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ORIGINAL ARTICLE
Acute kidney injury in HIV-positive patients
1
Devi PS, 2 Singh Lk S, 2 Dhanaraj Ch, 3 Shreeniwas S, 4 Singh S
Abstract
Objective : To study the incidence, spectrum,
prognosis and outcome of clinical renal
disease with special emphasis on acute
kidney injury in patients with HIV infection.
Methods: A protocol of study was prepared.
All HIV patients of both genders regardless of
age attending Antiretroviral treatment (ART)
Centre and those admitted in the wards of the
hospital (Sir Sunderlal Hospital, Varanasi, Uttar
Pradesh, India) were subjected for screening
of clinical renal disease. HIV-seropositive
patients with clinical renal diseases were
included and divided into two groups: (A)
Asymptomatic patients without manifestations
of renal diseases but found to have a
significant renal involvement on screening
and (B) Patients with symptomatic renal
diseases. HIV-associated renal disease were
diagnosed using the following criteria: 1)
Positive HIV Serology, 2) CD4 T-Lymphocyte
count, 3) Proteinuria / Haematuria, 4) Elevated
serum creatinine and 5)Quantitative
proteinuria (24 hours urinary protein or spot
urine Protein/creatinine ratio). National AIDS
Control Organisation (NACO) Guidelines of
India, 2007 were followed for the diagnosis of
1
Assistant Professor 2 Associate professor, Regional
Institute of Medical Sciences, Imphal; 3 Consultant
Nephrologist, ARTEMIS Hospital, Gurgaon; 4 Lecturer,
Department of Nephrology, Institute of Medical
Sciences, Banaras Hindu University, Varanasi (India).
Address for Correspondence:
Dr Loukrakpam Sharatchandra Singh, Associate
Professor (Medicine), Regional Institute of Medical
Sciences, Imphal – 795004 (India).
e-mail: lkbhu@sify.com
HIV-seropositivity. Results: 47 HIVseropositive
patients were found to have
clinical renal disease during the study period
of August 2007 and July 2009. During the two
years study period, there were 3545 patients
of HIV-seropositive patients and only 1725
patients (611 females and 1114 males) were
enrolled for ART as they fulfilled NACO
guidelines. 47 (1.33%) patients (44 males and
3 females) were found to have clinical renal
disease. Most of the patients (45/47) had AKI
(pre-renal-15, acute tubular necrosis-27,
interstitial nephritis-3). Proteinuria, serum
creatinine and serum albumin were 0.935±
0.985 gm/day, 5.28± 5.64 mg% and 2.92± 0.58
respectively. Renal biopsy were done on 2
indicated patients who showed
granulomatous glomerulonephritis, and
Tubulointerstitial nephritis in one patient each.
CD4 count was in the range of 43-
842(170.36± 157.75) cells/µL. 9 patients
(1.7%) having HIV-related clinical renal disease
died due to sepsis (5), tubercular meningitis
(3) and hypovolemia (2). Peritoneal dialysis
could be done in 6 patients. Conclusion: AKI
mostly related to acute tubular necrosis was
the most common HIV-related clinical renal
disease. Evidence of non-specific glomerular
disease with or without interstitial nephritis
was observed in 2 patients. HIV-associated
nephropathy well documented in western /
African-American literatures was not observed
in our study
Key words: HIV Infection, Acute Kidney injury,
Mortality, CD4.
8 JMS * JMS Vol 25 * Vol * No. 25 3 * No. * September, 1 * June, 2010 2011