title: Acute kidney injury in patients with human immunodeficiency virus infection.
abstract: Acute kidney injury (AKI) is an important cause of hospitalization and morbidity in human immunodeficiency virus (HIV)-positive patients. However, the data on AKI in such patients is limited. The aim of the present study was to analyze the incidence, causes and outcome of AKI in HIV-positive patients from our antiretroviral therapy centre. All HIV-positive patients were evaluated for evidence of clinical AKI. AKI was noted in 138/3540 (3.9%) patients. Of 138 AKI patients, 96 (69.6%) had acquired immuno deficiency syndrome and 42 (30.4%) were HIV seropositive. Majority of AKI patients belonged to AKI network (AKIN) Stage II (42%) or III (48.5%) at presentation. Prerenal, intrinsic and postrenal AKI were noted in 53.6%, 44.2% and 2.2% of cases, respectively. Hypovolemia (44.2%) and sepsis (14.5%) contributed to AKI in vast majority of cases. AKI was multifactorial (volume depletion, sepsis and drugs) in 39% of patients. Acute tubular necrosis (ATN) was the most common intrinsic lesion. Acute interstitial nephritis and diffuse endocapillary proliferative glomerulonephritis were noted in five and two cases, respectively. In-hospital mortality was 24.64%. Lower CD4 count, decreased serum albumin level and Stage 4 WHO disease were associated with higher mortality. At 3 months or more follow-up complete recovery of renal function, chronic kidney disease Stage 3-5 and progression to end stage renal disease were noted in 58.69%, 14.5% and 2.2% of cases, respectively. Thus, prerenal factors and ischemic ATN were the most common cause of AKI in HIV-infected patients. Recovery of renal function was seen in 59% of cases, but AKI had high in-hospital mortality.
authors.affiliation: Department of Nephrology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: J
authors.initials: J
authors.lastname: Prakash
authors.affiliation: Department of Medicine, TNMC, Mumbai, Maharashtra, India.
authors.forename: T
authors.initials: T
authors.lastname: Gupta
authors.affiliation: Department of Medicine, TNMC, Mumbai, Maharashtra, India.
authors.forename: S
authors.initials: S
authors.lastname: Prakash
authors.affiliation: Department of Nephrology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: S S
authors.initials: SS
authors.lastname: Rathore
authors.affiliation: Department of Pathology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India.
authors.lastname: Usha
authors.affiliation: Department of Medicine, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: S
authors.initials: S
authors.lastname: Sunder
keywords: Acute glomerulonephritis; acute kidney injury; acute tubular necrosis; human immunodeficiency virus; sepsis
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