalence and incidence of KD leading to hospital admission in PLHIV and the associated risk factors. RESULTS The prevalence of patients hospitalised for KD was 1.5 higher in PLHIV than in the general population, and increased significantly from 3.0% in 2008 to 3.7% in 2013 (p<0.01). The main cause of hospitalisation for KD was acute renal failure (ARF, 25.4%). Glomerular diseases remained stable (6.4%) throughout the study period, focal segmental glomerulosclerosis being the main diagnosis (37.6%). Only 41.3% of patients hospitalised for glomerular disease were biopsied. The other common motives for admission were nephrolithiasis (22.1%) and pyelonephritis (22.6%).The 5-year cumulative incidence of KD requiring hospitalisation was 5.9% in HIV patients newly diagnosed for HIV in 2009. Factors associated with a higher risk of incident KD requiring hospitalisation were cardiovascular disease (HR 3.30, 95% CI 1.46 to 7.49), and, for female patients, AIDS (HR 2.45, 95% CI 1.07 to 5.58). Two-thirds of hospitalisations for incident ARF occurred in the first 2 years of follow-up. CONCLUSIONS Hospital admission for KD is more frequent in PLHIV than in the general population and increases over time. ARF remains the leading cause. Glomerular diseases are infrequently documented by renal biopsies. Older patients and those with cardiovascular disease are particularly concerned.
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Affiliation(s)
- Magali Louis
- Infectious Diseases Department, University Hospital, Dijon, France
- Nephrology, University Hospital, Dijon, France
| | - Jonathan Cottenet
- CHRU Dijon, Service de Biostatistique et d’Informatique Médicale (DIM), Université de Bourgogne, Dijon, France
| | | | - Mathieu Blot
- Infectious Diseases Department, University Hospital, Dijon, France
| | | | | | - Pascal Chavanet
- Infectious Diseases Department, University Hospital, Dijon, France
- CIC 1432, INSERM, Dijon, France
| | | | - Catherine Quantin
- CHRU Dijon, Service de Biostatistique et d’Informatique Médicale (DIM), Université de Bourgogne, Dijon, France
| | - Lionel Piroth
- Infectious Diseases Department, University Hospital, Dijon, France
- CIC 1432, INSERM, Dijon, France
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Yilma D, Abdissa A, Kæstel P, Tesfaye M, Olsen MF, Girma T, Ritz C, Friis H, Andersen ÅB, Kirk O. Serum creatinine and estimated glomerular filtration rates in HIV positive and negative adults in Ethiopia. PLoS One 2019; 14:e0211630. [PMID: 30753190 PMCID: PMC6372225 DOI: 10.1371/journal.pone.0211630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Glomerular filtration rate estimating equations using serum creatinine are not validated in most African settings. We compared serum creatinine and estimated glomerular filtration rate (eGFR) in HIV positive and negative adults and assessed the performance of eGFR equations ((Cockcroft and Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)) compared to 24-hour creatinine clearance in HIV positive adults. METHODS Data were collected on demographic, anthropometric, body composition, clinical parameters and serum creatinine in HIV positive and negative adults. 24-hour urine was collected from some of the HIV positive adults who volunteered. Bias was calculated as mean difference between 24-hr creatinine clearance and eGFR (eGFR- 24 hour creatinine clearance) and the accuracy of each eGFR equation was calculated as the percentage of estimates within 30% of creatinine clearance. RESULTS A total of 340 HIV positive and 100 HIV negative adults were included in this study. Creatinine clearance was determined for 46 of HIV positive adults. Serum creatinine increased with increasing age, weight, height, body surface area, fat free mass and grip strength in both HIV positive and negative adults (P<0.05). No difference was observed in eGFR between HIV positive and HIV negative adults. For all eGFR equations, the correlation between eGFR and 24-hr creatinine clearance was 0.45-0.53 and the accuracy within 30% of 24-hr creatinine clearance was 24-46%. Removing ethnic coefficient reduced the bias and improved accuracy of the CKD-EPI and the MDRD estimates. CONCLUSION Ethiopian HIV positive adults in the present study had good kidney function at the initiation of antiretroviral treatment. However, all eGFR equations overestimated 24-hr creatinine clearance in the study population. Creatinine based eGFR equations that accounts for low muscle mass and body surface area are needed.
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Affiliation(s)
- Daniel Yilma
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Alemseged Abdissa
- Department of Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Tsinuel Girma
- Department of Paediatric and Child Health, Jimma University, Jimma, Ethiopia
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Åse B. Andersen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen and Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Ole Kirk
- Department of Infectious Diseases, Rigshospitalet, Copenhagen and Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Denmark
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Prakash J, Ganiger V, Prakash S, Sivasankar M, Sunder S, Singh U. Kidney Disease in Human Immunodeficiency Virus-seropositive Patients: Absence of Human Immunodeficiency Virus-associated Nephropathy was a Characteristic Feature. Indian J Nephrol 2017; 27:271-276. [PMID: 28761228 PMCID: PMC5514822 DOI: 10.4103/0971-4065.202400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection can cause a broad spectrum of renal diseases. However, there is paucity of Indian data on the patterns of renal lesions in HIV-seropositive patients. The aim of the present study was to delineate the spectrum of renal lesions in HIV/acquired immunodeficiency syndrome patients. In this prospective study, all HIV-positive patients of both genders aged >18 years were screened for renal disease. Patients with proteinuria of more than 1 g/24 h were subjected to renal biopsy. A total of 293 HIV-positive patients were screened; of these, 136 (46.4%) patients found to have renal involvement. Dipstick-positive proteinuria of 1+ or more was observed in 112 (38.2%) patients, and 16 (14.2%) patients had proteinuria of more than 1 g/24 h. Renal biopsy in 14 cases revealed glomerulonephritis (GN) in 12 (85.7%) (isolated GN in 4 [28.5%] and GN mixed with chronic TIN in 8 [57.1%]) patients. These include mesangioproliferative GN in 5 (35.7%), membranoproliferative GN in 2 (14.2%), focal segmental glomerulosclerosis in 2 (14.2%), diffuse proliferative GN in 2 (14.2%), and diabetic nephropathy in 1 (7.1%) patients. Chronic interstitial nephritis was noted in 10 (71.42%) (superimposed on GN in 8 [57.1%], isolated in 2 [14.2%]) patients. Granulomatous interstitial nephritis was seen in 3 (24.1%) cases. GN and chronic interstitial nephritis were noted in 85.7% and 71.42% of patients, respectively, mostly superimposed on each other. Mesangioproliferative GN was the most common glomerular lesion, but classical HIV-associated nephropathy was not observed.
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Affiliation(s)
- J Prakash
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - V Ganiger
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - S Prakash
- Department of Medicine, TNMC, Mumbai, Maharashtra, India
| | - M Sivasankar
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - S Sunder
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - U Singh
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Diana NE, Naicker S. Update on current management of chronic kidney disease in patients with HIV infection. Int J Nephrol Renovasc Dis 2016; 9:223-234. [PMID: 27695357 PMCID: PMC5033612 DOI: 10.2147/ijnrd.s93887] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of HIV-associated chronic kidney disease (CKD) varies geographically and depends on the definition of CKD used, ranging from 4.7% to 38% globally. The incidence, however, has decreased with the use of effective combined antiretroviral therapy (cART). A wide variety of histological patterns are seen in HIV-associated kidney diseases that include glomerular and tubulointerstitial pathology. In resource-rich settings, there has been a plateau in the incidence of end-stage renal disease secondary to HIV-associated nephropathy (HIVAN). However, the prevalence of end-stage renal disease in HIV-positive individuals has risen, mainly due to increased longevity on cART. There is a disparity in the occurrence of HIVAN among HIV-positive individuals such that there is an 18- to 50-fold increased risk of developing kidney disease among HIV-positive individuals of African descent aged between 20 and 64 years and who have a poorer prognosis compared with their European descent counterparts, suggesting that genetic factors play a vital role. Other risk factors include male sex, low CD4 counts, and high viral load. Improvement in renal function has been observed after initiation of cART in patients with HIV-associated CKD. Treatment with an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker is recommended, when clinically indicated in patients with confirmed or suspected HIVAN or clinically significant albuminuria. Other standard management approaches for patients with CKD are recommended. These include addressing other cardiovascular risk factors (appropriate use of statins and aspirin, weight loss, cessation of smoking), avoidance of nephrotoxins, and management of serum bicarbonate and uric acid, anemia, calcium, and phosphate abnormalities. Early diagnosis of kidney disease by screening of HIV-positive individuals for the presence of kidney disease is critical for the optimal management of these patients. Screening for the presence of kidney disease upon detection of HIV infection and annually thereafter in high-risk populations is recommended.
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Affiliation(s)
- Nina E Diana
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Odongo P, Wanyama R, Obol JH, Apiyo P, Byakika-Kibwika P. Impaired renal function and associated risk factors in newly diagnosed HIV-infected adults in Gulu Hospital, Northern Uganda. BMC Nephrol 2015; 16:43. [PMID: 25881003 PMCID: PMC4381399 DOI: 10.1186/s12882-015-0035-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background Screening for renal diseases should be performed at the time of diagnosis of human immunodeficiency virus (HIV) infection. Despite the high prevalence of HIV/AIDS in Northern Uganda, little is known about the status of renal function and its correlates in the newly diagnosed HIV-infected individuals in this resource limited region. We aimed to determine the status of renal function and factors associated with impaired renal function in newly diagnosed HIV-infected adults in Northern Uganda. Methods This was a seven month cross-sectional hospital-based study, involving newly diagnosed HIV-infected patients, 18 years and older. Patients with history of diabetes mellitus, hypertension and renal disease were excluded. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula (Table one). Factors associated with impaired renal function (eGFR < 60 ml/min/1.73 m2) were thus sought. Results We enrolled 361 participants (230, 63.7% female) with Mean ± standard deviation age of 31.4 ± 9.5 years. 52, (14.4%) had impaired renal function (eGFR <60 mL/min/1.73 m2) and of this 37 (71.2%) moderate renal impairment (eGFR 30–59.9 mL/min/1.73 m2) while 15 (28.8%) had severe renal impairment (eGFR <30 mL/min/1.73 m2). Proteinuria was recorded in 189 (52.4%) participants. Of these, 154 (81.5%) had mild (1+) while 8 (4.2%) had severe (3+) proteinuria. Using logistic regression, age, CD4 cell count, and proteinuria were significantly associated with impaired renal function; age >34 years (OR 2.8, 95% CI 1.3 – 5.9; P =0.009), CD4 count <350 cells/μL (OR 2.4, 95% CI 1.0-4.7; P =0.039) and proteinuria (OR 9.6, 95% CI 5.2–17.9; P < 0.001). Conclusion The prevalence of impaired renal function was high in new HIV-infected individuals in this region with limited resources. So, screening for renal disease in HIV is recommended at the time of HIV diagnosis.
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Affiliation(s)
- Pancras Odongo
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda.
| | - Ronald Wanyama
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda.
| | - James Henry Obol
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda.
| | - Paska Apiyo
- Infectious Diseases Clinic, Gulu Regional Referral Hospital, P.O. Box 160, Gulu, Uganda.
| | - Pauline Byakika-Kibwika
- Department of Medicine, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda.
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Abstract
HIV is a highly adaptive, rapidly evolving virus, which is associated with renal diseases including collapsing glomerulopathy-the classic histomorphological form of HIV-associated nephropathy. Other nephropathies related to viral factors include HIV-immune-complex kidney disease and thrombotic microangiopathy. The distribution of HIV-associated kidney diseases has changed over time and continues to vary across geographic regions worldwide. The reasons for this diversity are complex and include a critical role of APOL1 variants and possibly other genetic factors, disparities in access to effective antiviral therapies, and likely other factors that we do not yet fully understand. The mechanisms responsible for HIVAN, including HIV infection of podocytes and tubular epithelial cells, the molecules responsible for HIV entry, and diverse mechanisms of cell injury, have been the focus of much study. Although combined antiretroviral therapy is effective at preventing and reversing HIVAN, focal segmental glomerulosclerosis, arterionephrosclerosis and diabetic nephropathy are increasingly common in individuals who have received such therapy for many years. These diseases are associated with metabolic syndrome, obesity and premature ageing. Future directions for HIV-related kidney disease will involve regular screening for drug nephrotoxicity and incipient renal disease, as well as further research into the mechanisms by which chronic inflammation can lead to glomerular disease.
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Tonolini M, Villa F, Villa C, Ippolito S, Bianco R. Renal and urologic disorders in antiretroviral-treated patients with HIV infection or AIDS: spectrum of cross-sectional imaging findings. Curr Probl Diagn Radiol 2014; 42:266-78. [PMID: 24159925 DOI: 10.1067/j.cpradiol.2013.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the aging human immunodeficiency virus (HIV)-infected population with improved immune function under antiretroviral treatment, many different opportunistic disorders may be encountered, along with rare presentations or complicated forms of common diseases. Renal and urologic abnormalities observed in the setting of HIV infection or acquired immunodeficiency syndrome are reviewed with their imaging appearances, including renal dysfunction, urolithiasis, urinary tract infections and related complications, genitourinary tuberculosis, vascular lesions, urogenital tumors, and bladder abnormalities, with emphasis on characterization. In HIV-positive patients, early cross-sectional imaging is warranted to detect uncommon disorders and complications, with the aim to preserve renal function.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy.
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Abstract
Antiretroviral therapy has been immensely successful in reducing the incidence of opportunistic infections and death after HIV infection. This has resulted in heightened interest in noninfectious comorbidities including kidney disease. Although HIV-associated nephropathy, the most ominous kidney disease related to the direct effects of HIV, may be prevented and treated with antiretrovirals, kidney disease remains an important issue in this population. In addition to the common risk factors for kidney disease of diabetes mellitus and hypertension, HIV-infected individuals have a high prevalence of other risk factors, including hepatitis C and exposure to antiretrovirals and other medications. Therefore, the differential diagnosis is vast. Early identification (through efficient screening) and prompt treatment of kidney disease in HIV-infected individuals are critical to lead to better outcomes. This review focuses on clinical and epidemiological issues, treatment strategies (including dialysis and kidney transplantation), and recent advances among kidney disease in the HIV population.
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