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Clinical Management of Kidney Disease in HIV Infection
Slide 1.
CLINICAL MANAGEMENT OF KIDNEY DISEASE IN HIV INFECTION
Slide 1.
OUTLINE
Slide 2.
HIV-ASSOCIATED NEPHROPATHY (HIVAN)
Slide 3.
CASE #1: INITIAL PRESENTATION
Slide 4.
CASE #1 CONTINUED
Slide 5.
CASE #1 CONTINUED
Slide 6.
KIDNEY BIOPSY SPECIMENS OBTAINED BEFORE AND AFTER THE INITIATION OF HAART
Slide 7.
KIDNEY BIOPSY SPECIMENS OBTAINED BEFORE AND AFTER THE INITIATION OF HAART
Slide 8.
HIV-1 RNA IN SITU HYBRIDIZATION OF KIDNEY BIOPSY SPECIMENS BEFORE AND AFTER HAART
Slide 9.
NEPHROPATHY AND ESTABLISHMENT OF A RENAL RESERVOIR OF HIV DURING PRIMARY INFECTION
Slide 10.
DOES ANTIRETROVIRAL THERAPY IMPROVE THE PROGNOSIS OF HIV-ASSOCIATED NEPHROPATHY?
Slide 11.
EFFECT OF HAART ON RENAL SURVIVAL
Slide 12.
RISK FACTORS FOR PROGRESSION
Slide 13.
ESRD DUE TO AIDS NEPHROPATHY AND DEATHS IN AFRICAN AMERICANS WITH AIDS
Slide 14.
SUMMARY OF HIVAN TREATMENT
Slide 15.
No Slide. Question from audience.
Slide 16.
ACUTE KIDNEY INJURY (AKI)
Slide 17.
ACUTE KIDNEY INJURY (AKI)
Slide 18.
DEFINITION OF ACUTE KIDNEY INJURY (AKI)
Slide 19.
INCIDENCE OF AKI IN VA HEALTHCARE SYSTEM
Slide 20.
DIALYSIS AND AKI RATES PER 1OOO PERSON-YEARS, 1986-2006
Slide 21.
DIALYSIS AKI RATES PER 1OOO PERSON-YEARS, 1986-2006
Slide 22.
LONG-TERM CLINICAL CONSEQUENCES OF ACUTE KIDNEY INJURY IN HIV-INFECTED PERSONS
Slide 	23.
AGE-STANDARDIZED EVENT RATES 90 DAYS AFTER DISCHARGE BY STAGE OF IN-HOSPITAL AKI
Slide 24.
CONCLUSIONS
Slide 25.
POSSIBLE MECHANISMS
Slide 26.
CLINICAL IMPLICATIONS
Slide 27.
IMMUNE COMPLEX GLOMERULONEPHRITIS (ICGN)
Slide 28.
CASE #2: INITIAL PRESENTATION
Slide 29.
RENAL BIOPSIES SHOWING LUPUS-LIKE GLOMERULONEPHRITIS
Slide 30.
RENAL BIOPSIES SHOWING LUPUS-LIKE GLOMERULONEPHRITIS
Slide 31.
IMMUNE COMPLEX GLOMERULONEPHRITIS
Slide 32.
CLINICAL FEATURES
Slide 33.
CASE #2: CLINICAL FOLLOW-UP
Slide 34.
LABORATORY, IMMUNOLOGICAL, AND VIROLOGICAL MONITORING DURING RENAL DISEASE
Slide 35.
LABORATORY, IMMUNOLOGICAL, AND VIROLOGICAL MONITORING DURING RENAL DISEASE
Slide 36.
CASE #2: CLINICAL FOLLOW-UP CONTINUED
Slide 37.
LABORATORY, IMMUNOLOGICAL, AND VIROLOGICAL MONITORING DURING RENAL DISEASE
Slide 38.
HIV CHARACTERISTICS AT TIME OF DIAGNOSIS
Slide 39.
HIV-RELATED NEPHROPATHIES ASSOCIATED WITH CHANGES IN BLOOD AND KIDNEY TISSUE VIRUS LOAD
Slide 40.
HIV-RELATED NEPHROPATHIES ASSOCIATED WITH CHANGES IN BLOOD AND KIDNEY TISSUE VIRUS LOAD
Slide 41.
EFFECT OF VIREMIA ON KIDNEY FUNCTION
Slide 42.
CHANGES IN VIRAL LOAD AND GFR IN A PATIENT
Slide 43.
CLINICAL QUESTIONS
Slide 44.
BACKGROUND
Slide 45.
METHODS
Slide 46.
COVARIATES
Slide 47.
STATISTICAL ANALYSIS
Slide 48.
BASELINE CHARACTERISTICS
Slide 49.
RISK FACTORS IN TREATED CONTROLLERS
Slide 50.
CONCLUSIONS
Slide 51.
TENOFOVIR-ASSOCIATED NEPHROPATHY
Slide 52.
CASE #3: INITIAL PRESENTATION
Slide 53.
CASE #3 CONTINUED
Slide 54.
RENAL BIOPSY SHOWING ACUTE TUBULAR INJURY
Slide 55.
TENOFOVIR NEPHROTOXICITY
Slide 56.
WORK-UP
Slide 57.
RENAL HANDLING OF TENOFOVIR
Slide 58.
IMPACT OF TENOFOVIR ON RENAL FUNCTION IN HIV-INFECTED, ANTIRETROVIRAL-NAIVE PATIENTS
Slide 59.
PROXIMAL TUBULAR RENAL DYSFUNCTION
Slide 60.
OVERALL CHANGE OF GFR FROM BASELINE (ADJUSTED MODEL)
Slide 61.
CONCLUSIONS
Slide 62.
SMART CONTINUATION STUDY
Slide 63.
RISK FOR OPPORTUNISTIC DISEASE AND DEATH AFTER REINITIATING CONTINUOUS ANTIRETROVIRAL THERAPY IN PATIENTS WITH HIV PREVIOUSLY RECEIVING EPISODIC THERAPY
Slide 64.
RENAL DISEASE BEFORE AND AFTER STUDY MODIFICATION
Slide 65.
MORE IS BETTER?
Slide 66.
WHERE TO GO FROM HERE?
Slide 67.
THANK YOU!
Slide 68.
QUESTIONS?
Slide 69.

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