Reviewed by: HU Medical Review Board | Last reviewed: September 2019 | Last updated: May 2021
When an individual has kidney disease (also called renal disease), it means their kidneys are not working in the way that they should.
Healthy kidneys are about the size of a fist and are bean-shaped. The two kidneys sit inside the abdomen near the middle of the back (one on each side of the spine). They filter out waste and extra fluid from the body, specifically, from our blood. The kidneys get rid of this waste and fluid by making urine that gets passed out of the body.
The kidneys also each have a gland that sits on top of them called the adrenal gland. These two glands regulate hormones that are important in many of our body’s functions.
Complications of kidney disease
If kidney disease is severe, and function is significantly declined, an individual may progress to end-stage renal disease (ESRD). This occurs when 90 percent or more of kidney function has been lost. When kidney function is so low, the kidneys can completely fail, and an individual may need dialysis or a kidney transplant to stay alive. The most common causes of ESRD are type 2 diabetes and high blood pressure.
Factors that may influence kidney disease
Other issues may lead to impaired kidney functioning and kidney disease, including illicit drug use, kidney infections, kidney stones, overuse of some over-the-counter pain medications, family history of kidney disease or kidney failure, heart disease, and other kidney-related conditions called polycystic kidney disease or glomerulonephritis. Kidney function also generally declines with age.1-3
How is kidney disease related to HIV?
The relationship between HIV and kidney disease is complex. Individuals with HIV are more likely than those without the virus to have an acute (sudden onset) kidney injury, which can lead to kidney disease. In some cases, acute kidney injury can be caused by an infection, which individuals with HIV are at higher risk for since the virus weakens their immune system. However, the risk of developing an acute kidney injury has been decreasing since the widespread use of antiretroviral medications (ART) to treat HIV. Additionally, HIV can infect cells in the kidneys or impact the filters (nephrons) in the kidneys, impacting their ability to function.4
The risk of kidney disease may also be increased in those with HIV due to shared characteristics and risk factors. For example, common characteristics of individuals with chronic (long-term) kidney disease include having high blood pressure, diabetes, coinfection with hepatitis C, and being of African American race. All of these characteristics are also shared amongst many with HIV infection and may be why kidney disease and HIV co-occur in some individuals.
Regardless of other risk factors, though, infection with both HIV and hepatitis C carries an increased risk of developing kidney disease, and it has been estimated that about 25 percent of individuals with HIV also have hepatitis C. Additionally, some HIV-treating medications may increase the risk of developing kidney disease, and may need to be avoided in some individuals who have other kidney-related risk factors.1,5,6
Signs of kidney disease
Those with kidney disease often won’t have symptoms until kidney function has significantly decreased. Signs of poor kidney function include, but are not limited to:
- Changes in urination frequency, amount, or color
- Feeling tired
- Difficulty sleeping
Treatment of kidney disease
Managing kidney failure may involve taking high blood pressure or diabetes medications regularly to prevent further damage. If an individual’s kidneys fail, they may need to undergo a process called dialysis. Dialysis involves using a machine outside of the body to filter the blood or abdominal fluid. Essentially, the dialysis machine does the work that the kidney would normally do and filters out wastes and excess fluids. In some cases, a kidney transplant from a donor may be needed to replace the failing kidney.1
Prevention of kidney disease
Kidney function is monitored regularly for those receiving care for HIV. If you are concerned about your risk of developing kidney disease or your current kidney function, talk with your healthcare provider and they can order tests to check the status of your kidneys. Otherwise, taking ART every day as prescribed, taking blood pressure or diabetes medicines as prescribed, eating a healthy diet with limited sugar and salt, participating in regular exercise, and regularly checking in with your healthcare provider are all steps that can be taken to reduce the chances of developing kidney disease.1