Makindo Medical Notes

Related Subjects: |AIDS (HIV) Neurological Disease |AIDS (HIV) Respiratory disease |AIDS Dementia Complex (HIV) |AIDS HIV Infection |AIDS(HIV) Gastrointestinal Disease |Acute Retroviral Syndrome (HIV) |HIV and Post-Exposure Prophylaxis (PEP) |HIV and Pre-exposure prophylaxis |HIV associated nephropathy (HIVAN) |HIV disease Assessment

About

HIV-Associated Nephropathy (HIVAN) is a type of kidney disease that occurs in individuals infected with the Human Immunodeficiency Virus (HIV). It is a serious complication that can lead to end-stage renal disease (ESRD) if not properly managed. This document provides an overview of HIVAN, including its causes, symptoms, diagnosis, treatment, and prevention strategies.

Causes and Risk Factors

• Direct Viral Infection:HIV infects renal epithelial cells, leading to kidney damage.
• Genetic Predisposition: Genetic factors, particularly the APOL1 gene variants, increase the risk of HIVAN in individuals of African descent. Affects the Black population much more than whites.
• Immunosuppression: Severe immunosuppression if untreated HIV increases the risk of developing HIVAN.
• Other Factors: Co-infections, drug toxicity, and chronic inflammation can also contribute to the development of HIVAN.

Symptoms

• Nephrotic: Proteinuria, Oedema
• Nephritic: Reduced urine output, Proteinuria, Hypertension
• Fatigue, Unintentional weight loss

Diagnosis

• Medical History and Physical Examination: Review of symptoms and risk factors. Physical examination to assess for oedema and other signs of kidney disease.
• Laboratory Tests: Urinalysis, U&E, HIV viral load and CD4 count to evaluate HIV status.
• Imaging Studies: Ultrasound: large bright kidneys.
• Kidney Biopsy: Definitive diagnosis is often confirmed by kidney biopsy, which shows characteristic findings such as focal segmental glomerulosclerosis (FSGS) and tubular microcystic dilatation. Focal and segmental with sclerosis of the glomerulus. Crescents may form. Microcystic dilatation of the renal tubules containing casts. EM shows tubuloreticular inclusions

HAART can lead to dramatic improvements in renal function

Treatment

• Antiretroviral Therapy (ART): Initiation of ART is crucial to control HIV replication and improve immune function. ART can slow the progression of HIVAN and improve renal outcomes.
• Angiotensin-Converting Enzyme (ACE) Inhibitors or Angiotensin II Receptor Blockers (ARBs): These medications help reduce proteinuria and control blood pressure.
• Supportive Care: Management of hypertension, oedema, and other symptoms. Dietary modifications to reduce salt and protein intake.
• Dialysis:For patients who progress to end-stage renal disease (ESRD), dialysis may be necessary to manage kidney failure.
• Kidney Transplantation: Transplantation may be considered if ESRD. HIV-positive individuals can undergo kidney transplantation.

Prevention

• Early diagnosis and treatment of HIV with antiretroviral therapy (ART) to maintain immune function.
• Regular monitoring of kidney function in HIV-positive individuals.
• Lifestyle modifications to reduce risk factors for kidney disease, such as controlling blood pressure with ACEI/ARBs and avoiding nephrotoxic drugs.
• Genetic counseling for individuals of African descent who may carry APOL1 gene variants.