Acute kidney injury in HIV-positive patients

Abstract

Objective: To study the incidence, spectrum, prognosis and outcome of clinical renal disease with special emphasis on acute kidney injury in patients with HIV infection. Methods: A protocol of study was prepared. All HIV patients of both genders regardless of age attending Antiretroviral treatment (ART) Centre and those admitted in the wards of the hospital (Sir Sunderlal Hospital, Varanasi, Uttar Pradesh, India) were subjected for screening of clinical renal disease. HIV-seropositive patients with clinical renal diseases were included and divided into two groups: (A) Asymptomatic patients without manifestations of renal diseases but found to have a significant renal involvement on screening and (B) Patients with symptomatic renal diseases. HIV-associated renal disease were diagnosed using the following criteria: 1) Positive HIV Serology, 2) CD4 T-Lymphocyte count, 3) Proteinuria / Haematuria, 4) Elevated serum creatinine and 5)Quantitative proteinuria (24 hours urinary protein or spot urine Protein/creatinine ratio). National AIDS Control Organisation (NACO) Guidelines of India, 2007 were followed for the diagnosis of HIV-seropositivity. Results: 47 HIVseropositive patients were found to have clinical renal disease during the study period of August 2007 and July 2009. During the two years study period, there were 3545 patients of HIV-seropositive patients and only 1725 patients (611 females and 1114 males) were enrolled for ART as they fulfilled NACO guidelines. 47 (1.33%) patients (44 males and 3 females) were found to have clinical renal disease. Most of the patients (45/47) had AKI (pre-renal-15, acute tubular necrosis-27, interstitial nephritis-3). Proteinuria, serum creatinine and serum albumin were 0.935± 0.985 gm/day, 5.28± 5.64 mg% and 2.92± 0.58 respectively. Renal biopsy were done on 2 indicated patients who showed granulomatous glomerulonephritis, and Tubulointerstitial nephritis in one patient each. CD4 count was in the range of 43- 842(170.36± 157.75) cells/μL. 9 patients (1.7%) having HIV-related clinical renal disease died due to sepsis (5), tubercular meningitis (3) and hypovolemia (2). Peritoneal dialysis could be done in 6 patients. Conclusion: AKI mostly related to acute tubular necrosis was the most common HIV-related clinical renal disease. Evidence of non-specific glomerular disease with or without interstitial nephritis was observed in 2 patients. HIV-associated nephropathy well documented in western / African-American literatures was not observed in our study.