This World Kidney Day, UKZN’s Extension for Community Healthcare Outcome (ECHO)-Outreach Project hosted a webinar titled: HIV and the Kidney, presented by Dr Astley Frank, a consultant at Inkosi Albert Luthuli Central Hospital’s Department of Nephrology and Hypertension.
Frank explained that even with antiretroviral therapy and viral suppression, HIV infection persists in triggering inflammation within the kidney. This inflammatory process can be exacerbated by factors (‘second hits’) such as drug toxicity, including adverse effects from antiretroviral therapy (ART) designed to combat HIV such as Tenofovir disoproxil fumarate (TDF).
Additionally, genetic predisposition (APOL 1 polymorphisms), exposure to herbal therapies, co-infection with hepatitis B or C and tuberculosis and non-communicable disease (diabetes) could contribute to disease progression.
Frank emphasised the necessity of individualised screening and education programmes for patients living with HIV to effectively limit the progression of kidney disease. Such programmes should encompass the following key components:
• History taking and drug review
• Physical examination, including urinalysis, urine dipsticks, blood pressure measurement and a renal function test (estimated glomerular filtration rate)
• Addressing chronic comorbidities such as diabetes or hypertension
• Addressing social and behavioural factors
Frank emphasised that any abnormality detected signalled an increased risk of kidney disease and warranted early intervention or referral to a higher level of care. These preventative strategies would certainly mitigate disease progression and the need for dialysis.
Frank’s insights were commended by the audience, webinar facilitator and Clinical Unit Head of Nephrology IALCH and UKZN, Dr Sudesh Hariparshad, and by UKZN ECHO-Outreach Project Lead, Dr Serela Ramklass.
The UKZN ECHO-Outreach is a partnership between UKZN, the Department of Health, and the University of New Mexico.
Kidney disease is at epidemic proportions. Many affected individuals will require some form of renal replacement therapy (dialysis or kidney transplant) if comprehensive strategies are not instituted to curb this public health crisis. It is known that injury or disease, including HIV infection, can damage the kidneys and lead to kidney disease. Kidneys function primarily to filter blood, remove waste and balance bodily fluids.
In the context of HIV, kidney disease can manifest even in individuals with controlled infection. With the emergence of newly described histopathological patterns (such as tubulointerstitial disease and immune complex deposition), the presentation highlighted the evolving pathological mechanisms, precipitating risk factors and various clinical considerations in order to prevent the progression of HIV associated kidney disease in the post-antiretroviral therapy era.
Words: Lunga Innocent Memela
