Tubulointerstitial Nephritis: Underdiagnosed Kidney Disease in Person Living with HIV

Afiatin Makmun; Aditya Rangga Fandiarta; Lilik Sukesi; Yovita Hartantri

doi:10.3889/oamjms.2023.11585

Authors

Afiatin Makmun Nephrology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia https://orcid.org/0000-0003-3779-3414
Aditya Rangga Fandiarta Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia https://orcid.org/0000-0001-7194-0524
Lilik Sukesi Nephrology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
Yovita Hartantri Tropical Disease And Infection Division, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital,Bandung, Indonesia https://orcid.org/0000-0002-1267-7815

DOI:

https://doi.org/10.3889/oamjms.2023.11585

Keywords:

Diabetes mellitus, Glomerulopathy, Hypertension, Tenofovir, Tubulointerstitial nephritis

Abstract

BACKGROUND: Kidney disease in human immunodeficiency virus (HIV) is often overlooked. The types of kidney disease in HIV consist of glomerulopathy and tubulointerstitial nephritis. Hypertension, diabetes mellitus, and the use of tenofovir increase the risk of kidney disease.

AIM: The purpose of this study is to analyze the type of kidney disease in person living with HIV using the urine albumin-protein ratio.

METHODS: This research is an analytic observational study. Data were collected using the consecutive sampling. The urine albumin-protein ratio was carried out to differentiate glomerulopathy from tubulointerstitial nephritis.

RESULTS: Screening with dipstick proteinuria in 1148 person living with HIV, total of 189 subjects (16.5%) with proteinuria were obtained, with a urinary protein-creatinine ratio over 150 mg/g in 101 persons (8.7%). The proportion of tubulointerstitial nephritis (73.3%) was higher than glomerulopathy (26.7%). Kidney disease mostly occurs at glomerular-filtration rate ≥90 ml/minute/1.73 m2, specifically glomerulopathy (66.7%), and tubulointerstitial nephritis (52.7%). The risk stratification of cardiovascular complications and worsening of kidney function was mostly at moderate risk (60%), there were 6.9% of study subjects with a glomerular-filtration rate ≥90 ml/min/1.73 m2 with high-risk stratification. There was no significant difference in the proportion of glomerulopathy and tubulointerstitial nephritis based on comorbidities.

CONCLUSION: Kidney disease in HIV is mostly tubulointerstitial nephritis. Evaluation of kidney function and risk stratification needs to be done to reduce the cardiovascular complications and progressive worsening of kidney function.

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