Adverse events: ART and the kidney: alterations in renal function and renal toxicity

Area of Science:

• Nephrology
• Infectious Diseases
• Pharmacology

Background:

• Renal dysfunction is frequently observed in patients with HIV receiving antiretroviral therapy (ART).
• Certain antiretroviral drugs are linked to kidney disease progression, affecting renal tubular transporters and reabsorption of phosphate and proteins.
• While often non-limiting, these renal function aberrations can sometimes lead to severe toxicity.

Purpose of the Study:

• To discuss ART-associated changes in renal function.
• To detail treatment-limiting renal toxicity, including incidence, risk factors, and mechanisms.
• To provide clinical practice recommendations for managing renal complications.

Main Methods:

• Review of literature on antiretroviral therapy and renal function.
• Analysis of reported cases of severe renal toxicity associated with specific ART drugs.
• Discussion of mechanisms underlying ART-induced kidney injury.

Main Results:

• ART can lead to impaired renal tubular function, affecting creatinine secretion and nutrient reabsorption.
• Severe renal toxicity, such as acute tubular injury, tubulointerstitial nephritis, or nephrolithiasis, is infrequent but can be caused by drugs like Tenofovir-DF and atazanavir.
• Discontinuation of the causative agent is crucial for mitigating adverse renal and bone effects.

Conclusions:

• ART-associated renal dysfunction is common, but severe, treatment-limiting toxicity is rare in well-managed patients.
• Understanding the incidence, risk factors, and mechanisms of renal toxicity is vital for clinical practice.
• Clinical management should focus on monitoring renal function and prompt discontinuation of nephrotoxic ART agents when indicated.