HIVAN/TDF Induced Nephropathy
•Download as PPTX, PDF•
0 likes•326 views
This document discusses HIVAN (HIV Associated Nephropathy) and TDF (tenofovir disoproxil fumarate) induced nephropathy. HIVAN occurs in advanced HIV disease and causes rapid progression to end-stage renal disease. It predominantly affects young black males and has a distinct histology. TDF is an antiretroviral medication that can accumulate in kidney cells and impair mitochondrial DNA, potentially leading to proximal tubular dysfunction or Fanconi syndrome. The document provides statistics on HIVAN and outlines the pathophysiology, clinical presentation, and recommendations regarding both conditions.
Recommended
More Related Content
What's hot
What's hot (20)
Similar to HIVAN/TDF Induced Nephropathy
Similar to HIVAN/TDF Induced Nephropathy (20)
More from Natangwe Tangi
More from Natangwe Tangi (15)
Recently uploaded
Recently uploaded (20)
HIVAN/TDF Induced Nephropathy
- 2. Outline Introduction Statistics What is HIVAN (HIV Associated Nephropathy) & TDF Nephropathy References
- 3. Introduction
- 4. NAMPHIA 2017
- 6. HIVAN • HIVAN occurs in advanced HIV disease and is classically associated with rapid progression to end-stage renal disease (ESRD). • HIVAN has a distinct histology, representing a collapsing form of focal segmental glomerulosclerosis (FSGS) • Affects mostly young black males, 10: 1 Male to female ratio
- 7. Characteristics of HIVAN • Azotemia • Nephrotic range Proteinuria • Normal serum complement levels, microhematuria • Normal to large kidneys on Ultrasound • FSGS on renal Biopsy
- 9. • HIV 1, infects the renal glomerular and tubular epithelial cells. The exact mechanism of remains unclear but one study stipulates that IL6 & TNFa were shown to be potent stimuli for HIV1 expression in HIV1 Infected monocytes which play a role in HIVAN. • Histopathological features include: enhanced proliferation and loss glomerular epithelial cells which lead to glomerulosclerosis, tubulainterstitial scarring. • Prognosis: halted by HAART • Treatment with ACEI may be beneficial & steroids
- 10. • Prognosis: halted by HAART • Treatment with ACEI may be beneficial & steroids
- 11. TDF Nephropathy
- 12. • Tenofovir disoproxil fumarate is a bioavailable prodrug of tenofovir, a potent acyclic nucleotide analogue reverse-transcriptase inhibitor with activity against HIV and hepatitis B virus. • TAF (tenofovir Alafenamide fumarate) • Administered 300-mg once daily.
- 13. • Eliminated unchanged in Urine by glomerular filtration & proximal tubular secretion. • 20-30% is actively transported into renal proximal tubule cells by organic anion transporter (LOAT1) and to a lesser extent in the basolateral membrane. • Subsequently it’s secreted into the tubular lumen by apical membrane transporter MRP4&2. • Several drugs may interact with these transporters and may cause exessive entry or reduced outflow of TDF favoring intracellular accumulation and renal toxicity.
- 14. • Acyclic NRTIs impair mitochondrial DNA (mDNA) replication by inhibiting mitochondrial DNA polymerase.
- 15. Clinical Presentation • Proximal tubular dysfunction, with preserved renal function • Proximal tubular dysfunction with impaired renal function • Fanconi Like Syndrome
- 16. • In its complete form: – Renal tubular acidosis – Hypouricemia – Tubular proteinuria – Normoglycaemia but glycosuria – Aminoaciduria – Hypophosphataemia
- 17. Recommendations
- 18. References • NAMIBIA POPULATION-BASED HIV IMPACT ASSESSMENT NAMPHIA 2017 • Namibian GUIDELINES NATIONAL GUIDELINES FOR ANTIRETROVIRAL THERAPY, 2016. 5th Edition • Sean R. Hosein, nov 2015. TAF vs. TDF (original tenofovir)— improvements in safety. https://www.catie.ca/en/treatmentupdate/treatmentupdat e-211/anti-hiv-agents/taf-vs-tdf-original-tenofovir- improvements-safet
Editor's Notes
- NAMIBIA POPULATION-BASED HIV IMPACT ASSESSMENT NAMPHIA 2017
- Other reported glomerular lesions in patients with HIV include IgA nephropathy, cryoglobulinemia, amyloidosis, and a lupuslike immune complex glomerulopathy
- Azotemia increase in nitrogen containing compounds in the blood Proteinuria > 2g/m^2/24 hours (spot urine > 30mg) SIADH: hyponatraemia, high k, fluid overload
- HIV 1, infects the renal glomerular and tubular epithelial cells. The exact mechanism of remains unclear but one study stipulates that IL6 & TNFa were shown to be potent stimuli for HIV1 expression in HIV1 Infected monocytes which play a role in HIVAN. Histopathological features include: enhanced proliferation and loss glomerular epithelial cells which lead to glomerulosclerosis, tubulainterstitial scarring and proteinuria.