Renal disease is increasingly common as life expectancy of HIV-infected persons continues to improve. Several biomarkers are available for monitoring renal function, although no consensus exists on how best to apply these tools in HIV infection. This review describes recent findings for the more common renal biomarkers.
Although widely used in clinical practice, creatinine-based estimates of glomerular filtration rate have not been validated in HIV infection. Serum cystatin C has been proposed as a more sensitive marker of renal dysfunction in HIV infection, although it may also reflect systemic inflammation. Screening for proteinuria and albuminuria allows identification of patients at higher risk of kidney disease and other adverse outcomes. Fanconi syndrome, which has been associated with tenofovir use, is associated with severe tubular proteinuria, and several low molecular weight proteins, including retinol-binding protein, β2-microglobulin, and neutrophil gelatinase-associated lipocalin have been studied as markers of tubular dysfunction. Studies have reported a high prevalence of subclinical proximal tubular dysfunction in patients receiving antiretroviral therapy.
Future studies are needed to determine the optimal biomarkers for the detection and monitoring of renal disease in HIV.
aKing's College London School of Medicine, London, UK
bDivision of Nephrology, Department of Medicine, Mount Sinai School of Medicine, New York, USA
cResearch Department of Infection and Population Health, University College London Medical School, London, UK
Correspondence to Dr A. Mocroft, Research Department of Infection and Population Health, University College London Medical School, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK Tel: +44 207 830 2239; fax: +44 207 794 1224; e-mail: firstname.lastname@example.org