Renal insufficiency

Signs and symptoms

Chronic kidney disease (CKD) is usually asymptomatic in the early stages: 1,2

Patients generally do not have symptoms, so it is essential to regularly monitor renal function in patients at risk.
Monitoring should be frequent if there are risk factors for CKD and / or before starting treatment with nephrotoxic drugs.
People living with HIV, whether or not they are receiving antiretroviral (ARV) treatment, should be subject to a risk assessment on a yearly basis.
The estimation of the glomerular filtration rate (GFR) should be performed at the time of diagnosis, before starting the combined antiretroviral therapy and, subsequently, every 3-12 months, with a higher frequency if there are risk factors for CKD and / or Before starting and with the treatment of nephrotoxic drugs. 3
A test strip urine test should be performed at the time of diagnosis before starting the combined antiretroviral therapy and then every 6 months if the GFR <60 ml / min; If proteinuria ≥ 1 or more and / or GFR <60 ml / min, the ratio of albumin-creatinine to urine or the ratio of albumin to creatinine to urine should be measured. 3

Patients with CKD may not notice any symptoms until they reach the stage of end-stage renal disease (ESRD) requiring dialysis or transplantation (eGFR <15 ml / min / 1.73 m 2 ).
Symptoms of ERT include the following: 1
Nicturia
General discomfort
Anorexia / nausea / vomiting
Pruritus
"Restless legs"
Dyspnoea

Patients with acute renal failure due to glomerulonephritis caused by viral infection and immune reaction may have proteinuria and "nephritic sediment". Clinical symptoms are determined by the extent of proteinuria with loss of protein and renal function and including include: 4

Edema
Fatigue
Reduced operation
Susceptibility to infections
Hyperlipidemia
Anemia
Metabolic acidosis
Problems with calcium-phosphate metabolism

Signs and alarming symptoms of kidney disease in people living with HIV are the following: 5

Severe respiratory distress due to pulmonary edema, especially in cases of renal insufficiency, with bilateral crackles (in both lungs) in auscultation with stethoscope and hypoxia;
Hyperventilation (especially in people with metabolic acidosis), which can present deep and very fast laborious ventilation;
Shock state, whose rapid recognition and treatment is essential to maintain and / or restore kidney function and save life. Some symptoms of the shock are pallor, cold and viscous skin, weak but rapid pulse, capillary filling lasting more than 2 or 3 seconds, dizziness and fatigue.

Some patients, especially those treated with antiretroviral causing renal impairment may have Fanconi syndrome signs such as: 6

Renal insufficiency
Hypokalemia
Hypophosphatemia
Metabolic acidosis
Albuminuria / proteinuria
Hyperaminoaciduria
Glucosuria
Hypercalciuria
Hipouricemia
Phosphate and potassium loss.

Table 1: Classification of hypophosphataemia levels 7

Classification    level
Grade 1 (light)    2.5 mg / dl- <LNI *
     0.81 mmol / l- <LNI
Level 2 (moderate)    2.0-2.4 mg / dl
     0.65-0.80 mmol / l
Grade 3 (serious)    1.0-1.9 mg / dl
     0.32-0.64 mmol / l
Grade 4 (potentially deadly)    <1.00 mg / dl
     <0.32 mmol / l