Chronic Renal Disease In Hiv
The prevalence of chronic kidney disease in the various stages of HIV infection is difficult to assess. Proteinuria and elevated creatinine level have been found in 7.2% to 32% of HIV-seropositive patients and were associated with an increased rate of death in a study of 2038 female HIV-infected patients . Proteinuria still remains a nonspecific finding in HIV-infected patients. Autopsy studies yield a prevalence of up to 43% of pathological changes on histological examination . Both autopsy and biopsy studies may be limited by bias of selecting subjects presenting with apparent renal disease. HAART has been found to reduce progression from AIDS to end-stage renal disease in patients of African descent by 38%, yet a significant increase in the prevalence of end-stage renal disease associated with an increase in the prevalence of HIV infection in this population has been predicted . Even though exact epidemiologic data are missing because of the use of different screening techniques, chronic kidney disease in HIV-infected patients is a common and clinically relevant finding. The cause of chronic renal disease in HIV-infected patients can be difficult to assess on clinical grounds alone and can most often only be determined by renal biopsy.
Weight Gain In Participants Initiating Art
In pooled analyses, the 96-week median weight gain was 2.0 kg , with the greatest rate of weight gain occurring during the initial 48 weeks . Through 96 weeks, 48.6%, 36.6%, and 17.3% of participants had at least 3%, 5%, and 10% weight increase from baseline, respectively. Weight gain was not observed in all participants 30.2% lost weight. The proportion of participants in overweight and obese BMI categories increased over time .
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What Happens If A Kidney Infection Is Left Untreated
If a kidney infection is left untreated, it can lead to a number of complications including kidney scarring, blood poisoning, and pregnancy complications if you are expecting which is why its crucial to get in touch with your doctor if you are experiencing any symptoms or signs of kidney infection .
Its important to note that there are steps you can take to reduce your risk of developing a kidney infection including drinking plenty of water, urinating after sex, and going to the bathroom once you feel the urge to go.
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One of the most reliable ways to keep an eye on your kidney health is through regular testing this can be done with your doctor or if you would prefer, from the comfort of home with an at-home lab test.
LetsGetCheckeds Kidney Function Test allows you to monitor your kidney function and performance. Online results will be available within 2-5 days and our dedicated clinical team will be available to answer any questions you may have throughout the process.
You should consider taking a Kidney Function Test if any of the below are applicable to you:
- You suffer from high blood pressure
- You suffer from diabetes
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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 , sometimes shortness of breath, abdominal pain, or fatigue, nausea and vomiting if severe.
Medications That Can Harm The Kidneys
No matter what kind of medicine you take, whether OTC or prescription, it is destined to take a trip through your kidneys. Taking a drug the wrong way or in excessive amounts can damage these vital, bean-shaped organs and lead to serious complications. In the worst-case scenario, it could necessitate a kidney transplant.
Compared with 30 years ago, patients todayhave a higher incidence of diabetes and cardiovascular disease, take multiple medications, and are exposed to more diagnostic and therapeutic procedures with the potential to harm kidney function, according to Cynthia A. Naughton, PharmD, senior associate dean and associate professor in the department of pharmacy practice at North Dakota State University. All of these factors are associated with an elevated risk of kidney damage.
An estimated 20% of cases of acute kidney failure are due to medications. The technical term for this scenario is nephrotoxicity, which is growing more common as the aging population grows, along with rates of various diseases.
The kidneys get rid of waste and extra fluid in the body by filtering the blood to produce urine. They also keep electrolyte levels balanced and make hormones that influence blood pressure, bone strength and the production of red blood cells. When something interferes with the kidneys, they cant do their job, so these functions can slow down or stop altogether.
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When Will I Begin To Feel Better
Once you start treatment, you should start to feel better in a few days.
Can I have sex while being treated for a kidney infection?After you have started treatment and your symptoms have gone away, it is usually safe to have sex. Remember to urinate after sex to avoid getting more bacteria in your urinary tract.
What Are The Symptoms Of Kidney Disease
Kidney disease can advance very slowly. Slowly worsening kidney disease is called chronic kidney disease.
As kidney disease gets worse, a person may have swelling of the legs, feet, or ankles . Symptoms of advanced chronic kidney disease can include:
- Increased or decreased urination
- Feeling tired or having trouble sleeping
- Nausea and vomiting
- Itching or numbness
Blood and urine tests are used to detect kidney disease. Care for people with HIV includes testing for kidney disease.
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Why Do People Gain Weight
The reasons for weight gain after starting treatment are unclear. Several explanations have been proposed.
One explanation is that weight gain is a result of immune recovery. Long-term viral infection depletes fat stores. When people recover from famine or severe infection, body fat stores are replenished. Weight gain may represent a restoration of weight to what it might have been, had the person not been living with HIV for a number of years . However, weight gain may overshoot in people more prone to obesity for dietary or genetic reasons. Studies show that people with more advanced HIV disease gain more weight, as do people who were underweight before starting treatment.
Another theory is that integrase inhibitors might cause weight gain through effects on the hormonal system which governs appetite regulation, leading to increased food intake . But a laboratory study by one of the drugs manufacturers found that the amount of any integrase inhibitor needed to interfere with the normal activity of this system would be far greater than the drug concentrations achieved from normal doses of integrase inhibitors .
Furthermore, one study found that people did not eat more after starting treatment nor did they experience a reduction in metabolic rate . Another study found that substantial weight gain after four years of treatment was largely attributable to higher pre-treatment weight and lower physical activity, not increased food intake .
How Often Should I Be Tested For Kidney Disease
Everyone with HIV should be tested for kidney disease at least once. This should be done when you first learn you have HIV. Ask your health care provider if you were ever tested for kidney disease if not, get tested. People with HIV who have additional risk factors for kidney disease will need to be tested at least once a year.
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Can You Get Chickenpox If Youve Been Vaccinated
Yes. About 15% 20% of people who have received one dose of varicella vaccine do still get chickenpox if they are exposed, but their disease is usually mild. Vaccinated persons who get chickenpox generally have fewer than 50 spots or bumps, which may resemble bug bites more than typical, fluid-filled chickenpox blisters. In 2006, the Advisory Committee on Immunization Practices voted to recommend routine two-dose varicella vaccination for children. In one study, children who received two doses of varicella vaccine were three times less likely to get chickenpox than individuals who have had only one dose.
Getting Tested For A Uti
Testing for a UTI usually takes place in a doctors office, laboratory, or hospital. Most tests for UTIs involve a urine sample obtained by clean-catch or catheterization. Your doctor can help determine which method is appropriate for you.
- Clean catch urine samples are collected by patients with special precautions to prevent outside germs from getting into the urine sample. Patients are given instructions on obtaining a clean catch sample and avoiding contamination.
- Catheterization involves inserting a thin rubber tube through the urethra into the bladder. When performing this procedure, the urine is collected in a sterile container for testing before removing the catheter.
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Characteristics Of The Study Cohort
For the 3-year study period, there were 446 465 incident dialysis patients. After applying the exclusion criteria, the sample consisted of 221 546 individuals. From this group, 2784 patients had a zoster diagnosis and 51% died .
summarizes descriptive statistics by mortality status. Patients who died were older, white and non-Hispanic when compared with those who were alive at 2years. The time to death or follow-up was 8.1 and 16.7 months in nonsurvivors versus survivors, respectively .
Descriptive statistics for mortality within each risk factor and chi-square or t-test results among ESRD zoster patients
Zoster patients who died had a higher CCI and a greater incidence of bacteremia/septicemia, CDI and malnutrition. Patients with a history of kidney transplant had a significantly lower incidence of mortality. The most common primary causes of death were cardiac and unclassified other . A total of 27 patients received the zoster vaccination. Ten patients developed zoster and 17 did not .
Diarrhea And Kidney Failure
Diarrhea is one gastrointestinal tract symptom of kidney failure. Excessive accumulation of creatinine, blood urea nitrogen and other wastes in the patients body can cause many sick feeling such as fatigue, nausea, poor appetite. If left untreated, patients can develop serious vomiting, indigestion, diarrhea, low blood volume or even rapid decline of kidney functions.
Diarrhea can cause or worsen kidney failure. There have been many reports about renal failure after serious diarrhea. Diarrhea can be caused by food poisons and it can cause many complications if left untreated. Many organs can be involved and renal failure is one relatively severe complication.
Why diarrhea causes renal failure? Not all diarrhea will cause renal damages or renal failure. Here we refer to very serious diarrhea. In case of diarrhea, the whole bodys effective blood volume will experience sharp decline. Blood flow to the kidneys will be suddenly reduced and cause hypoperfusion in the kidneys. Unclean foods can cause gastrointestinal tract infections which can cause renal damages too. Besides, diarrhea can cause dehydration, electrolyte disorders, malnutrition and disturbed internal environment. As a result, kidneys will be impaired and kidney functions will be lost and kidney failure will occur.
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Normal Podocyte Function At The Glomerular Filtration Barrier
Podocytes are an essential cellular component of the tripartite glomerular filtration barrier . Podocytes are post-mitotic epithelial cells characterized by their highly specialized, actin-based membranous extentions known as foot processes . Podocytes envelop glomerular capillaries, adhering to the glomerular basement membrane through a network of intermolecular interactions connecting foot processes to the GBM . Between interdigitating foot processes, a zipper-like assembly of proteins known as the slit-diaphragm functions as a molecular seive to provide charge and size selectivity for ultrafiltration . Podocytes produce the molecular constituents of the slit diaphragm and the expression of these proteins coincides with podocyte differentiation and maturation . For example, the slit diaphragm protein nephrin, first identified in a Finnish cohort study of congenital nephrotic syndrome , is produced by podocytes. The various roles of nephrin at the slit diaphram and as a modulator of prosurvival signaling in podocytes are well-documented and will not be detailed in this review, however, it is clear that disease processes that impair podocyte nephrin expression, and other slit diaphragm components, result in podocyte dysfunction and drive the development of proteinuria and the FSGS lesion .
Tenofovir Leading Hiv Medication Linked With Risk Of Kidney Damage
Risk Remains After Drug Use Ends, Say Researchers, Who Call for Patient Monitoring
Tenofovir, one of the most effective and commonly prescribed antiretroviral medications for HIV/AIDS, is associated with a significant risk of kidney damage and chronic kidney disease that increases over time, according to a study of more than 10,000 patients led by researchers at the San Francisco VA Medical Center and the University of California, San Francisco .
The researchers call for increased screening for kidney damage in patients taking the drug, especially those with other risk factors for kidney disease.
In their analysis of comprehensive VA electronic health records, the study authors found that for each year of exposure to tenofovir, risk of protein in urine a marker of kidney damage rose 34 percent, risk of rapid decline in kidney function rose 11 percent and risk of developing chronic kidney disease rose 33 percent. The risks remained after the researchers controlled for other kidney disease risk factors such as age, race, diabetes, hypertension, smoking and HIV-related factors.
Patients were tracked for an average of 1.2 years after they stopped taking tenofovir. They remained at elevated risk for at least six months to one year compared with those who never took the drug, suggesting that the damage is not quickly reversible, said Shlipak. We do not know the long-term prognosis for these patients who stop tenofovir after developing kidney disease, he cautioned.
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What Tests Are Needed
Blood and urine tests are used to determine if kidney failure is present, and if it is, how severe it is. Other tests, such as x-rays, sonogram , and special blood tests are usually necessary to tell what caused the kidney failure. Sometimes a biopsy of the kidney is recommended. The cause of kidney failure is not always easily discernable.
Treatment of AKI depends on whats causing your illness and how severe it is.
You may need:
- to increase your intake of water and other fluids if youre dehydrated
- antibiotics if you have an infection
- to stop taking certain medicines
- a urinary catheter, a thin tube used to drain the bladder if theres a blockage
You may need to go to hospital for some treatments.
Most people with AKI make a full recovery, but some people go on to develop chronic kidney disease or long-term kidney failure as a result.
In severe cases, dialysis, where a machine filters the blood to rid the body of harmful waste, extra salt and water, may be needed.
Kidney Function And Kidney Disease
The primary task of the kidneys is to maintain the fluid balance in the body. They accomplish this task through increasing or decreasing the amount of fluid excreted in the urine. Electrolytes like sodium and potassium are an important component of fluid management. When you eat or drink liquids, the fluid eventually makes its way to the kidneys. A complex mechanism of fluid and electrolyte transfers, mediated by hormones and other chemicals, results in the movement of fluid into the kidneys and bladder, from which the urine is excreted. Kidney disease damages these mechanisms.
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What Consult Service Or Services Would Be Helpful For Making The Diagnosis And Assisting With Treatment
If you decide the patient has renal disease, what therapies should you initiate immediately?
The general approach to the treatment of kidney disease includes the following steps. A nephrologist can be helpful at any point in this approach and is particularly helpful when a biopsy is required.
Attempt to identify the cause of the disease noninvasively.
Identify what therapies can be initiated empirically.
Observe the impact of these empiric therapies on urine protein excretion and serum creatinine.
If empiric therapies fail to achieve the desired result , kidney biopsy should be considered to identify the histology of the kidney disease for more specific therapy.
For a person with glomerular disease, the amount of protein in their urine should be used as an intermediate outcome. Instituting therapies with a goal of reducing proteinuria is a key concept in the therapy of glomerular disease. Following the institution of such therapies , a reduction in the quantitative level indicates therapeutic success. Therapies should be titrated up to suppress the proteinuria to the lowest degree possible. It is generally felt that suppression of an elevated urine protein excretion to 1g or less is associated with better kidney survival.
Impact Of Antiretroviral Therapy On Renal Function
Proper selection and dose-adjustment of antiretrovirals and other commonly used drugs for patients with kidney disease are important components of care for patients with HIV infection. Tables and summarize the nephrotoxic potential of antiretroviral agents and their recommended dose adjustments for those with kidney disease. Isolated case reports of nephrotoxicity have been reported with almost all agents, but renal disease has been associated with indinavir and tenofovir more often than with other drugs .
Nucleoside or nucleotide dosage adjustment for HIV-infected patients with reduced glomerular filtration rate.
Indinavir causes nephrolithiasis and chronic interstitial nephritis in as many as 12% of patients who receive it. The mainstay of prevention of this condition is adequate hydration, with intake of at least 1.5 L of noncaffeinated fluid. One report described 4 cases of renal colic and nephrolithiasis in patients who received lopinavir-ritonavir treatment, but a causal effect was not established . Three cases of kidney stones containing atazanavir have been reported, and a review of the US Food and Drug Administration adverse event reporting system detected 12 additional confirmed cases . Most cases required hospitalization for pain relief and stent insertion, percutaneous nephrostomy, lithotripsy, or endoscopic surgical extraction. Predisposing factors are unknown, and the drug was discontinued in most but not all cases.
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