HIV and Renal Health with Dr. Patrice Junod, Clinique médicale l'Actuel - Algorithm

Dr. Patrice Junod Clinique médicale l’Actuel

This activity is supported by an educational grant from:

1- Algorithm Nephropathy Advisory Committee on the clinical management of people living with HIV

2- HIV and Renal Health – Management tool National Development Committee – Supported by Janssen

Algorithm

− Nephropathy −

Advisory Committee on the Clinical Management of Persons Living with HIV

PERIODIC HEALTH EXAMINATION OF ADULTS LIVING WITH HIV (HUMAN

IMMUNODEFICIENCY VIRUS)

Screening schedule based on risk factors for kidney disease (EACS 2011)

Untreated HIV+ patients

Treated HIV+ patients Without TDF With TDF

Assessment of risk factors for CKD* Annual Annual 6–12 months

Urinalysis or urine dipstick Annual

Annual 6 months if GFR < 60

3-6 months

eGFR 6-12 months 3-6 months 3-6 months

Phosphorus As needed As needed Optional 3-6 months

* Risk factors for CKD: Diabetes, hypertension, CVD, viral hepatitis, concomitant nephrotoxic drugs, family history of CKD, black African ethnicity

Advisory Committee on the Clinical Management of Persons Living with HIV Screening for Kidney Problems

GFR using CKD-EPI or MDRD

ACR and MAU

Refer to proteinuria algorithm

(next page)

Referral to nephrologist or internist

< 60 cc/min* < 30 cc/min*

CaPO4 Renal ultrasound

> 60 and < 90 cc/min

Increase in Cr > 20% for > 3

months**

Repeat CKD-EPI or

MDRD calculation

Refer to algorithms (next pages)

GFR < 90

Glucose+ Protein+ HypoPO4

GFR > 90

Regular follow-up

Follow up every

3 months

* If GFR < 50 cc/min: consider adjusting the dose of certain ARV and concomitant medications

** Test for tubulopathy if GFR declines > 10 cc/min while on tenofovir





months**

Repeat CKD-EPI or MDRD calculation


GFR < 90


GFR > 90

Regular follow-up

Follow up every

3 months



ACR and MAU


(next page)






months**

Repeat CKD-EPI or

MDRD calculation


GFR < 90


GFR > 90

Regular follow-up

Follow up every

3 months




ACR and MAU


(next page)

Referral to nephrologist or

internist





Urinalysis or urine dipstick

Glucose > 0

Glycosuria

DB +

Glycosuria

DB –

DB follow-up

Fasting glucose +

Rule out diabetes

Repeat 1x

Glycosuria

DB –


ACR ≤ 0.05 g/mmol and MAU < 2.1 mg/

mmol

Normal - Renal ultrasound

- Ascertain the risk factors - Referral to nephrologist or internist, or to urologist

for isolated hematuria

Protein ≥ 1 + or 0.25 g/L

Repeat at next appt.

Protein < 1+ or 0.25

g/L

Protein ≥ 1+ or 0.25

g/L

Normal ACR and

MAU

ACR > 0.05 g/mmol or

MAU > 2.1 mg/mmol or

hematuria (> 2 RBC/HPF)


Glucose > 0

Glycosuria

DB +

Glycosuria

DB –

DB follow-up

Fasting glucose +

Rule out diabetes

Repeat 1x

Glycosuria

DB –



Glucose > 0

Glycosuria

DB +

Glycosuria

DB –

DB follow-up

Fasting glucose +

Rule out diabetes

Repeat 1x

Glycosuria

DB –



mmol







g/L


g/L

Normal ACR and

MAU






mmol







g/L


g/L

Normal ACR and

MAU




Serum phosphorus

< normal levels

Repeat and if < normal levels

PTH assay 25-OH Vit D Albumin-corrected Ca

< 50: deficiency < 75: insufficiency

> 75

Vit D Rx Normal

Abnormal Normal


Urinary fractional excretion of phosphorus if available (if > 20% or > 10% and hypophosphatemia: referral to a specialist

Abnormal Normal


0.65 – normal level

0.32 – 0.65 mmol/L

< 0.32 mmol/L

Repeat in 3 months

Repeat in 1 month

Treat immediately Referral to

nephrologist

Serum phosphorus

< normal levels




0.32 – 0.65 mmol/L

< 0.32 mmol/L

Repeat in 3 months

Repeat in 1 month


nephrologist

Serum phosphorus

< normal levels




> 75

Vit D Rx Normal

Abnormal Normal



Abnormal Normal



0.32 – 0.65 mmol/L

< 0.32 mmol/L

Repeat in 3 months

Repeat in 1 month


nephrologist

Serum phosphorus

< normal levels




> 75

Vit D Rx Normal

Abnormal Normal



Abnormal Normal


Algorithm

HIV and Renal Health with Dr. Patrice Junod, Clinique médicale l'Actuel - Algorithm

Health & Medicine

Transcript of HIV and Renal Health with Dr. Patrice Junod, Clinique médicale l'Actuel - Algorithm