Acute kidney injury in patients with human immunodeficiency virus infection

• Published in: Indian journal of nephrology 2015-03, Vol.25 (2), p.86-90
• Main Authors: Prakash, J, Gupta, T, Prakash, S, Rathore, S S, Usha, Sunder, S
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Acute kidney failure; AIDS; Biopsy; Diabetes; Diagnosis; Diseases; Drugs; Health aspects; Highly active antiretroviral therapy; HIV; HIV patients; Hospitalization; Hospitals; Human immunodeficiency virus; Hypertension; Infections; Kidney diseases; Laboratories; Medical examination; Medical prognosis; Mortality; Original; Risk factors; Sepsis; Urinalysis
• ISSN: 0971-4065; 1998-3662
• DOI: 10.4103/0971-4065.138696

Acute kidney injury (AKI) is an important cause of hospitalization and morbidity in human immunodeficiency virus (HIV)-positive patients. However, the data on AKI in such patients is limited. The aim of the present study was to analyze the incidence, causes and outcome of AKI in HIV-positive patients from our antiretroviral therapy centre. All HIV-positive patients were evaluated for evidence of clinical AKI. AKI was noted in 138/3540 (3.9%) patients. Of 138 AKI patients, 96 (69.6%) had acquired immuno deficiency syndrome and 42 (30.4%) were HIV seropositive. Majority of AKI patients belonged to AKI network (AKIN) Stage II (42%) or III (48.5%) at presentation. Prerenal, intrinsic and postrenal AKI were noted in 53.6%, 44.2% and 2.2% of cases, respectively. Hypovolemia (44.2%) and sepsis (14.5%) contributed to AKI in vast majority of cases. AKI was multifactorial (volume depletion, sepsis and drugs) in 39% of patients. Acute tubular necrosis (ATN) was the most common intrinsic lesion. Acute interstitial nephritis and diffuse endocapillary proliferative glomerulonephritis were noted in five and two cases, respectively. In-hospital mortality was 24.64%. Lower CD4 count, decreased serum albumin level and Stage 4 WHO disease were associated with higher mortality. At 3 months or more follow-up complete recovery of renal function, chronic kidney disease Stage 3-5 and progression to end stage renal disease were noted in 58.69%, 14.5% and 2.2% of cases, respectively. Thus, prerenal factors and ischemic ATN were the most common cause of AKI in HIV-infected patients. Recovery of renal function was seen in 59% of cases, but AKI had high in-hospital mortality.