Its prevalence in patients under cART ranges between 10 and 30% and constitutes an independent risk factor for progression of CKD and all-cause mortality. In addition, proteinuria is an important finding in patients with HIV infection. These relatively infrequent findings may appear in the context of preserved glomerular filtration rate (GFR), although in some studies a decrease in GFR has been reported. Although the underlying mechanism is still unclear, tenofovir may produce proximal tubule damage characterized by proteinuria, normoglycemic glycosuria, hypokalemic renal tubular acidosis, and phosphaturia. In addition, these variables can be associated with exposure to combined antiretroviral therapy (cART) which may induce direct toxic effects on the nephron. Traditional risk factors for renal disease such as hypertension, diabetes, and hyperlipidemia are more prevalent in seropositive patients and are also associated with the advancing age of the HIV-positive population. Longer survival of patients on antiretroviral treatment as well as specific effects of some antiretroviral drugs and viral-related factors contributes to this finding. Renal disease is increasingly recognized as a cause of morbidity and mortality among patients with HIV infection.
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The present study documented that proximal tubule sodium reabsorption was preserved while free water clearance and maximal urine dilution capability were reduced in stable HIV patients treated or not with tenofovir. Proximal tubular function was normal in both studied groups. Free water clearance was lower and urine osmolarity was higher in both HIV+ groups. After the test, both HIV groups had a significant reduction of serum sodium and osmolarity compared with the control group. The control group included 10 healthy volunteers. Chaimowitz' test was performed on 20 HIV positive volunteers who had normal renal functional parameters. We analyzed the function of the proximal tubule and TALH in patients with HIV infection receiving or not tenofovir-containing antiretroviral treatment in comparison with healthy seronegative controls, by applying a tubular physiological test, hyposaline infusion test (Chaimowitz' test). The thick ascending limb of Henle's loop (TALH) is the tubule segment where free water clearance is generated, determining along with glomerular filtration rate the kidney's ability to dilute urine. Viral infection itself and the use of some antiretroviral drugs contribute to this condition. Renal disease is a well-recognized complication among patients with HIV infection.
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