Apart from common causes such as diabetes and high blood pressure, people with HIV have additional risk factors for kidney disease. HIV itself, or the inflammation it causes, can damage the kidneys, even if the viral load is undetectable. Certain HIV medications can also decrease kidney function.
WHAT HAPPENS WHEN YOU HAVE KIDNEY DISEASE?
Kidneys filter waste products out of the blood and make urine. They also control blood pressure and keep your body chemicals in balance. When the kidneys are damaged, blood pressure can get so high that it damages other organs, like the heart or the or the brain. This can cause heart attacks or strokes, leading to decreased function or death. A buildup of waste or chemicals can cause confusion, bone problems, or death.
TALK TO YOUR DOCTOR IF YOU HAVE DIABETES OR HIGH BLOOD PRESSURE
People with high blood pressure or diabetes should be checked regularly for kidney disease since these conditions can damage the kidneys. Work with your doctor to keep them under control.
ASK IF YOU NEED TO CHANGE OR STOP SOME OF YOUR MEDS
Kidneys filter the unwanted chemicals from your meds and pass them out of your body as urine. If your kidneys are damaged, you may need to change your meds or change the dose to prevent a toxic buildup. Bring all your pill bottles to your doctor, including over-the-counter and herbal pills. Sit down with your doctor and go through them one by one, to see if you need to change any of them. Any time you start a new med or alternative treatment, be sure to discuss it with your doctor.
Ask your doctor exactly which over-the-counter meds you should avoid. For example, most people with reduced kidney function should not take drugs like aspirin, ibuprofen, Advil, Motrin, or Aleve. Ask your doctor which pain meds are right for you.
TALK TO YOUR DOCTOR BEFORE YOUR KIDNEY DISEASE WORSENS
In some cases, kidney function can worsen to the point where the kidneys are unable to function. When this happens, people may need to go on dialysis (using a machine to filter the blood) or get a kidney transplant. Plan and talk to your doctor early about your options. Bring a friend or family member you trust who can help you decide what to do if your kidneys get worse.
WHAT YOU CAN DO YOURSELF
Take the right number of pills at the right time of day as prescribed. This is especially important for people with kidney disease. Uncontrolled HIV, blood sugar, or blood pressure can damage your kidneys. Also, the right pills will keep your chemicals balanced and prevent you from feeling ill. If you have reduced kidney function, alert any new doctor you see, since the dose of many medications may need to be adjusted.
EAT A BALANCED DIET
If you eat a lot of salt or protein, the kidneys must work harder to filter them out. To protect your kidneys, eat a low-salt diet with the right amount of protein. To plan a diet that is easier on your kidneys, see a nutritionist. Ask your physician if a multi-vitamin or mineral supplement is right for you.
BACKGROUND
Diseases of the kidney (renal diseases) are more common in older adults with HIV than in those without HIV. Fortunately, the risk has decreased due to better and earlier HIV treatment. That has reduced, but not eliminated, the effect of HIV on the kidneys. Also, the negative effect of the virus appears to be stronger in Black men. A large study of veterans found that kidney disease may occur somewhat earlier in people with HIV. Infectious disease doctors and nephrologists are now working together to prevent, diagnose, and treat kidney problems earlier in patients.
CAUSES
When HIV infection first begins, the virus enters the covering of the kidney and subsequently causes damage to the deeper structures of the kidney (glomeruli and tubules). These parts of the kidney cleanse harmful products and control the balance of chemicals in the body. Usually, the kidney disease process is slow, but there can also be acute kidney problems. This process can be made worse by various factors. It appears that Black people may have genetic factors that make those with HIV more prone to chronic kidney disease. Research is not clear about the causes of chronic kidney disease in Black People specifically whether it is genetic or related to other co-existing condition, such as hypertension and diabetes that are not being adequately treated. Hepatitis C infection can also affect the kidneys.
HIV drugs can adversely affect the kidneys, especially atazanavir and ritonavir. Also, the PrEP drug Truvada contains TDF, which has led to kidney problems in a very small number of users. A new version the drug, TAF, may lower the risk of kidney problems. Over the counter pain meds, such as ibuprofen and aspirin, can also affect the kidneys, so people with kidney disease should use drugs like acetaminophen instead. In addition, ibuprofen can also cause acute kidney disease.
DIAGNOSIS
Early diagnosis of kidney problems relies on regular testing of the blood and urine. Your healthcare provider may measure creatinine levels to assess kidney function. Elevated levels could suggest a developing kidney problem. Also, creatinine levels are used in determining creatinine clearance by the kidneys, sometimes called the glomerular filtration rate. A normal value is 100 ml/minute or greater. A value of 60 suggest a problem, while a value of 30 is serious and requires the consultation from a nephrologist. Urine should also be checked twice a year for the amount of albumin, a type of protein. If albumin is elevated, the kidney may be damaged and leaking protein. This condition would require a consultation with a nephrologist.
A biopsy of the kidney may be indicated to determine the cause and seriousness of a kidney problem. This is done under local anesthesia and involves the removal of a piece of tissue that is checked under the microscope. Certain patterns can tell for sure what is going on and clarify the best course of action.
TREATMENT
If kidney problems are developing, you should still continue taking your HIV meds to ensure undetectable viral load. You should also make sure your blood pressure is not elevated. Any level below 140/90 is good, but the optimal reading is 120/80. An elevated blood pressure can be addressed by weight loss and medications.
If your blood sugar levels are elevated (as indicated by the A1C blood test), you may be at risk of diabetes. In some cases, weight loss will be sufficient to lower blood sugar, but medications may be necessary to control the condition.
To avoid kidney failure (the technical term is “end-stage renal disease”), a diet of low protein and low salt will be helpful. However, you may need dialysis to ensure regular cleansing of the body. If all these interventions fail, you may need a kidney transplant. Kidney transplants are becoming more common. Recently, kidney transplants have been done between people living with HIV.
Preventing kidney disease is, of course, the best strategy. However, other more complicated treatments are becoming quite successful in prolonging life, even if they might seem extreme.