HIV and Kidney Disease
Please click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using. Click here to access the Adult Hospital Level Chapter 10: HIV_and_AIDS_with_supporting_NEMLC_Report_Reviews_2025-9-Versio
Please click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using.
N28.9 + (B23.8)
DESCRIPTION
A number of kidney disorders are associated with HIV infection.
Acute kidney injury due to sepsis, dehydration or nephrotoxicity from medicines occurs commonly.
The commonest chronic kidney disorder is HIV-associated nephropathy (HIVAN).
Typical features of HIVAN are:
- Heavy proteinuria.
- Rapidly progressive chronic kidney disease with preserved kidney size on imaging.
Early detection of kidney disease is important in order to implement interventions that may slow kidney disease progression, and for adjusting the dose of relevant medicines.
Risk factors for HIV renal disease:
- CD4 count <200 cells/mm3.
- Use of nephrotoxic medications.
- Comorbidity such as diabetes mellitus, hypertension, or hepatitis C virus co-infection.
- ART may slow progression of HIVAN.
Screening for renal disease in HIV
- Tests should include:
- Urine dipstick for haematuria and proteinuria (request urine protein:creatinine ratio if proteinuria is detected; discuss with a specialist if >0.15 g/mmol).
- Serum creatinine and eGFR.
Dose adjustment of ART in renal impairment: Refer to table: Dosing and important adverse effects associated with ART in Antiretroviral therapy.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 2.1_09 December 2024
Chapter 10 HIV and AIDS_10.3 HIV and Kidney Disease