Module Abstract

Does Polypharmacy Increase the Likelihood of Renal Toxicity Among Persons With HIV?

Abstract

In this Clinical Vignette, Lynda Szczech, MD, MSCE, FASN, discusses acute kidney injury diagnosis and management considerations for a 55-year-old HIV-infected male with undetectable HIV-1 RNA on a tenofovir-containing regimen. Following an acute myocardial infarction, the case patient underwent urgent percutaneous coronary artery angioplasty with stent placement in his left anterior descending coronary artery. In addition, persistently elevated blood glucose prompted the measurement of HbA1c, which was 8.9%. At that time, he had evidence of diabetic nephropathy with a spot urine protein-to-creatinine ratio of 1.2 but appeared to have preserved kidney function (serum creatinine 0.9 mg/dL, creatinine clearance 98 cc/min). On discharge from hospital, he was taking carvedilol, enalapril, glipizide, and furosemide in addition to his antiretrovirals. After several years that saw increases to his diuretic dose, he presents to clinic complaining of malaise, nausea, and weakness. In addition to his prescribed medications, he had been taking an over-the-counter nonsteroidal antiinflammatory drugs for several weeks to treat back pain.