Kidney Week

Abstract: SA-PO682

Nephrolithiasis in HIV+ Patients with CKD: A Case Series

Session Information

• Bone and Mineral Metabolism: Clinical - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• Spiardi, Ryan, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States

Ryan Spiardi,

• Ahmed, Maliha, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States

Maliha Ahmed,

• Fleyshman, Robert, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States

Robert Fleyshman,

• Raza, Abbas, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States

Abbas Raza,

• Boyle, Suzanne, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States

Suzanne Boyle,

Background

Nephrolithiasis and CKD are highly prevalent in the HIV+ population, independent of each other. The association between some anti-retroviral therapy (ART) and both nephrolithiasis and CKD, respectively, has been demonstrated. However, amongst HIV+ patients, there are limited data on the relationship between nephrolithiasis and CKD progression. It is unknown if HIV+ patients have risk factors for nephrolithiasis beyond ART. We describe a series of HIV+ patients with a history of nephrolithiasis in a CKD clinic.

Methods

In a CKD clinic of HIV+ patients (n = 55), we identified those with history of nephrolithiasis by radiology or self-report. Data was collected on demographics; co-morbidities; HIV control; age at first stone; urologic interventions; ART; creatinine trends; urine chemistries; and stone composition.

Results

The prevalence of nephrolithiasis was 21.8% (n = 12). Sixty-seven percent were black; 92% male; 75% had HTN; 8%, DM. At the initial CKD appointment, median age was 53; baseline creatinine, 1.5 mg/dl (IQR, 1.2-1.8); eGFR, 49 ml/min/1.73m²; UPCR, 1.02 (IQR, 0.37-1.89). Ninety-two percent had an undetectable viral load (VL). Eighty-three percent had taken tenofovir disoproxil fumarate (TDF); 50%, atazanavir; 17%, indinavir. The majority had their first stone after HIV diagnosis (58%) and 42% of first episodes were between ages 51-60. After the first stone, there was a generalized upward creatinine slope in 75% of patients (n = 9). Only one patient had data on stone composition, and two, urine chemistry.

Conclusion

There was a high prevalence of nephrolithiasis among HIV+ patients in a CKD clinic. Most patients had their first stone after HIV diagnosis and experienced an upward slope in creatinine after this. Nearly all had early CKD with sub-nephrotic proteinuria and undetectable VL. While most patients had exposure to ART that might increase stone risk, we cannot infer that this entirely accounts for the high prevalence. Studies show that proximal tubule cells are a reservoir for HIV. This could be a potential risk factor for stones by altering urine chemistry. Controlled studies are needed to describe urine chemistries in HIV+ patients with nephrolithiasis as well as the association between nephrolithiasis and CKD progression.