Diagnostic challenges of kidney diseases in HIV-infected patients |
| |
Authors: | Robin Chazot Elisabeth Botelho-Nevers Anne Frésard Nicolas Maillard Christophe Mariat Frédéric Lucht |
| |
Affiliation: | 1. Department of Nephrology, Dialysis, Transplantation and Hypertension, University Hospital of Saint-étienne, Saint-étienne, France;2. Department of Infectious and Tropical Diseases, University Hospital of Saint-étienne, Saint-étienne, France;3. GIMAP – Groupe sur l’Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean Monnet, Université de Lyon, Saint-étienne, France |
| |
Abstract: | Introduction: Chronic kidney disease (CKD) is a prevalent comorbidity in persons living with HIV infection (PLWH) associated with an increase in cardiovascular morbidity and all-cause mortality. Furthermore, early diagnosis of CKD is difficult in PLWH. Areas covered: We reviewed the main diagnostic tools for CKD in PLWH, and discussed their strengths and limits. We performed a literature search on PubMed to identify reviews and clinical trials dealing with attractive kidney biomarkers of CKD in PLWH, with the following key words: ‘HIV AND kidney’, ‘HIV AND Kidney biomarkers’, ‘CKD AND Kidney biomarkers’. Expert commentary: Currently, CKD diagnosis is based on the estimation of Glomerular Filtration Rate (GFR), and measurement of proteinuria by urine protein/creatinine ratio (uPCR). These parameters are independent and complementary predictors of outcomes. GFR estimates are lacking in accuracy in PLWH. The best GFR estimate is CKD-EPI study equation. Moreover, low-grade proteinuria is associated with an increased risk of kidney disease progression in PLWH, and guidelines derived from the general population may lack sensitivity. Different biomarkers of kidney diseases like N-acetyl beta glucosaminidase (NAG), Kidney Injury Molecule-1 (KIM-1), and Alpha-1-microglobulin may predict kidney disease progression and mortality in PLWH. Others may help clinicians detect antiretroviral-induced tubulopathy, or predict cardiovascular events. More studies are needed to validate the routine use of these types of biomarkers. |
| |
Keywords: | HIV kidney biomarkers glomerular filtration rate chronic kidney disease |
|
|