Kidney Function and Disease
Your kidneys filter extra water and wastes out of your blood and make urine. They also help control your blood pressure and make hormones that your body needs to stay healthy.
If your kidneys don’t work properly, harmful waste products can build up in your body and cause serious health problems.
Kidney disease (also known as “renal disease”) is an important complication of HIV infection. Up to 30 percent of people living with HIV have abnormal kidney function, which can lead to end-stage renal disease (ESRD), the complete or almost complete failure of the kidneys to work. This can require dialysis or a kidney transplant. Untreated kidney problems can be fatal.
Are You at Risk?
If you have HIV, you are more likely to develop kidney disease if you:
- Are African American
- Have diabetes
- Have high blood pressure
- Are older
- Have a lower CD4 count (below 200 cells/mm3)
- Have a higher viral load
- Have Hepatitis B or Hepatitis C
For more information, see the National Kidney Disease Education Programs’ About Kidney Disease.
Signs and Symptoms
Unfortunately, early kidney disease has no symptoms. If your kidneys are not working properly, they may suffer serious damage before you begin experiencing problems. That’s why it’s so important for your healthcare provider to test your kidney function on a regular basis.
A urinalysis is the most common test used to check kidney function. Your healthcare provider will order this test to check your urine for a number of things, including protein, ketones, and sugar. Protein in your urine is a sign that your kidneys are not working the way they should. Ketones and sugar in your urine are markers for diabetes—a major cause of kidney disease.
What Role Does HIV Play in Kidney Disease?
Kidney disease is common in people living with HIV/AIDS—up to 30% have abnormal kidney function. HIV can affect your kidneys in many different ways, but the most common are HIV-associated nephropathy and nephrotoxicity.
HIV Associated Nephropathy (HIVAN)
HIVAN is damage to your kidneys caused by the Human Immunodeficiency Virus (HIV) itself. African American men with HIV/AIDS seem to be most at risk for developing HIVAN. It is most common in patients with CD4 counts less than 200 cells/mm3, but it can occur at any CD4 count.
HIVAN is extremely uncommon in individuals with HIV who have a suppressed viral load (a low amount of HIV in their blood). Therefore, if you have HIVAN, it is very important to be started on antiretroviral therapy (ART) at the earliest sign of kidney problems—and to stay on it—no matter what your CD4 count is. Research shows that people who have HIVAN can stay healthy and live longer by staying on ART.
“Nephrotoxicity” is a term that means “toxicity or injury to the kidneys.” For people living with HIV/AIDS, nephrotoxicity can be an adverse side effect of certain HIV medications, including protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTIs—commonly called “nukes”).
Your kidneys clear many medications from your body, so if your kidneys aren’t working properly, your healthcare provider may need to adjust the HIV meds that you are taking. Sometimes that means changing which HIV meds you take; other times it means changing your dosage. Work with your healthcare provider to find a treatment regimen that works for you.
For more information, see The Body’s HIV and Kidney Disease .
HIV Treatment and Kidney Disease
Thanks to scientific advances in effective ART, people with HIV are living longer. But as people with HIV live longer, kidney problems may increase. While widespread access to and earlier initiation of ART has led to a decrease in HIVAN, other causes of kidney disease persist and, in some cases, are on the rise.
For example, in the U.S., people who are infected with HIV are three times more likely to develop hypertension (high blood pressure) and are four times more likely to develop diabetes than uninfected individuals. Both hypertension and diabetes are common causes of end-stage renal disease.
In addition, about 25% of people living with HIV in the United States are co-infected with hepatitis C virus (HCV), an inflammation of the liver that causes a chronic infection. HCV is associated with several types of kidney disease.
People living with HIV can also develop kidney disease caused by side effects of medication, including some antiretroviral (ARV) medications, as noted above.
For these reasons, it is very important to work closely with your healthcare provider to monitor your HIV treatment and ensure your kidneys stay healthy.
- HRSA – Guide for HIV/AIDS Clinical Care: Renal Disease
- NIH AIDSinfo – Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
- NIH/NIDDK, National Kidney Disease Education Program – Kidney Disease Basics
- NIH National Library of Medicine - Kidney Failure
- HIV Medicine Association - Guidelines for the Management of Chronic Kidney Disease in HIV-Infected Patients: Recommendations of the HIV Medicine Association of the Infectious Diseases Society of America
Last revised: 08/09/2013