Tubulointerstitial Nephropathies in HIV-Infected Patients over the Past 15 Years

Zaidan, Mohamad; Lescure, François-Xavier; Brochériou, Isabelle; Dettwiler, Sarah; Guiard–Schmid, Jean–Baptiste; Pacanowski, Jérôme; Rondeau, Éric; Pialoux, Gilles; Girard, Pierre‐Marie; Ronco, Pierre; Plaisier, Emmanuelle

doi:10.2215/cjn.10051012

Cited by 63 publications

(55 citation statements)

References 53 publications

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“…Although it can cause NDI in about 12.5% of cases, it is usually associated with kidney injury and metabolic acidosis, in contrast with our patient, who presented chloride resistant metabolic alkalosis and normal kidney function [17,18].…”

contrasting

confidence: 87%

Nephrogenic diabetes insipidus as the first manifestation of Ectopic ACTH syndrome in a HIV infected patient

Costalonga

Moreira²,

Borges³

et al. 2016

Int Arch Med

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The Ectopic Adrenocorticotrophic Hormone (ACTH) Syndrome (EAS) is a high mortality paraneoplastic syndrome, which represents 10-15% of Cushing Syndromes (CS). Around 70% of tumors are located in the chest, neck or adrenals. It frequently has atypical manifestations, leading to delay in diagnosis. Here, we report a particular case of EAS manifested predominantly by nephrogenic diabetes insipidus (NDI). A 48 years old man, HIV infected, was admitted with polyuria, polidipsia and lower limb weakness. He had hipertension, crackles in the right hemithorax and linphanedophathy. Laboratory assessments showed hyperglycemia, hypernatremia, severe hypocalemia, metabolic alkalosis and low urinary osmolarity, which persisted after water deprivation test and desmopressin administration, characterizing a NDI. Chest images showed a lung tumor, which, in conjunction with the clinical and laboratorial picture lead to the suspicion of EAS. Cortisol levels after dexametasona were 143μg/dL and serum ACTH was 630pg/ mL. Pituitary was normal and adrenals showed bilateral hyperplasia. Lymph node biopsy revealed a neuroendocrine tumor with positive immunohistochemistry for ACTH. Patient died a few days later due to nosocomial pneumonia. The EAS can be associated with very high cortisol levels, which evolves rapidly, resulting in the absence of typical features of CS. The knowledge of the different clinical presentations is essential to establish prompt diagnostic and support. This syndrome has to be considered in patients with a neoplasm and diabetes insipidus, especially if accompanied by signs of excess of mineralocorticoid action. Although the ideal treatment is excision of the tumor, adrenolitic drugs may help to reduce complications and improve survival.

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contrasting

confidence: 87%

Nephrogenic diabetes insipidus as the first manifestation of Ectopic ACTH syndrome in a HIV infected patient

Costalonga

Moreira²,

Borges³

et al. 2016

Int Arch Med

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“…56 AKI results from direct toxicity to tubular cells, mediated by mitochondrial injury, resulting in ATN. 57 Proximal tubular dysfunction presents as electrolyte derangements, including an overt Fanconi syndrome.…”

Section: Antiretroviral Drugsmentioning

confidence: 99%

Drug-induced impairment of renal function

Pazhayattil¹,

Shirali²

2014

IJNRD

118

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Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. However, all agents also carry adverse drug effect profiles. While most of these are clinically insignificant, some drugs may cause unacceptable toxicity that impacts negatively on patient morbidity and mortality. Recognizing adverse effects is important for administering appropriate drug doses, instituting preventive strategies, and withdrawing the offending agent due to toxicity. In the present article, we will review those drugs that are associated with impaired renal function. By focusing on pharmaceutical agents that are currently in clinical practice, we will provide an overview of nephrotoxic drugs that a treating physician is most likely to encounter. In doing so, we will summarize risk factors for nephrotoxicity, describe clinical manifestations, and address preventive and treatment strategies.

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“…Thus, our study indicates that AKI due to TDF induced tubule interstitial disease is an important mechanism and the incidence of AKI is therefore much less in TDF sparing regimen. [12] 5(6.09%) patients with AKI who were on TDF based regimen had a partial recovery with high creatinine values at the time of discharge and at 3 months follow up suggesting progression to CKD.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury and Chronic Kidney Disease in Hiv Patients in the Era of Antiretroviral Therapy

Patil¹,

B²,

C³

et al. 2018

jemds

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BACKGROUND HIV/AIDS may have renal involvement as a direct consequence of HIV infection, due to opportunistic infections, neoplasm or related to drug toxicity. The present study was done to determine etiological factors, biochemical profile and outcome of patients of HIV with acute kidney injury (AKI) and chronic kidney disease (CKD) separately. MATERIALS AND METHODSIn this descriptive study, HIV positive patients aged >18 years who were admitted or seen on OPD basis were screened for renal involvement Patients who were positive on screening were classified as AKI or CKD, underwent investigations for cause including kidney biopsy if indicated and followed up prospectively. RESULTSTotal 116 patients were observed of which 82 had AKI, and 34 patients had CKD. Infectious diseases causing AKI was the most prevalent cause especially in patients not on ART followed by tenofovir (TDF) use causing AKI. 74/82 (90.24%) had CD4 count of < 500 cells/mm3. CKD group comprised of only CKD in 5 patients, TDF nephrotoxicity overlapping with CKD in 19 patients and AKI on CKD in 10 patients. 32/34 (94.11%) had CD4 count of < 500 cells/mm3. In total 84 (72.41%) patients with renal failure comprising 54 (65.85%) from AKI group and 30 (88.24%) patients from CKD group were on TDF based ART regimen. In 5 (6%) patients with TDF induced AKI had the partial recovery with high creatinine values at the time of discharge and 3 months follow up suggesting progression to CKD. CONCLUSIONPrerenal AKI due to various opportunistic infections was a significant cause of AKI particularly in patients not on ART. Tenofovir was leading cause of renal failure causing AKI as well as contributing to nephrotoxicity in CKD cases. Thus, our study shows that drug-induced nephrotoxicity mainly due to TDF is a very important cause of morbidity in HIV. Our study showed a strong correlation between advanced immunosuppression and renal failure.

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Tubulointerstitial Nephropathies in HIV-Infected Patients over the Past 15 Years

Cited by 63 publications

References 53 publications

Nephrogenic diabetes insipidus as the first manifestation of Ectopic ACTH syndrome in a HIV infected patient

Nephrogenic diabetes insipidus as the first manifestation of Ectopic ACTH syndrome in a HIV infected patient

Drug-induced impairment of renal function

Acute Kidney Injury and Chronic Kidney Disease in Hiv Patients in the Era of Antiretroviral Therapy

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