Beruflich Dokumente
Kultur Dokumente
Kerentanan pasien berkulit hitam terhadap toksisitas ginjal sudah dilaporkan sebagai nol atau jarang.13
9-12
Penelitian tenofovir yang diberikan dengan rejimen yang dikuatkan oleh PI juga menunjukkan tingkat
nefrotoksisitas nol atau kurang dari 2%.14-16
Pengobatan CKD
• Alat tes urin dengan
dipstick yang baku cukup untuk menskrining terhadap proteinuria; pasien dengan diabetes harus juga
dites terhadap mikroalbuminuria. • Biopsi ginjal sangat perlu dipertimbangkan untuk penyakit ginjal
yang tidak dapat dijelaskan berdasarkan proteinuria berat atau
penurunan GFR karena kejadian itu menunjukkan risiko terbesar
terhadap ESRD.
• Nefropati terkait HIV: Biopsi ginjal biasanya ditunjukkan dan ART harus diberikan terlepas pada
jumlah CD4 karena replikasi HIV adalah penyebab kerumitan tersebut.
• Pasien dengan hipertensi harus menerima penghambat enzim pengubah angiotensin atau
penghambat reseptor angiotensin karena kedua enzim tersebut mengurangi pengeluaran protein dan
memperlambat pengembangan terhadap ESRD. Pada penderita diabetes, pengendalian gula darah
adalah penting untuk menunda nefropati terkait diabetes.
Referensi:
1. Rao TK, Filippone EJ, Nicastri AD, et al. Associated focal and segmental glomerulosclerosis in the
acquired immunodeficiency syndrome. N Engl J Med. 1984;310:669-673. Abstract
2. Winston JA, Klotman PE. Are we missing an epidemic of HIV-associated nephropathy? Am Soc
Nephrol. 1996;7:1-7.
3. Brown TT, Cole SR, Li X, et al. Antiretroviral therapy and the prevalence and incidence of diabetes
mellitus in the multicenter AIDS cohort study. Arch Intern Med. 2005;165:1179-1184. Abstract
4. Gazzaruso C, Bruno R, Garzaniti A, et al. Hypertension among HIV patients: prevalence and
relationships to insulin resistance and metabolic syndrome. J Hypertens. 2003;21:1377-1382. Abstract
5. Stehman-Breen CO, Gillen D, Steffes M, et al. Racial differences in early-onset renal disease among
young adults: the coronary artery risk development in young adults (CARDIA) study. J Am Soc Nephrol.
2003;14:2352-2357. Abstract
6. Lucas GM, Lau B, Atta MG, et al. Chronic kidney disease incidence, and progression to end-stage
renal disease, in HIV-infected individuals: a tale of two races. J Infect Dis. 2008;197:1548-1557.
Abstract
7. Franceschini N, Napravnik S, Eron JJ Jr, Szczech LA, Finn WF. Incidence and etiology of acute renal
failure among ambulatory HIV-infected patients. Kidney Int. 2005;67:1526-1531. Abstract
8. Arribas JR, Pozniak AL, Gallant JE, et al. Tenofovir disoproxil fumarate, emtricitabine, and efavirenz
compared with zidovudine/lamivudine and efavirenz in treatment-naive patients: 144-week analysis. J
Acquir Immune Defic Syndr. 2008;47:74-78. Abstract
9. Gallant JE, Parish MA, Keruly JC, Moore RD. Changes in renal function associated with tenofovir
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Penyakit ginjal terkait HIV
disoproxil fumarate treatment, compared with nucleoside reverse-transcriptase inhibitor treatment. Clin
Infect Dis. 2005;40:1194-1198. Abstract
10. Cihlar T, Ray AS, Laflamme G, et al. Molecular assessment of the potential for renal drug
interactions between tenofovir and HIV protease inhibitors. Antivir Ther. 2007;12:267-272. Abstract
11. Goicoechea M, Liu S, Best B, et al. Greater tenofovir-associated renal function decline with protease
inhibitor-based versus nonnucleoside reverse-transcriptase inhibitor-based therapy. J Infect Dis.
2008;197:102-108. Abstract
12. Gérard L, Chazallon C, Taburet AM, et al. Renal function in antiretroviral-experienced patients
treated with tenofovir disoproxil fumarate associated with atazanavir/ritonavir. Antivir Ther.
2007;12:31-39. Abstract
13. Reid A, Stöhr W, Walker AS, et al. Severe renal dysfunction and risk factors associated with renal
impairment in HIV-infected adults in Africa initiating antiretroviral therapy. Clin Infect Dis.
2008;46:1271-1281. Abstract
14. Johnson M, Grinsztejn B, Rodriguez C, et al. 96-week comparison of once-daily atazanavir/ritonavir
and twice-daily lopinavir/ritonavir in patients with multiple virologic failures. AIDS. 2006;20:711-718.
Abstract
15. Smith KY, Weinberg WG, Dejesus E, et al. Fosamprenavir or atazanavir once daily boosted with
ritonavir 100 mg, plus tenofovir/emtricitabine, for the initial treatment of HIV infection: 48-week results
of ALERT. AIDS Res Ther. 2008;5:5.
16. Buchacz K, Young B, Baker RK, et al. Renal function in patients receiving tenofovir with
ritonavir/lopinavir or ritonavir/atazanavir in the HIV Outpatient Study (HOPS) cohort. J Acquir Immune
Defic Syndr. 2006;43:626-628. Abstract
Ringkasan: HIV-Associated Kidney Disease
Sumber: Clin Infect Dis. 2008;47:1449-1457
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