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Renal Impairment – Treatment Overview

Treatment Overview

Guidelines provide recommendations on when to discontinue or adjust ARV drug doses.1

Lifestyle modifications including smoking cessation, dietary counselling and exercise have also been recommended.1

Table 1: Recommendations for management of nephropathy in HIV-infected patients.1 


HIVAN suspected if black ethnicity & UP/C > 100 mg/mmol & no hematuria

Reproduced with permission from the European AIDS Clinical Society Guidelines. Version 6.0.
 

  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists reduce urinary protein excretion and slow the progression of end-stage renal disease2
    • treatment should also be considered in diabetic patients with microalbuminuria, as microalbuminuria predicts subsequent decreases in glomerular filtration rate (GFR).2
       
  • In the case of HIV-associated nephropathy (HIVAN), starting antiretroviral therapy may be warranted in patients with >350 CD4+ cells/mm3; reduction of ongoing viral replication may preserve kidney function and improve survival.2

Download further recommendations on the management of kidney disease



For HIV-infected patients receiving antiretrovirals and other commonly used medications, dosage reductions are often recommended in those with RI.

References

  1. European AIDS Clinical Society. Guidelines. Version 6.0. Accessed 4 July 2012. 
  2. Rieke A. Clinical manifestation/diagnosis of nephropathy: HIV and Renal Function. Accessed 1 March 2011.