Guide to side effects and complications
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Kidney health and renal side effects
Associated drugs: Drugs cleared by the kidney with potential for renal toxicity include AZT, 3TC, FTC, tenofovir, atazanavir and maraviroc. Truvada, Atripla, Eviplera and Quad all contain tenofovir. Kidney stones can also occur with atazanavir and efavirenz. The kidney is a major organ that: • Filters salts and impurities from your blood to be excreted in urine. • Regulates blood pressure. • Regulates oxygen levels in blood. • Helps bone health by processing vitamin D. Kidney function (also called renal function) can be affected by HIV and other illnesses, including high blood pressure and diabetes. In someone who has reduced kidney function related to HIV (including HIVAN), this can be improved by starting HIV treatment. However, several HIV drugs can affect your kidneys and the use and monitoring of these drugs should be managed individually. Kidney function generally reduces as we get older.
Symptoms Mild kidney disease often has no symptoms, but more advanced kidney symptoms include: • Nausea and/or vomiting. • Feeling tired, being short of breath. • Needing to urinate more often, especially at night, or less often. • Itchy skin. • Muscle cramps. • Loss of appetite. • Swollen hands or feet (from retaining water) or numbness.
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Monitoring kidney function Routine tests monitor kidney function before and after treatment. High levels of protein or a waste product called creatinine, indicate that the kidneys may not be working well. Results from blood and urine tests calculate how well your kidneys are processing creatinine. Dipstick urine tests Urine tests can show abnormal levels of protein, blood, white blood cells, glucose and markers for diabetes. Blood tests Blood tests can measure protein and creatinine and are used to estimate glomerular filtration rate (eGFR). eGFR Estimated GFR is a common way to grade kidney function. It is measured in mL/min per 1.73 m2. Higher than 90 normal
stage 0/1
60–89
mild
stage 2
30–59
moderate
stage 3
15–29
severe
stage 4
Less than 15
end stage
stage 5
An eGFR less than 60 is defined as Chronic Kidney Disease (CKD). End Stage Renal Disease (ESRD) inludes preparation for dialysis, transplant etc.
July 2012