Acute renal failure in HIV-infected patients: A brief review of common causes

Acute renal failure is a well-described renal syndrome observed in patients infected with the human immunodeficiency virus (HIV). Underlying glomerula r disease and disturbances in renal tubular function predispose these patie nts to a number of hemodynamic and nephrotoxic insults. Prerenal azotemia f rom both "true" and "effective" depletion of intravascular volume is the mo st common cause of acute renal insufficiency in patients infected with HIV. Direct damage to the renal tubules from both nephrotoxic medications and p rolonged ischemic processes occurs frequently in hospitalized patients. Inj ury to the tubulointerstitium of the kidney may also result from allergic r eactions to medications prescribed to patients. Deposition of crystals in t he tubular lumens, and rarely in the glomerular capillaries, will cause acu te renal failure in the setting of tumor lysis syndrome or during therapy w ith medications associated with crystal nephropathy. Finally, obstruction o f the urinary system will rarely cause postrenal azotemia in patients infec ted with HIV.