Consensus document on the management of renal disease in HIV-infected patients.

Abstract

OBJECTIVE:

To update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients.

METHODS:

This document was approved by a panel of experts from the AIDS Working Group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Nephrology (S.E.N.), and the Spanish Society of Clinical Chemistry and Molecular Pathology (SEQC). The quality of evidence and the level of recommendation were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

RESULTS:

The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, Urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document advises on the optimal time for referral of a patient to the nephrologist and provides indications for renal biopsy. The indications for and evaluation and management of dialysis and renal transplantation are also addressed.

CONCLUSIONS:

Renal function should be monitored in all HIV-infected patients. The information provided in this document should enable clinicians to optimize the evaluation and management of HIV-infected patients with renal disease.

• Authors: AIDS Working Group (GESIDA) of the Spanish Society of InfectiousDiseases and Clinical Microbiology (SEIMC), Spanish Society of Nephrology (S.E.N.), Spanish Society of Clinical Chemistry and Molecular Pathology (SEQC), José L Górriz, Félix Gutiérrez, Joan C Trullas, Piedad Arazo, José R Arribas, Guillermina Barril, Miguel Cervero, Frederic Cofan, Pere Domingo, Vicente Estrada, Xavier Fulladosa, María J Galindo, Silvia Gracia, José A Iribarren, Hernando Knobel, José López-Aldeguer, Fernando Lozano, Alberto Martínez-Castelao, Esteban Martínez, María A Mazuecos, Celia Miralles, Rosario Montañés, Eugenia Negredo, Rosario Palacios, María J Pérez-Elías, Joaquín Portilla, Manuel Praga, Carlos Quereda, Antonio Rivero, Juan M Santamaría, José Sanz, Jesús Sanz, José M Miró
• Journal: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia (Nefrologia) Vol. 34 Suppl 2 Pg. 1-81 ( 2014) ISSN: 1989-2284 [Electronic] Spain
• PMID: 25467377 (Publication Type: Consensus Development Conference, Journal Article, Practice Guideline, Research Support, Non-U.S. Gov't)

Topics

• Algorithms
• HIV Infections (complications)
• Humans
• Kidney Function Tests
• Referral and Consultation
• Renal Insufficiency, Chronic (classification, complications, diagnosis, therapy)
• Risk Factors