Screen for kidney disease among PLHIV with symptoms.

Should we screen for kidney disease among people living with HIV taking Tenofovir-based ART?

In our article today, we use the findings from a recent paper by Nyende et al. published in BMC Nephrology to ascertain whether we (health care providers) should screen for kidney disease among people living with HIV taking Tenofovir-based ART.

Kidney disease, one of several non-communicable diseases, is on the rise worldwide. At the same time, the increasing enrolment of people living with HIV (PLHIV) into antiretroviral therapy (ART) care has progressively increased their life expectancy. It implies that such people join the general population and the exposure to the possible risk factors for kidney diseases. In particular, most people living with HIV in Uganda take Tenofovir disoproxil fumarate (TDF)-based regimens to suppress the HIV viral loads. Studies have noted that PLHIV on TDF have a substantial risk of renal derangements because the drug can cause nephrotoxicity.

Nyende et al. assessed 278 patients and noted renal dysfunction was prevalent in 2.52% (7 patients). Of the electrolytes assessed, 15.44% had low calcium levels; 3.7% and 4.44% had low and high phosphate levels, respectively. And about 5.26% had elevated potassium levels. They defined renal dysfunction as a low glomerular filtration rate (below 60ml/min/1.73m2).  They concluded that this prevalence was low. And that we should screen for kidney disease in any patient living with HIV who presents to the clinic with symptoms suggestive of an underlying kidney disease.

Related:

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Kidney disease may present with hypertension, haematuria, body swelling, altered micturition habits, among others. PLHIV are particularly prone to renal dysfunction: besides the potential renal toxicity from TDF, they may suffer from HIV-associated nephropathy, HIV immune complex disease, use of nonsteroidal inflammatory drugs (NSAIDs), herbal medications, diabetes, hypertension, among others. They may get acute kidney injury or chronic kidney disease.

Based on the preliminary findings from a small cohort of patients in Nyende et al.’s study, it becomes imperative to screen for kidney diseases in patients at risk during ART clinic visits. Screening can range from inquiring about any symptoms suggestive of kidney damage to non-invasive tests like urinalysis, random blood sugars. And if the situation necessitates, carry out renal function tests with possible consultation from a nephrologist to further stratify the risks.

It’s noteworthy that prevention is crucial. The cost of treating chronic and end-stage kidney diseases is high. Besides, services like renal replacement therapy and dialysis are not readily available country-wide: early diagnosis of all the reversible causes of kidney damage to preventing irreparable impairment.

To read Nyende et al.’s study findings, check here.

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