Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 145 No. 2122 (2015)

Acute kidney injury KDIGO stage 2 to 3 in HIV-positive patients treated with cART – a case series over 11 years in a cohort of 1,153 patients

  • Mario Kurz
  • Felix Burkhalter
  • Michael Dickenmann
  • Helmut Hopfer
  • Michael Mayr
  • Luigia Elzi
  • Manuel Battegay
Cite this as:
Swiss Med Wkly. 2015;145:w14135


OBJECTIVES: We aimed to explore acute kidney injury (AKI) Kidney Disease Improving Global Guidelines (KDIGO) stage 2 to 3 in a cohort of antiretroviral treated HIV-infected individuals.

METHODS: HIV-infected individuals of the Swiss HIV Cohort Study (Basel site), treated with combination antiretroviral therapy (cART) 2002–2013, were included. AKI was defined and classified according to the KDIGO Clinical Practice Guidelines for AKI. Data were prospectively collected and reports of kidney biopsies obtained from records.

RESULTS: Among 1,153 cART-treated patients, 13 experienced AKI KDIGO stage 2 to 3 (1 patient stage 2, 12 patients stage 3; median age 46 years; 9 male; median CD4 count 366 cells/μl), corresponding to an incidence rate of AKI of 0.77 (95% confidence interval 0.45–1.33) per 1000 patient-years. Baseline estimated glomerular filtration rate (eGFR) was 87 ml/min (interquartile range 66–100). Ten patients were treated with tenofovir (TDF). Nine patients (69%) had ≥1 cardiovascular risk factor, only two patients had known pre-existing kidney disease. Three patients needed chronic and two temporary dialysis. AKI was associated with TDF therapy in 6 of 13 (46%) patients (mean TDF exposure time before AKI 41 months). Impaired renal function was partially reversible in all patients. In three patients with biopsy-proven pre-existing kidney disease (AA amyloidosis, calcineurin inhibitor-induced nephropathy and minimal change glomerulopathy), TDF potentially added to AKI.

CONCLUSIONS: AKI KDIGO stage 2 to 3 demonstrates complex associations at the individual level and can occur without early signs. Although treatment with TDF and presence of cardiovascular risk factors were found frequently, predicting AKI seems very difficult.


  1. Fine DM, Atta MG. Kidney disease in the HIV-infected patient. AIDS patient care and STDs. 2007;21:813–24.
  2. Kalim S, Szczech LA, Wyatt CM. Acute kidney injury in HIV-infected patients. Semin Nephrol. 2008;28:556–62.
  3. Valeri A, Neusy AJ. Acute and chronic renal disease in hospitalized AIDS patients. Clin Nephrol. 1991;35:110–8.
  4. Rao TK, Friedman EA. Outcome of severe acute renal failure in patients with acquired immunodeficiency syndrome. Am J Kidney Dis. 1995;25:390–8.
  5. Franceschini N, Napravnik S, Eron JJ, Jr., Szczech LA, Finn WF. Incidence and etiology of acute renal failure among ambulatory HIV-infected patients. Kidney Int. 2005;67:1526–31.
  6. Estrella MM, Fine DM, Atta MG. Recent developments in HIV-related kidney disease. HIV Ther. 2010;4:589–603.
  7. Rodriguez-Novoa S, Alvarez E, Labarga P, Soriano V. Renal toxicity associated with tenofovir use. Expert Opin Drug Saf. 2010;9:545–59.
  8. Ryom L, Mocroft A, Kirk O, Worm SW, Kamara DA, Reiss P, et al. Association between antiretroviral exposure and renal impairment among HIV-positive persons with normal baseline renal function: the D:A:D study. J Infect Dis. 2013;207:1359–69.
  9. Hall AM. Update on tenofovir toxicity in the kidney. Pediatr Nephrol. 2012;28:1011–23.
  10. Khwaja A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clin Pract. 2012;120:179–84.
  11. Swiss HIVCS, Schoeni-Affolter F, Ledergerber B, Rickenbach M, Rudin C, Gunthard HF, et al. Cohort profile: the Swiss HIV Cohort study. Int J Epidemiol. 2010;39:1179–89.
  12. Ferguson MA, Waikar SS. Established and emerging markers of kidney function. Clin Chem. 2012;58:680–9.
  13. Arora P, Vasa P, Brenner D, Iglar K, McFarlane P, Morrison H, et al. Prevalence estimates of chronic kidney disease in Canada: results of a nationally representative survey. CMAJ. 2013;185:E417–23.
  14. Gaspari F, Ferrari S, Stucchi N, Centemeri E, Carrara F, Pellegrino M, et al. Performance of different prediction equations for estimating renal function in kidney transplantation. Am J Transplant. 2004;4:1826–35.
  15. Hall AM, Hendry BM, Nitsch D, Connolly JO. Tenofovir-associated kidney toxicity in HIV-infected patients: a review of the evidence. Am J Kidney Dis. 2011;57:773–80.
  16. Nishijima T, Shimbo T, Komatsu H, Takano M, Tanuma J, Tsukada K, et al. Urinary beta-2 microglobulin and alpha-1 microglobulin are useful screening markers for tenofovir-induced kidney tubulopathy in patients with HIV-1 infection: a diagnostic accuracy study. J Infect Chemother. 2013;19:850–7.
  17. Herlitz LC, Mohan S, Stokes MB, Radhakrishnan J, D’Agati VD, Markowitz GS. Tenofovir nephrotoxicity: acute tubular necrosis with distinctive clinical, pathological, and mitochondrial abnormalities. Kidney Int. 2010;78:1171–7.
  18. Nelson MR, Katlama C, Montaner JS, Cooper DA, Gazzard B, Clotet B, et al. The safety of tenofovir disoproxil fumarate for the treatment of HIV infection in adults: the first 4 years. AIDS. 2007;21:1273–81.

Most read articles by the same author(s)

1 2 3 4 5 > >>