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Kidney problems and HIV

facts and figures

HIV can cause specific kidney damage known as ‘HIV associated nephropathy’ (HIVAN) where the kidneys become enlarged.

Symptoms of kidney problems can include:

  • headaches
  • tiredness
  • nausea
  • muscle cramps
  • reduced flow of urine - although an early sign of kidney problems can be frequent urination at night.

What is HIV associated nephropathy (HIVAN)?

HIV can cause specific kidney damage known as ‘HIV associated nephropathy’ (HIVAN) where the kidneys become enlarged.

HIVAN tends to be more common in African people or people of African descent. Usually HIVAN improves once you start taking antiretroviral treatment.

Similarly chronic kidney disease (CKD) seems to be more prevalent among south Asian and black people. This is probably because there are higher rates of diabetes in south Asian people and higher rates of high blood pressure in African and Caribbean people.

Does HIV treatment cause kidney problems?

Links have been made between the NRTI antiretroviral drug Tenofovir (also found in the combination drugs Truvada, Atripla and Eviplera) and impaired kidney function. However various studies have made different findings about the severity and incidence of kidney problems caused by Tenofovir.

The protease inhibitors, Atazanvir and the rarely-used Indinavir, have been linked to kidney stones. These are crystals which form inside the kidney which can form a ‘stone’ over time. These can cause pain as your body tries to pass them out through your bladder.

The D:A:D study - which has over 35,000 participants with HIV across Europe, the USA and Australia - has found that no antiretrovirals, including Tenofovir, cause advanced CKD.

Will I have to have extra tests?

Most people with HIV will be offered regular kidney function tests and if your healthcare team detects any problems you will be monitored more closely so the problem can be managed.

Tests often look for protein in the urine, as it should only be found in the blood. They also look for creatinine, a waste product, in the blood. If the levels of creatinine are high it shows that the kidneys are having trouble removing it. High blood pressure can be picked up in routine tests and may be a sign of kidney damage.

If kidney problems become more serious you might require dialysis, which is where waste is filtered from your blood medically. It is also possible to have a kidney transplant if necessary - having HIV doesn’t exclude you from this.

What do my kidneys do?

Most people have two kidneys which are located in the middle of their back below their ribcage (although many people function with just one).

Kidneys filter toxins and waste products from your blood, which are then converted into urine and expelled from your body via the bladder. Your kidneys also regulate your blood pressure and the production of red blood cells.

Chronic kidney disease (CKD) is when other conditions such as high blood pressure and diabetes cause strain on the kidneys. This leads to a gradual loss of kidney function, which can result in kidney failure. This is because diabetic people may have high glucose levels in their blood which can damage the kidneys' nephrons (part of the kidneys’ filtration system). High blood pressure can put strain on the blood vessels which surround the nephrons, causing damage.

Over 50 and living with HIV?

The Health Wealth and Happiness Project supports the financial, emotional and physical wellbeing of over 50s living with HIV in Brighton, Bristol, London, Manchester and the West Midlands.

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The Information Standard: Certified member

This article was last reviewed on 20/2/2015 by Anna Peters

Date due for the next review: 20/2/2018

Content Author: Kerri Virani

Current Owner: Health promotion

More information:

HIV and Chronic Kidney Disease, National Kidney Foundation (2008)

Tenofovir treatment impairs kidney function, but clinical significance limited, NAM aidsmap (2010)

The kidneys, NAM aidsmap (2011)

HIV and the kidneys, NAM aidsmap (2010)

Kidney disease in people with HIV: a clinical review (part one), NAM aidsmap (2011)

Kidney stones, NHS, June 2014

Vitamin D and Kidney Disease, DaVita, April 2009

HIV-associated nephropathy: a diagnosis in evolution, Patricio E. Ray, Nephrology, Dialysis, Transplantation Journal, March 5, 2012

Chronic Kidney Disease - Overview, NHS Choices, March 2013

Tenofovir (Viread) - Side effects - Kidney toxicity, NAM aidsmap, March 2011

Tenofovir (Viread), NAM aidsmap, March 2011

Indinavir (Crixivan) - Side effects, NAM aidsmap, March 2011

ART use not linked to advanced kidney disease in 35,000 with HIV, Mark Mascolini, International AIDS Society, February 2014

HIV. ARVs and kidney impairment, NAM aidsmap, March 2011