• Hypercoagulable state in severe nephrotic syndrome
  • Patients with nephrotic syndrome have increased risk of thromboembolism, particularly deep vein and renal vein thrombosis
  • Nephrotic syndromes (except for Minimal Change Disease) are characterized by non-selective proteinuria
  • Possible that patients with significant proteinuria lose anticoagulant proteins in the urine
  • Tendency to have VTE in nephrotic syndrome can correlate with degree of hypoalbuminemia
  
  

  Posted 08/18/16 09:48:57 AM by Anna Krigel

• Hyperkalemia causes decreased ammonia production in the proximal tubule -> leads to decreased excretion of acid -> causes a non anion gap metabolic acidosis (type IV RTA)
  
  

  Posted 08/18/16 09:49:48 AM by Anna Krigel

• WBC casts on urinalysis may indicate pyelonephritis or acute interstitial nephritis
  
  

  Posted 08/18/16 09:50:27 AM by Anna Krigel

• AKI in HIV-positive patients
  
  
  1. ATN and pre-renal states, similar to patient without HIV
  2. Medication nephrotoxicity secondary to ART (protease inhibitors, tenofovir) and medications used to treat opportunistic infections (antivirals, Bactrim, etc)
  3. HIV-associated thrombotic microangiopathy - more rare in the ART era
  
  CKD in HIV-positive patients
  
  
  1. HIV associated nephropathy (HIVAN) - collapsing form of focal segmental glomerulosclerosis, presents with significant proteinuria and rapidly progressive kidney disease, not seen in those with normal CD 4 count and undetectable viral load
  2. Immune complex mediated glomeruonephritis - can be membranous nephropathy, membranoproliferative GN, and "lupus-like" proliferative GN
  3. Glomerulonephritis due to HCV co-infection
  
  

  Posted 08/18/16 10:04:17 AM by Anna Krigel

• For further reading...

  Nephropathy in HIV infection
  Clinical Practice Guideline for the Management of CKD in HIV-infected patients
  
  

  Posted 08/18/16 10:15:41 AM by Anna Krigel

Created by Christopher Kelly

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