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Approach to acute kidney injury in HIV-infected patients in South Africa

BACKGROUND: HIV-infected patients have an increased risk of renal disease. Current first-line antiretroviral therapy contains tenofovir disoproxil fumarate (TDF), which has nephrotoxic potential, characterised by proximal tubular cell injury. This may result in acute kidney injury, chronic kidney di...

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Autores principales: Boswell, Michael T., Rossouw, Theresa M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AOSIS 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843257/
https://www.ncbi.nlm.nih.gov/pubmed/29568636
http://dx.doi.org/10.4102/sajhivmed.v18i1.714
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author Boswell, Michael T.
Rossouw, Theresa M.
author_facet Boswell, Michael T.
Rossouw, Theresa M.
author_sort Boswell, Michael T.
collection PubMed
description BACKGROUND: HIV-infected patients have an increased risk of renal disease. Current first-line antiretroviral therapy contains tenofovir disoproxil fumarate (TDF), which has nephrotoxic potential, characterised by proximal tubular cell injury. This may result in acute kidney injury, chronic kidney disease or partial or complete Fanconi syndrome. OBJECTIVES: We reviewed the existing literature on acute kidney injury and TDF-associated nephrotoxicity with the aim of providing an approach to diagnosis and management, which is relevant to a general medical practitioner. METHODS: We performed a broad literature search of biomedical databases including PubMed and ScienceDirect. Our search terms included, but were not limited to, ‘tenofovir’, ‘nephrotoxicity’, ‘HIV’, ‘acute kidney injury’ and ‘renal tubular acidosis’. Our aim was not to generate a systematic literature review with weighted evidence, but rather to provide a review of best practice from a variety of sources. Where published studies were not available from the above databases, we relied on relevant textbooks and professional guidelines. RESULTS: Potential nephrotoxicity is not an impediment to the widespread use of TDF in treating HIV infection, because most patients will tolerate the medication well. However, patients with advanced disease, low body weight, advanced age, pre-existing kidney disease and concomitant use of other nephrotoxic medications are at increased risk of adverse renal events and may develop severe complications if not appropriately managed. These risk factors are unfortunately common in patients initiating antiretroviral therapy in South Africa. CONCLUSION: Prevention of renal damage by means of careful screening and monitoring of high-risk patients is of paramount importance. Increased awareness of this problem and knowledge of how to manage kidney disease should be emphasised for general medical practitioners who work with HIV-infected patients.
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spelling pubmed-58432572018-03-22 Approach to acute kidney injury in HIV-infected patients in South Africa Boswell, Michael T. Rossouw, Theresa M. South Afr J HIV Med Overview BACKGROUND: HIV-infected patients have an increased risk of renal disease. Current first-line antiretroviral therapy contains tenofovir disoproxil fumarate (TDF), which has nephrotoxic potential, characterised by proximal tubular cell injury. This may result in acute kidney injury, chronic kidney disease or partial or complete Fanconi syndrome. OBJECTIVES: We reviewed the existing literature on acute kidney injury and TDF-associated nephrotoxicity with the aim of providing an approach to diagnosis and management, which is relevant to a general medical practitioner. METHODS: We performed a broad literature search of biomedical databases including PubMed and ScienceDirect. Our search terms included, but were not limited to, ‘tenofovir’, ‘nephrotoxicity’, ‘HIV’, ‘acute kidney injury’ and ‘renal tubular acidosis’. Our aim was not to generate a systematic literature review with weighted evidence, but rather to provide a review of best practice from a variety of sources. Where published studies were not available from the above databases, we relied on relevant textbooks and professional guidelines. RESULTS: Potential nephrotoxicity is not an impediment to the widespread use of TDF in treating HIV infection, because most patients will tolerate the medication well. However, patients with advanced disease, low body weight, advanced age, pre-existing kidney disease and concomitant use of other nephrotoxic medications are at increased risk of adverse renal events and may develop severe complications if not appropriately managed. These risk factors are unfortunately common in patients initiating antiretroviral therapy in South Africa. CONCLUSION: Prevention of renal damage by means of careful screening and monitoring of high-risk patients is of paramount importance. Increased awareness of this problem and knowledge of how to manage kidney disease should be emphasised for general medical practitioners who work with HIV-infected patients. AOSIS 2017-11-28 /pmc/articles/PMC5843257/ /pubmed/29568636 http://dx.doi.org/10.4102/sajhivmed.v18i1.714 Text en © 2017. The Authors https://creativecommons.org/licenses/by/4.0/ Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
spellingShingle Overview
Boswell, Michael T.
Rossouw, Theresa M.
Approach to acute kidney injury in HIV-infected patients in South Africa
title Approach to acute kidney injury in HIV-infected patients in South Africa
title_full Approach to acute kidney injury in HIV-infected patients in South Africa
title_fullStr Approach to acute kidney injury in HIV-infected patients in South Africa
title_full_unstemmed Approach to acute kidney injury in HIV-infected patients in South Africa
title_short Approach to acute kidney injury in HIV-infected patients in South Africa
title_sort approach to acute kidney injury in hiv-infected patients in south africa
topic Overview
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843257/
https://www.ncbi.nlm.nih.gov/pubmed/29568636
http://dx.doi.org/10.4102/sajhivmed.v18i1.714
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