scholarly journals Acute Kidney Injury and Urinary Biomarkers in Human Immunodeficiency Virus–Associated Cryptococcal Meningitis

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Charlotte Schutz ◽  
David R. Boulware ◽  
Katherine Huppler-Hullsiek ◽  
Maximilian von Hohenberg ◽  
Joshua Rhein ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Cd4 Count ◽  
Urine Ngal ◽  
Urine Protein ◽  
Immunodeficiency Virus

Abstract Background Cryptococcus is the most common etiology of adult meningitis in Africa. Amphotericin B deoxycholate remains paramount to treatment, despite toxicities, including acute kidney injury (AKI). We assessed the ability of the following urine markers to predict AKI in patients who received amphotericin B: urine neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC), tissue inhibitor of metalloproteinases-2 (TIMP-2), and protein. Methods One hundred and thirty human immunodeficiency virus (HIV)–infected participants with cryptococcal meningitis were enrolled and received amphotericin and fluconazole for 2 weeks. We defined AKI as glomerular filtration rate (GFR) < 60 mL/min/1.73 m2; measured urine NGAL, CysC, TIMP-2, and protein; and explored AKI incidence, risk factors, and associations with mortality using Cox proportional hazards models. Results Participants were 48% female with a median age of 35 years, a median CD4 count of 21 cells/μL, and 44% died within 12 months. Incident AKI occurred in 42% and was associated with mortality (adjusted hazard ratio [aHR] = 2.8; P < .001). Development of AKI was associated with female sex (P = .04) and with higher CD4 count (49 vs 14 cells/μL; P < .01). Urine protein level in the highest quartile independently predicted AKI and mortality (aHR = 1.64, P = .04; aHR = 2.13, P = .02, respectively). Urine NGAL levels in the highest quartile independently predicted AKI (aHR = 1.65; P = .04). Conclusions Acute kidney injury occurred in 42% of patients, and AKI was associated with mortality. Urine biomarkers, specifically urine protein, may be useful for antecedent prediction of amphotericin-associated AKI but need further evaluation.

scholarly journals A Rare Cause of Acute Kidney Injury: Primary Renal Lymphoma in a Patient with Human Immunodeficiency Virus

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Ruslinda Mustafar ◽  
Lydia Kamaruzaman ◽  
Beh Hui Chien ◽  
Azyani Yahaya ◽  
Noor’Ain Mohd Nasir ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Acute Kidney Injury ◽  
Hematological Malignancy ◽  
Kidney Injury ◽  
B Cell Lymphoma ◽  
Hiv Disease ◽  
Large B Cell Lymphoma ◽  
Renal Lymphoma ◽  
Immunodeficiency Virus ◽  
Combined Antiretroviral Therapy

We reported a case of primary renal lymphoma (PRL) presented with non-oliguric acute kidney injury and bilateral kidney infiltrates in an individual with human immunodeficiency virus (HIV) disease. Acute kidney injury secondary to lymphoma infiltrates is very rare (less than 1% of hematological malignancy). A 37-year-old gentleman with underlying human immunodeficiency virus (HIV) disease was on combined antiretroviral therapy since diagnosis. He presented to our center with uremic symptoms and gross hematuria. Clinically, bilateral kidneys massively enlarged and were ballotable. Blood investigations showed hemoglobin of 3.7 g/L, urea of 65.6 mmol/L, and serum creatinine of 1630 µmol/L with hyperkalemia and metabolic acidosis. An urgent hemodialysis was initiated, and he was dependent on regular hemodialysis subsequently. Computed tomography renal scan showed diffuse nonenhancing hypodense lesion in both renal parenchyma. Diagnosis of diffuse large B cell lymphoma with germinal center type, CD20 positive, and proliferative index 95% was confirmed via renal biopsy, and there was no bone marrow infiltrates. Unfortunately, the patient succumbs prior to initiation of chemotherapy.

scholarly journals Comparative Effectiveness of Induction Therapy for Human Immunodeficiency Virus-Associated Cryptococcal Meningitis: A Network Meta-Analysis

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Jeffrey I. Campbell ◽  
Steve Kanters ◽  
John E. Bennett ◽  
Kristian Thorlund ◽  
Alexander C. Tsai ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Amphotericin B ◽  
Induction Therapy ◽  
Cryptococcal Meningitis ◽  
Comparative Effectiveness ◽  
Treatment Guidelines ◽  
Meta Analysis ◽  
High Dose ◽  
Mortality Benefit ◽  
Immunodeficiency Virus

Abstract Background.  Multiple international treatment guidelines recommend amphotericin-based combination regimens for induction therapy of cryptococcal meningitis. Yet, only 1 trial has reported a mortality benefit for combination amphotericin-flucytosine, and none have reported a mortality benefit for combination amphotericin-fluconazole. Methods.  We conducted a Bayesian network meta-analysis to estimate the comparative effectiveness of recommended induction therapies for HIV-associated cryptococcal meningitis. We searched PubMed and Cochrane CENTRAL for clinical reports of induction therapy for HIV-associated cryptococcal meningitis. We extracted or calculated early (two-week) and late (six to 12-week) mortality by treatment arm for the following induction regimens: amphotericin B alone, amphotericin B + flucytosine, amphotericin B + triazoles, amphotericin B + flucytosine +triazoles, triazoles alone, triazoles + flucytosine, liposomal amphotericin B, and amphotericin B + other medicines. Results.  In the overall sample (35 studies, n = 2483), we found no evidence of decreased mortality from addition of flucytosine or triazoles to amphotericin B, compared with amphotericin B alone. Although we did find a nonsignificant benefit for addition of flucytosine to amphotericin B in studies including participants with altered levels of consciousness, we did not ide.jpegy a benefit for combination therapy in restricted analyses in either resource-rich or resource-limited settings, studies conducted before or after 2004, and studies restricted to a high dose of amphotericin B and fluconazole. Conclusions.  Given considerations of drug availability and toxicity, there is an important need for additional data to clarify which populations are most likely to benefit from combination therapies for human immunodeficiency virus-associated cryptococcal meningitis.

scholarly journals A case–control study of human immunodeficiency virus-negative patients with cryptococcemia and cryptococcal meningitis in a Chinese tertiary care hospital during 10 years

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098465
Author(s):  
Liling Liang ◽  
Zhixin Liang ◽  
Danyang She ◽  
Liang’an Chen
Keyword(s):  
Human Immunodeficiency Virus ◽  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Case Control Study ◽  
Tertiary Care ◽  
Case Control ◽  
Care Hospital ◽  
Retrospective Case ◽  
Immunodeficiency Virus ◽  
Control Study

Objective This study aimed to characterize patients with cryptococcemia and compare the clinical features of cryptococcemia and cryptococcal meningitis. Methods This was a retrospective, case–control study. We retrospectively identified blood cultures with Cryptococcus spp. growth. Controls were hospitalized patients who suffered from cryptococcal meningitis, but did not experience cryptococcemia. Controls and cases were matched by admission date, age, sex, and body weight. Clinical information was analyzed by two independent reviewers. Results Eight patients with cryptococcemia and eight patients with cryptococcal meningitis were included. They were all negative for human immunodeficiency virus. The most common underlying disease was primary nephrotic syndrome. All patients presented with fever. The incidence of headache, nausea/vomiting, seizures, and cough/expectoration was significantly lower in patients with cryptococcemia than in those with cryptococcal meningitis. All clinical strains of Cryptococcus, except for one, were sensitive to fluconazole, voriconazole, itraconazole, amphotericin B, and flucytosine in vitro. The rate of receiving an amphotericin B-containing regimen was significantly higher in patients with cryptococcal meningitis than in those with cryptococcemia. In-hospital mortality was significantly higher in cryptococcemia cases compared with cryptococcal meningitis cases. Conclusion Cryptococcemia is an unusual infection characterized by a high mortality. Cryptococcemia requires early identification and prompt antifungal therapy.

scholarly journals Extended Peritoneal Dialysis and Renal Recovery in HIV-Infected Patients with Prolonged AKI: A Report of 2 Cases

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Donlawat Saengpanit ◽  
Pongpratch Puapatanakul ◽  
Piyaporn Towannang ◽  
Talerngsak Kanjanabuch
Keyword(s):  
Chronic Kidney Disease ◽  
Human Immunodeficiency Virus ◽  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Stage 4 ◽  
Ckd Stage ◽  
Immunodeficiency Virus ◽  
Small Solute

Peritoneal dialysis (PD) has recently been established as a treatment option for renal replacement therapy (RRT) in patients with acute kidney injury (AKI). Its efficacy in providing fluid and small solute removal has also been demonstrated in clinical trials and is equivalent to hemodialysis (HD). However, effect of RRT modality on renal recovery after AKI remains a controversy. Moreover, the setting of human immunodeficiency virus- (HIV-) infected patients with AKI requiring RRT makes the decision on RRT initiation and modality selection more complicated. The authors report here 2 cases of HIV-infected patients presenting with severe AKI requiring protracted course of acute RRT. PD had been performed uneventfully in both cases for 4–9 months before partial renal recovery occurred. Both patients eventually became dialysis independent but were left in chronic kidney disease (CKD) stage 4. These cases highlight the example of renal recovery even after a prolonged course of dialysis dependence. Thus, PD might be a suitable option for HIV patients with protracted AKI.

scholarly journals HIV-related nephropathy: new aspects of an old paradigm

2020 ◽  
Vol 66 (suppl 1) ◽  
pp. s75-s81 ◽  
Author(s):  
Érica Lofrano Reghine ◽  
Renato Demarchi Foresto ◽  
Gianna Mastroianni Kirsztajn
Keyword(s):  
Human Immunodeficiency Virus ◽  
Acute Kidney Injury ◽  
Chronic Disease ◽  
High Risk ◽  
Infected Patient ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Antiretroviral Drugs ◽  
High Morbidity ◽  
Immunodeficiency Virus

SUMMARY The scenario of infection by the human immunodeficiency virus (HIV) has been undergoing changes in recent years, both in relation to the understanding of HIV infection and regarding the treatments available. As a result, the disease, which before was associated with high morbidity and mortality, is now seen as a chronic disease that can be controlled, regarding both transmission and symptoms. However, even when the virus replication is well controlled, the infected patient remains at high risk of developing renal involvement, either by acute kidney injury not associated with HIV, nephrotoxicity due to antiretroviral drugs, chronic diseases associated with increased survival, or glomerular disease associated to HIV. This review will cover the main aspects of kidney failure associated with HIV.

scholarly journals The significance of antiretroviral-associated acute kidney injury in a cohort of ambulatory human immunodeficiency virus-infected patients

2013 ◽  
Vol 28 (8) ◽  
pp. 2073-2081 ◽  
Author(s):  
Philip Wikman ◽  
Pablo Safont ◽  
María Del Palacio ◽  
Ana Moreno ◽  
Santiago Moreno ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Immunodeficiency Virus

scholarly journals Seizures in Human Immunodeficiency Virus-Associated Cryptococcal Meningitis: Predictors and Outcomes

2019 ◽  
Vol 6 (11) ◽  
Author(s):  
Katelyn A Pastick ◽  
Ananta S Bangdiwala ◽  
Mahsa Abassi ◽  
Andrew G Flynn ◽  
Bozena M Morawski ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Proportional Hazards ◽  
Neurocognitive Function ◽  
Cox Proportional Hazards ◽  
Neurocognitive Performance ◽  
Cox Proportional Hazards Models ◽  
Immunodeficiency Virus ◽  
Z Scores

Abstract Background Seizures commonly occur in patients with cryptococcal meningitis, yet risk factors and outcomes related to seizures are not well described. Methods We performed post hoc analyses on participants prospectively enrolled in 3 separate human immunodeficiency virus (HIV)-associated cryptococcal meningitis clinical trials during 2010–2017. Documentation of seizures at presentation or during hospitalization and antiseizure medication receipt identified participants with seizures. We summarized participant characteristics by seizure status via Kruskal-Wallis and χ 2 tests. Cox proportional hazards models analyzed the relationship between seizures and mortality. We compared mean quantitative neurocognitive performance Z (QNPZ-8) scores, and individual domain z-scores, at 3-months using independent t tests. Results Among 821 HIV-infected cryptococcal meningitis participants, 28% (231 of 821) experienced seizures: 15.5% (127 of 821) experienced seizures at presentation, and 12.7% (104 of 821) experienced incident seizures. Participants with seizures at presentation had a significantly lower Glasgow coma scale ([GCS] <15; P < .001), CD4 count (<50 cells/mcL; P = .02), and higher cerebrospinal fluid (CSF) opening pressure (>25 cm H2O; P = .004) when compared with participants who never experienced seizures. Cerebrospinal fluid fungal burden was higher among those with seizures at presentation (125 000 Cryptococcus colony-forming units [CFU]/mL CSF) and with seizures during follow-up (92 000 CFU/mL) compared with those who never experienced seizures (36 000 CFU/mL, P < .001). Seizures were associated with increased 10-week mortality (adjusted hazard ratio = 1.45; 95% confidence interval, 1.11–1.89). Participants with seizures had lower neurocognitive function at 3 months (QNPZ-8 = −1.87) compared with those without seizures (QNPZ-8 = −1.36; P < .001). Conclusions Seizures were common in this HIV-associated cryptococcal meningitis cohort and were associated with decreased survival and neurocognitive function.

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