HIV associated nephropathy natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
HIV-associated nephropathy (HIVAN) will progress to end-stage renal disease (ESRD) in a few weeks to months without treatment. However, early diagnosis and treatment has shown better outcome. | |||
==Natural History== | ==Natural History== | ||
If left untreated, HIV-associated nephropathy will progress to end-stage renal disease in a few weeks to months.<ref name="pmid18588500">{{cite journal| author=Atta MG, Lucas GM, Fine DM| title=HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management. | journal=Expert Rev Anti Infect Ther | year= 2008 | volume= 6 | issue= 3 | pages= 365-71 | pmid=18588500 | doi=10.1586/14787210.6.3.365 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18588500 }}</ref> | |||
* If left untreated, HIV-associated nephropathy (HIVAN) will progress to end-stage renal disease (ESRD) in a few weeks to months.<ref name="pmid18588500">{{cite journal| author=Atta MG, Lucas GM, Fine DM| title=HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management. | journal=Expert Rev Anti Infect Ther | year= 2008 | volume= 6 | issue= 3 | pages= 365-71 | pmid=18588500 | doi=10.1586/14787210.6.3.365 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18588500 }}</ref> | |||
* Treatment with cART has shown 60% reduction in the developement of HIVAN.<ref name="pmid18588500" /> | |||
* Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.<ref name="pmid18588500" /> | |||
* Early diagnosis and Immediate treatment has shown better outcome.<ref name="pmid18588500" /> | |||
== Complications == | == Complications == | ||
Possible complications that are associated with HIV-associated nephropathy include: | Possible complications that are associated with HIV-associated nephropathy include: | ||
* End-stage renal disease | * End-stage renal disease (ESRD)<ref name="pmid18588500" /> | ||
==Prognosis== | ==Prognosis== | ||
* Before the advent of cART therapy, the prognosis of HIV-associated nephropathy was fatal. The mortality rate during this time was 100% within 6 months.<ref name="pmid18588500" /> | |||
* Today, the prognosis of HIVAN with the availability of cART therapy still remains grim,<ref name="pmid18588500" /> however, treatment with cART has increased renal survival rate. (41) | |||
* Early diagnosis and Immediate treatment has shown better outcome.<ref name="pmid18588500" /> | |||
* Treatment with cART has shown 60% reduction in the developement of HIVAN.<ref name="pmid18588500" /> | |||
* Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.<ref name="pmid18588500" /> | |||
* The current first and second year survival rate of HIV-associated nephropathy is estimated to be around 63% and 43% respectively, with the use of HAART therapy. (43) | |||
'''The following are favorable prognostic factors:''' | '''The following are favorable prognostic factors:''' | ||
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* Patients who have CD4 levels that are below 200 cells/mm<sup>3</sup> | * Patients who have CD4 levels that are below 200 cells/mm<sup>3</sup> | ||
* Patients who have lower estimated glomerular filtration rates | * Patients who have lower estimated glomerular filtration rates | ||
<br /> | |||
==References== | ==References== |
Revision as of 13:09, 28 June 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2];Associate Editor(s)-in-Chief: Krzysztof Wierzbicki M.D. [3]
Overview
HIV-associated nephropathy (HIVAN) will progress to end-stage renal disease (ESRD) in a few weeks to months without treatment. However, early diagnosis and treatment has shown better outcome.
Natural History
- If left untreated, HIV-associated nephropathy (HIVAN) will progress to end-stage renal disease (ESRD) in a few weeks to months.[1]
- Treatment with cART has shown 60% reduction in the developement of HIVAN.[1]
- Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.[1]
- Early diagnosis and Immediate treatment has shown better outcome.[1]
Complications
Possible complications that are associated with HIV-associated nephropathy include:
- End-stage renal disease (ESRD)[1]
Prognosis
- Before the advent of cART therapy, the prognosis of HIV-associated nephropathy was fatal. The mortality rate during this time was 100% within 6 months.[1]
- Today, the prognosis of HIVAN with the availability of cART therapy still remains grim,[1] however, treatment with cART has increased renal survival rate. (41)
- Early diagnosis and Immediate treatment has shown better outcome.[1]
- Treatment with cART has shown 60% reduction in the developement of HIVAN.[1]
- Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.[1]
- The current first and second year survival rate of HIV-associated nephropathy is estimated to be around 63% and 43% respectively, with the use of HAART therapy. (43)
The following are favorable prognostic factors:
- Patients on HAART therapy
- Patients with low-grade proteinuria
- Patients who have a suppressed HIV-1 viral load
- Patients who express a normal renal echogenicity
- Patients with CD4 levels that between 200 and 500 cells/mm3
- Patients who have higher estimated glomerular filtration rates
The following are poor prognostics factors:
- Patients not receiving HAART therapy
- Patients with high-grade proteinuria
- Patients who have under suppressed HIV-1 viral load
- Patients who express a large renal echogenicity
- Patients who have CD4 levels that are below 200 cells/mm3
- Patients who have lower estimated glomerular filtration rates