Medical Complications Caused By Kidney Failure
In addition to these symptoms, the failure of one or both kidneys causes a backup in the bodys excretion systems. This can lead to some other very serious medical complications as the rest of the body has to deal with it, including:
- Anemia, as hormones produced by the kidneys decreases, lowering the production of red blood cells,
- Hyperkalemia, as potassium builds up in the bloodstream,
- Polycystic kidney disease, which causes bubbles of fluid to form on the kidneys and liver,
- Osteomalacia, or bone damage from the altered levels of phosphates in the bloodstream, which the kidneys used to be able to filter,
- Fluid buildup as the kidneys are no longer able to excrete the volume of fluid as before, causing high blood pressure, swelling, and forcing fluid into the lungs,
- Lactic acidosis, and
- Heart disease.
While many of these medical conditions are severe or even life-threatening, the bone damage that can be caused by renal failure is especially problematic for people taking TDF drugs. This bone damage, or osteomalacia, can exacerbate the bone density loss that TDF toxicity already causes on a patients bone structure.
Causes Of Renal Disease In Plwhiv
As discussed in more detail below the aetiology of CKD in PLWHIV may be related to the HIV-infection and associated viral replication itself or, more commonly, be due to manifestations of a patients NICMs, or from side effects of ART . A classification system of CKD in PLWHIV based on the dominant tissue compartment affected in the kidney may be useful, as shown in Table . To differentiate with certainty between the wide-range of different renal pathologies that are possible in PLWHIV a renal biopsy is required, although, not always clinically available or indicated. The clinical risks of performing a renal biopsy must also be considered . As well, even with a renal biopsy, it can be difficult to attribute the causation of HIV in the pathological changes demonstrated .
Table 2 Classification of HIV associated renal pathology based on tissue compartment affected
Treatment Of Kidney Infection
Most kidney infections need prompt treatment with antibiotics to stop the infection damaging the kidneys or spreading to the bloodstream.
You may also need painkillers.
If youre especially vulnerable to the effects of an infection , you may be admitted to hospital and treated with antibiotics through a drip.
Most people who are diagnosed and treated promptly with antibiotics feel completely better after about 2 weeks.
People who are older or have underlying conditions may take longer to recover.
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Acute Kidney Injury In Hiv
AKI is more frequent in HIV-infected individuals than in the non-infected general population . HIV infection is an independent risk factor for AKI in hospitalized and community-dwelling patients. The incidence of AKI is variable according to different literature sources and comparisons are difficult, as most studies were retrospective and used diverse AKI diagnosis criteria, mainly based on clinical judgment . However, incidence of AKI appears to have decreased with widespread cART use, when AKI is diagnosed by using the new classification criteria . In any case, AKI remains common.
In the developed world and in the cART era, the incidence of AKI in ambulatory HIV-infected patients was reported to range from 2.7 to 6.9 per 100 person-years . The incidence differed between early and late-onset AKI, being more than 10-fold lower after the initial 3 months of HIV care . This suggests that cART and control of opportunistic infections are associated with decreased risk of AKI.
Among hospitalized patients AKI occurs at 23 times the rate observed in uninfected controls and the incidence ranges between 6 and 18% . The highest AKI incidence, as expected, was observed in intensive care unit settings, ranging from 47 to 66%. The main risk factors were previous comorbidities such as CKD and illness severity .
In general, AKI in HIV-infected individuals is more frequently related to severe opportunistic infections than to direct cART toxicity .
Kdigo Executive Conclusionskidney Disease In The Setting Of Hiv Infection: Conclusions From A Kidney Disease: Improving Global Outcomes Controversies Conference
HIV-positive individuals are at increased risk for kidney disease, including HIV-associated nephropathy, noncollapsing focal segmental glomerulosclerosis, immune-complex kidney disease, and comorbid kidney disease, as well as kidney injury resulting from prolonged exposure to antiretroviral therapy or from opportunistic infections. Clinical guidelines for kidney disease prevention and treatment in HIV-positive individuals are largely extrapolated from studies in the general population, and do not fully incorporate existing knowledge of the unique HIV-related pathways and genetic factors that contribute to the risk of kidney disease in this population. We convened an international panel of experts in nephrology, renal pathology, and infectious diseases to define the pathology of kidney disease in the setting of HIV infection describe the role of genetics in the natural history, diagnosis, and treatment of kidney disease in HIV-positive individuals characterize the renal risk-benefit of antiretroviral therapy for HIV treatment and prevention and define best practices for the prevention and management of kidney disease in HIV-positive individuals.
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Hiv Medication And Kidney Disease
Introduction
Antiretroviral therapy is helping people with HIV live longer and better than ever before. However, people with HIV still have a higher risk of other medical problems, including kidney disease. Kidney disease can be a result of an HIV infection or the drugs used to treat it. Fortunately, in many cases, kidney disease is treatable.
Here are a few things to know about the risks of kidney disease in people with HIV.
Urinary Tract Infection Faqs
Q: What causes a urinary tract infection?A: Urinary tract infections are very common, especially in women, and are most often caused when bacteria from the bowel or genital region enter the body through the urethra. This can lead to an infection of the urethra, bladder, ureters or kidneys. Over 85 percent of UTIs are caused in this way.
UTIs can also be caused by viral, fungal or parasitic infections, but these are much less common causes.
Q: Can men develop a urinary tract infection?A: Yes, although they are rare in men under 50 years of age. Men are less likely than women to develop a UTI because the male urinary tract has more natural defences to infection, such as a longer urethra and further distance between the urethra and the anus.
For this reason, urinary tract infections in men are more likely to be due to a medical cause or an anatomical predisposition to UTIs.{^33]
Q: Can children develop a urinary tract infection?A: Yes, urinary tract infections are a common condition in babies, toddlers and children. In fact, it is the most common bacterial infection in children under two years of age. The usual cause of UTIs in children is similar to adults: bacteria from the anal region entering the urinary tract through the urethra. Some children may be at added risk of developing a UTI due to not having developed effective personal hygiene methods, such as wiping from front to back after using the toilet.Read more about Pediatric Urinary Tract Infection û.
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What Do Kidneys Do
Most people have two kidneys, located on each side of the spine towards the back of the tummy .
Kidneys filter toxins and waste products from the blood. These are then converted into urine and expelled from the body via the bladder. Kidneys also release hormones to regulate blood pressure and the production of red blood cells, as well as helping the body to absorb calcium.
If you think you might have developed a problem with your kidneys, talk to your doctor at your HIV clinic. They might be able to help you or adjust your treatment if necessary.
What Are The Symptoms Of Kidney Disease
Kidney disease can advance very slowly. Slowly worsening kidney disease is called chronic kidney disease.
As kidney disease gets worse, a person may have swelling of the legs, feet, or ankles . Symptoms of advanced chronic kidney disease can include:
- Increased or decreased urination
- Feeling tired or having trouble sleeping
- Nausea and vomiting
- Itching or numbness
Blood and urine tests are used to detect kidney disease. Care for people with HIV includes testing for kidney disease.
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Complications Of Decreased Kidney Function
In addition to understanding the cause of kidney disease and implementing treatment, another focus in clinical care is treating the complications of decreased kidney function. These complications include anemia and disorders of calcium and phosphorus metabolism.
Anemia is frequently seen among persons with HIV infection due to a number of etiologies, including medications and the primary infection itself. Kidney disease adds to the likelihood of anemia with a decreased ability by the kidney to produce the hormone erythropoietin. While the importance of treatment focused on improving quality of life cannot be emphasized enough, the effects of anemia management should be considered when choosing a treatment program. Recent clinical trials demonstrating an increased risk of tumor progression among oncology patients treated with erythrocytosis-stimulating agents , which are drugs to reduce an excess of red blood cells, and an increased risk of cardiovascular events among persons with kidney disease treated to higher hemoglobin goals with ESAs have resulted in a change in the labels of these compounds, suggesting that they be utilized as the smallest dose required to obviate the need for blood transfusions. How these data and warnings should be translated to HIV positive patients has not been defined, but patients and health care providers should be aware of them in developing a treatment plan.
Introduction: The Era Of Potent Antiretroviral Therapy And Shift In Hiv Clinical Priorities
With the introduction of potent combination antiretroviral therapy has come the ability to durably and reliably control HIV disease progression. As a result, survival among people with HIV has improved dramatically and there is now hope for near-normal life expectancy .
The introduction of ART has also profoundly affected the course of HIV infection such that non-AIDS-related chronic conditions are replacing opportunistic illnesses as major causes of death and disease . Renal disease, for example, is increasingly prevalent in people with HIV and now ranks as a major cause of death in this group .
The dramatic improvements in survival afforded by ART have also shifted the clinical priorities of health care providers and patients whereas once delaying opportunistic illness was a primary focus, increasing emphasis is now placed on preventative health, management of comorbid chronic disease and avoidance of the long-term toxicities of ART .
Accumulating data from observational cohort studies suggest a number of potential long-term toxicities from ART, including lipoatrophy, neuropathy, dyslipidemia, glucose intolerance, osteopenia and cardiovascular disease . This review focuses on ART-associated nephrotoxicity and suggests strategies for early clinical recognition and possible prevention.
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Hepatitis C And Acute Kidney Injury
Acute kidney injury is when your kidneys stop working suddenly, over a very short period of time. Usually your kidneys will start working again, if the cause for the acute kidney injury is treated quickly. Sometimes hepatitis C can cause AKI, but this does not happen very often.
Hepatitis C is connected to AKI because:
- Hepatitis C can cause vasculitis. Vasculitis is the inflammation of blood vessels, arteries and veins. If the blood vessels of your kidneys get inflamed , this can cause acute kidney injury.
- In a few rare cases, some medicines for hepatitis C were connected to an increased chance of having AKI.
Investigating The Underlying Cause
Urine can be tested for protein, blood cells, sugar and waste products, which may give clues to the underlying cause.
Doctors also need to know about:
- any other symptoms, such as signs of sepsis or signs of heart failure
- any other medical conditions
- any medication thats been taken in the past week, as some medicines can cause AKI
An ultrasound scan should reveal if the cause is a blockage in the urinary system, such as an enlarged prostate or bladder tumour.
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What Tests Are Needed
Blood and urine tests are used to determine if kidney failure is present, and if it is, how severe it is. Other tests, such as x-rays, sonogram , and special blood tests are usually necessary to tell what caused the kidney failure. Sometimes a biopsy of the kidney is recommended. The cause of kidney failure is not always easily discernable.
Treatment of AKI depends on whats causing your illness and how severe it is.
You may need:
- to increase your intake of water and other fluids if youre dehydrated
- antibiotics if you have an infection
- to stop taking certain medicines
- a urinary catheter, a thin tube used to drain the bladder if theres a blockage
You may need to go to hospital for some treatments.
Most people with AKI make a full recovery, but some people go on to develop chronic kidney disease or long-term kidney failure as a result.
In severe cases, dialysis, where a machine filters the blood to rid the body of harmful waste, extra salt and water, may be needed.
Epidemiology And Risk Factors For Ckd In Hiv
CKD is defined as kidney damage or reduced kidney function that persists for > 3 months . A useful indicator of kidney damage is elevated urinary protein excretion, measured qualitatively with use of a urine dipstick or measured quantitatively with use of a spot urine protein-to-creatinine ratio . Kidney function can be reliably estimated from the serum creatinine by calculating the creatinine clearance or glomerular filtration rate through use of the Cockcroft-Gault or Modification of Diet in Renal Disease equations, respectively. A GFR < 60 mL/min meets criteria for CKD, a cutoff supported by epidemiologic data linking lower GFR to an increased frequency of hospitalization, cardiovascular events, or death. Neither the Cockcroft-Gault nor the MDRD equations has been specifically validated in the HIV-infected population. The MDRD equation was derived from patients with low GFR and therefore can yield variable results in persons with normal renal function . Nonetheless, these estimates remain the most highly validated formulas available, and both equations are more sensitive than measurement of serum creatinine alone.
Antivirals and antibiotics with known nephrotoxicity.
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Diarrhea And Kidney Failure
Diarrhea is one gastrointestinal tract symptom of kidney failure. Excessive accumulation of creatinine, blood urea nitrogen and other wastes in the patients body can cause many sick feeling such as fatigue, nausea, poor appetite. If left untreated, patients can develop serious vomiting, indigestion, diarrhea, low blood volume or even rapid decline of kidney functions.
Diarrhea can cause or worsen kidney failure. There have been many reports about renal failure after serious diarrhea. Diarrhea can be caused by food poisons and it can cause many complications if left untreated. Many organs can be involved and renal failure is one relatively severe complication.
Why diarrhea causes renal failure? Not all diarrhea will cause renal damages or renal failure. Here we refer to very serious diarrhea. In case of diarrhea, the whole bodys effective blood volume will experience sharp decline. Blood flow to the kidneys will be suddenly reduced and cause hypoperfusion in the kidneys. Unclean foods can cause gastrointestinal tract infections which can cause renal damages too. Besides, diarrhea can cause dehydration, electrolyte disorders, malnutrition and disturbed internal environment. As a result, kidneys will be impaired and kidney functions will be lost and kidney failure will occur.
How Did The Patient Develop Renal Disease What Was The Primary Source From Which The Infection Spread
At present, our understanding of the pathobiology of kidney disease suggests it develops based on the presence of a genetic predisposition, complications of metabolic or infectious diseases, or toxicities of medications. The precise risk factors for kidney disease differ based on the type of kidney disease.
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Independent of the cause of kidney disease among persons with human immunodeficiency virus , risk factors for the presence of chronic kidney disease include hepatitis C coinfection, lower cluster of differentiation 4 lymphocyte count, and higher HIV ribonucleic acid level.
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Among people with kidney disease related to diabetes mellitus or hypertension , risk factors for end organ damage among persons with DM include time since diagnosis of DM and less rigorous control of blood sugar. Risk factors for kidney disease related to both DM and hypertensive nephropathy also include higher blood pressures and African-American race.
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Causes Of Vomiting And Diarrhea At The Same Time
Vomiting and diarrhea can happen at the same time for a number of reasons. A stomach virus or bacterial gastrointestinal infection is the most likely cause in children. The gastrointestinal tract is part of the digestive system.
These infections can affect adults as well, but there are a number of other reasons why an adult may experience these symptoms simultaneously, such as drinking too much alcohol or being pregnant.
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