Renal disease in HIV patients: Difference between revisions
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= Renal disease in HIV = |
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= Differential Diagnosis = |
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* Infection-related |
* Infection-related |
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** Indinavir, sulfadiazine, and IV acyclovir: tubular obstruction from crystals |
** Indinavir, sulfadiazine, and IV acyclovir: tubular obstruction from crystals |
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= HIV-associated nephropathy (HIVAN) = |
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== Presentation == |
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* Proteinuria, mild creatinine elevation, normal-seized echogenic kidneys on renal US |
* Proteinuria, mild creatinine elevation, normal-seized echogenic kidneys on renal US |
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* Biopsy shows FSGS |
* Biopsy shows FSGS |
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== Management == |
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* Treat the HIV with usual therapy |
* Treat the HIV with usual therapy |
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* Steroids for 8 to 12 weeks |
* Steroids for 8 to 12 weeks |
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* ACEi/ARB as tolerated |
* ACEi/ARB as tolerated |
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[[Category:HIV]] |
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Revision as of 23:42, 14 August 2019
Differential Diagnosis
- Infection-related
- HIV-associated nephropathy (HIVAN)
- Immune complex-mediated glomerular disease
- Coinfection with hepatitis B or C
- Treatment-related
- Tenofovir: Fanconi syndrome
- Pantamidine, foscarnet, and aminoglycosides: ATN
- Indinavir, sulfadiazine, and IV acyclovir: tubular obstruction from crystals
HIV-associated nephropathy (HIVAN)
Presentation
- Proteinuria, mild creatinine elevation, normal-seized echogenic kidneys on renal US
- Usually have a detectable viral load, and decreased CD4 <200
- Biopsy shows FSGS
Management
- Treat the HIV with usual therapy
- Steroids for 8 to 12 weeks
- ACEi/ARB as tolerated
