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      Resumen ejecutivo del documento de consenso sobre el manejo de la patología renal en pacientes con infección por VIH Translated title: Executive summary of the consensus document on the management of renal disease in HIV-infected patients

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      Nefrología (Madrid)

      Sociedad Española de Nefrología

      Sida, VIH, Enfermedad renal crónica, Insuficiencia renal, Tenfovir, Toxicidad renal, Terapia antiretroviral, Trasplante renal, AIDS, HIV, Chronic kidney disease, Renal failure, Tenofovir, Renal toxicity, Antiretroviral therapy, Renal transplant

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          Abstract

          El objetivo de este documento es actualizar las recomendaciones sobre la evaluación y el manejo de la afectación renal en pacientes con infección por el VIH del año 2010. La función renal debe monitorizarse en todos los pacientes e incluir la medida de la concentración sérica de creatinina, la estimación del filtrado glomerular (ecuación CKD-EPI), la medida del cociente proteína/creatinina en orina y un sedimento urinario. El estudio básico de la función tubular ha de incluir la concentración sérica de fosfato y la tira reactiva de orina (glucosuria). En ausencia de alteraciones, el cribado será anual. En pacientes tratados con tenofovir o con factores de riesgo para el desarrollo de enfermedad renal crónica (ERC), se recomienda una evaluación más frecuente. Se debe evitar el uso de antirretrovirales potencialmente nefrotóxicos en pacientes con ERC o factores de riesgo para evitar su progresión. También se revisan las indicaciones de la biopsia renal, cuándo enviar el paciente al nefrólogo y las indicaciones, evaluación y manejo del paciente en diálisis o del trasplante renal.

          Translated abstract

          The aim of this article is to update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients. Renal function should be monitored in all HIV-infected patients. The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document provides indications for renal biopsy and advises on the optimal time for referral of a patient to the nephrologist. The indications for and evaluation and management of dialysis and renal transplantation are also addressed.

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          Most cited references 5

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          [Diagnosis, treatment and prevention of renal diseases in HIV infected patients. Recommendations of the Spanish AIDS Study Group/National AIDS Plan].

            (2010)
          The incidence of opportunistic infections and tumours in HIV-infected patients has sharply declined in the HAART era. At the same time there has been a growing increase of other diseases not directly linked to immunodeficiency. Renal diseases are an increasing cause of morbidity and mortality among HIV-infected patients. In the general population, chronic renal failure has considerable multiorgan repercussions that have particular implications in patients with HIV infection. The detection of occult or subclinical chronic kidney disease is crucial since effective measures for delaying progression exist. Furthermore, the deterioration in glomerular filtration should prompt clinicians to adjust doses of some antiretroviral agents and other drugs used for treating associated comorbidities. Suppression of viral replication, strict control of blood pressure, dyslipidemia and diabetes mellitus, and avoidance of nephrotoxic drugs in certain patients are fundamental components of programs aimed to prevent renal damage and delaying progression of chronic kidney disease in patients with HIV. Renal transplantation and dialysis have also special implications in HIV-infected patients. In this article, we summarise the updated clinical practice guidelines for the evaluation, management and prevention of renal diseases in HIV-infected patients from a panel of experts in HIV and nephrologists on behalf of the Spanish AIDS Study Group (GESIDA) and the National AIDS Plan. Copyright © 2009 Elsevier España, S.L. All rights reserved.
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            Diagnosis, treatment and prevention of renal diseases in HIV infected patients: Recommendations of the Spanish AIDS Study Group/National AIDS Plan

            (2010)
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              Jerarquización del conocimiento científico: El sistema GRADE

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                Author and article information

                Contributors
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                Journal
                nefrologia
                Nefrología (Madrid)
                Nefrología (Madr.)
                Sociedad Española de Nefrología (Cantabria, Santander, Spain )
                0211-6995
                1989-2284
                2014
                : 34
                : 6
                : 768-788
                Affiliations
                Valencia orgnameInstituto de Investigación Sanitaria La Fe
                Valencia orgnameHospital Clínico Universitario de Valencia
                Córdoba orgnameHospital Universitario Reina Sofía
                Valencia orgnameHospital Universitario Dr.Peset
                orgnameHospital Universitario Ramón y Cajal
                Girona orgnameUniversitat de Girona
                Vigo orgnameHospital Universitario Xeral
                Málaga orgnameHospital Universitario Virgen de la Victoria
                Badalona orgnameHospital Universitario Germans Trias i Pujol
                orgnameHospital Universitario La Fe
                L’Hospitalet de Llobregat orgnameUniversitat de Barcelona
                Sevilla orgnameHospital Universitario Virgen de Valme
                San Sebastián orgnameHospital Universitario Donostia
                Barcelona orgnameUniversitat Autònoma de Barcelona
                Leganés orgnameHospital Universitario Servero Ochoa
                Bilbao orgnameHospital de Basurto
                Madrid orgnameHospital Universitario 12 de Octubre
                orgnameInstitut d´Investigacions Biomèdiques August Pi i Sunyer- IDIBAPS
                Alicante orgnameUniversidad Miguel Hernández
                orgnameHospital Clínic
                Zaragoza orgnameHospital Universitario Miguel Servet
                Madrid orgnameInstituto de Investigación Sanitaria Ramón y Cajal- IRYCIS
                orgnameHospital General Universitario de Elche
                Madrid orgnameInstituto de Investigación Hospital Universitario La Paz - IdiPAZ
                Cádiz orgnameHospital Universitario Puerta del Mar
                Barcelona orgnameHospital Universitario Nuestra Señora del Mar
                orgnameHospital General Universitario de Alicante
                Barcelona orgnameUniversitat de Barcelona
                Alicante orgnameUniversidad Miguel Hernández
                Barcelona orgnameFundació Puigvert
                orgnameHospital Universitario La Paz
                Bellvitge orgnameHospital Universitari de Bellvitge
                orgnameHospital de la Santa Creu i Sant Pau
                Alcalá de Henares orgnameHospital Universitario Príncipe de Asturias
                Madrid orgnameHospital Universitario de la Princesa
                orgnameHospital Sant Jaume de Olot
                Madrid orgnameHospital Clínico San Carlos
                Article
                S0211-69952014000600012
                10.3265/Nefrologia.pre2014.Sep.12745

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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