Acute and chronic renal disease in hospitalized AIDS patients
Valeri, A.; Neusy, A.J.
Clinical Nephrology 35(3): 110-118
1991
ISSN/ISBN: 0301-0430 PMID: 2032395 Document Number: 384942
We peformed a retrospective chart analysis on 449 AIDS patients admitted to Bellevue Hospital Center from 1983-1986 to characterize the etiologies and clinical course of acute renal failure (ARF) and to define the incidence and clinical course of AIDS-associated nephropathy (AAN) in an unselected hospitalized AIDS population. Defining ARF as a rise from baseline serum creatinine of at least 2.0 mg%, we found 88 cases (a prevalence of almost 20%) or 14.5 cases per 100 admissions. Volume depletion was the most common etiology and was as severe a cause of ARF as other etiologies. There were 21 cases of ARF in 17 patients with a peak serum creatinine .gtoreq. 6.0 mg%. Volume depletion accounted for 7/21 of these cases. Baseline renal insufficiency existed in 9/17 patients (12/21 cases) and volume depletion was the cause of ARF in 3 of these cases. Only 4 cases required dialysis. There were 34 patients (prevalence of 7.6% or 3.0 cases per 100 patient-years) with otherwise unexplained chronic renal insufficiency and/or persistent qualitative or quantitative proteinuria and thus were defined on clinical grounds to have AIDS-associated nephropathy. Thirty-two of these patients (94%) had evidence of AAN at or within 1 year of presentation. Eleven patients (32%) reached ESRD (serum creatinine .gtoreq. 6.0 mg%); 9 patients did so within 1 year of presentation and 3 required dialysis. In those with adequate follow-up (9 cases), the mean survival from time of ESRD was 25.5 days and all cases died within 6 months of reaching ESRD. By life table analysis, there was a significantly shorter median survival time in those with AAN compared to all other AIDS patients in this study (9.5 months vs 12.25 months, p < 0.05 by chi-square analysis).