The Link Between HIV and Kidney Disease

Higher Rates Due to Infections and Medication Use

Kidney dialysis
HIV and Kidney Disease. Science Photo Library Ltd / Getty Images

The link between kidney disease and HIV is strong, particularly in people with long term HIV infection. While there are multiple reasons for this association—including the medications we take and the infections we are sometimes prone to—it is clear that HIV, in and of itself, contributes to higher rates due to the persistent inflammation one experiences during the long course of infection.

Understanding the Kidneys and Kidney Function

The kidney is one of the most important organs in the human body.

These bean-shaped organs, each the size of your fist, are located at about the middle of your back just below the rib cage.

The primary function of the kidneys is to filter waste and extra water from your blood. In fact, the kidneys together process about 200 quarts of blood each day, filtering out about two quarts of excess water and waste products each day. This waste is eliminated from the body as urine.

Normal kidney function (also known as renal function) is essential for a person a person to live and function normally. Unfortunately, this is not always the case, with certain people prone disorder as result of infection, injury, or exposure to toxic substances.

Some examples of the causes of renal dysfunction:

  • Diabetes
  • High blood pressure
  • HIV
  • Hepatitis B or hepatitis C
  • Recurrent kidney stones
  • Polycystic kidney disease
  • Lupus
  • Overuse of certain painkillers, particularly acetaminophen or ibuprofen
  • Cocaine or heroin use
  • Older age
  • People with a family history of kidney disease

In fact, about 30 percent of people with HIV will, at one time or another, be diagnosed with having protein in their urine, a substance not found in those with normally functioning kidneys. About 10 percent will go on to develop kidney disease.

This translates to around two percent of all persons with end stage renal disease being HIV-positive.

Why is Kidney Disease an Issue in HIV?

There are many causes and types of kidney disease in the HIV population. For some, it is the virus itself doing damage to the kidney. For others, HIV medications can contribute to the damage.

Among the prime causes of dysfunction:

  • Acute Tubular Necrosis (ATN) is a condition in which the tubules within the kidneys are damaged due to a lack of oxygen or exposure to certain chemicals, including some HIV medications. One such medication is the drug Viread (tenofovir), which can progressively interfere with the kidneys' ability to filter waste, causing abnormal renal function and even kidney failure in some. 
  • Fanconi syndrome can also cause damage to the tubules, impeding the kidneys' abiltiy to reabsorb certain electrolytes and substances such as glucose. 
  • Lactic acidosis is a potentially life-threatening condition associated primarily with older HIV drugs such as Zerit (stavudine), which can lead to the build up lactic acid in the blood. The kidneys are one of the systems that can be severely damaged as a result of lactic acidosis.
  • Kidney stones are known to cause damage by obstructing the architecture of the kidney as well as the flow of oxygen to tissues. Some HIV medications that are known to increase the incidence of kidney stones, including Crixivan (indinavir) and Reyataz (atazanavir).

    Signs and Symptoms of Renal Disease

    Unfortunately, most physical signs of renal disease only occur after significant kidney damage has been done. Visible symptoms of disease, such as swelling in the hands, face, and legs, typically occur only in the the more severe cases. Changes in urination—such as decreased urination or changes in the color or concentration of the urine—may also hint at the development of kidney dysfunction. 

    Whether symptoms are fully apparent or not, kidney disorders can be confirmed by way of  blood and urine testing, including:

    • Blood Urea Nitrogen (BUN) which measures the level of nitrogen (a waste product typically filtered by the kidneys) in blood sample. When the kidneys malfunction, the amount of nitrogen waste in the blood increases, as does the BUN value.
    • Creatinine is as substance produced when muscle is broken down, which is then filtered from the blood by the kidneys. When the kidneys are damaged, creatinine builds up, providing confirming of kidney impairment.
    • Protein found in the blood can also be indicative of kidney disorders given that normal kidney will reabsorb protein during the course of filtration. .

    While blood and urine tests can signal your doctor to the development of renal dysfunction, a biopsy of kidney tissue remains the most accurate means of diagnosing disease.


    Choi, A. and Rodriquez, R. "Renal Manifestations of HIV." HIV InSite Knowledge Base. November 2003; updated January 2008.

    Phair, J.and Palella, F. "Renal disease in HIV infected Individuals." Current Opinions In HIV/AIDS. July 2011;6(4):284-289.