HIV and the kidney

Written by: Professor Jeremy Levy
Published: | Updated: 11/12/2018
Edited by: Cal Murphy

HIV. One of the most well-known and often feared diseases in the world, this infection has been part of the public consciousness since the 1980s. While awareness of the disease itself is very high, many people are not aware of its effect on other parts of the body. Expert nephrologist Professor Jeremy Levy explains the effect HIV can have on the kidney:

HIV causing kidney problems

People with HIV can have kidney problems from a variety of causes, and this is very common. HIV itself can infect the kidneys (HIV-associated nephropathy, or HIVAN most commonly) and cause problems including poor kidney function, acute kidney injury, chronic kidney disease, proteinuria (protein in the urine), high blood pressure, and it can even cause kidney failure.

The drugs used to treat HIV (anti-retroviral drugs) can be damaging to the kidneys, including medications such as tenofovir (TDF), atazanavir, protease inhibitors and more. Other medications needed by patients, such as antibiotics or anti-viral agents can be toxic to kidneys. Many people living with HIV get high blood pressure, diabetes, or vascular disease (especially if they smoke) and these can all lead to kidney damage, especially as people living with HIV are getting older.

 

Nephropathy – what to look out for

Very often, nephropathy caused by HIV does not cause any symptoms, but can be detected by urine and blood tests. If the kidneys are damaged they almost always leak blood or protein into the urine, which is detected by a urine test, and is often the first or only sign. This is usually not visible. When symptoms do rarely occur they can be similar to symptoms of other kidney conditons like glomerulonephritis, including swelling of the legs (oedema), sometimes shortness of breath, abdominal pain, or fatigue, nausea and vomiting if severe.

Diagnosing HIV-associated nephropathy or kidney damage

To make a diagnosis, it is necessary to perform blood and urine tests, an ultrasound scan, and sometimes a kidney biopsy (a small sample is taken out from one kidney through a needle, under local anaesthetic).

 

Treating the kidney damage

Treatment will depend on the precise cause of the kidney damage. Often, this includes changes to the anti-retroviral drugs in close collaboration with the HIV doctors, and the patient may need new medications for blood pressure or diabetes, and sometimes other drugs to treat inflammation in the kidneys. All this requires close monitoring.

Patients are also advised to stop smoking, eat a healthy, balanced diet, and exercise. For most patients the kidney damage will only be mild, but it can sometimes (rarely) lead to complete kidney failure and the need for dialysis or a kidney transplant. Kidney transplantation can be performed if needed in patients with HIV and kidney failure and can be extremely successful.

 

If you are experiencing symptoms of kidney damage, whether you have HIV or not, you should consult your doctor, or a specialist.

By Professor Jeremy Levy
Nephrology

Professor Jeremy Levy is a top consultant nephrologist based in London who specialises in chronic kidney disease, glomerulonephritis, polycystic kidney disease and immune-mediated renal disease, including vasculitis.

He is actively involved in teaching and research, writing textbooks on dialysis and nephrology, including the Oxford Handbook of Dialysis, and developing online learning for undergraduates at Imperial College, and is invited to teach widely around the world. He serves as Director of Clinical Academic Training for Imperial College London and was Chair of the UK Renal Association Education and Training Committee. Professor Levy trained in London, Oxford and Cambridge, and holds a PhD in renal immunology.

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