No bigger than a fist and shaped like beans, your kidneys are easy to ignore. But when you’re living with HIV, kidney health deserves your undivided attention. Tim Horn shows you how to keep these miraculous organs working for you.
When it comes to kidney health, Fort Wayne, Indiana pastor Donald E. Archey has plenty to pray about. Diagnosed with HIV more than 20 years ago, the 45-year-old knows that he has several risk factors for kidney disease. Not only is he African American and HIV positive, both of which increase his risk of a condition called HIV-associated nephropathy, Archey also has hepatitis C, which makes him three to five times more likely to develop kidney problems. And he’s taking a few HIV drugs that can potentially damage his kidneys. (See “Mind Your Meds” for more information.)
Just because Archey has risk factors, doesn’t mean that the risk factors have him. “My kidneys are at the top of my health agenda,” declares the energetic pastor, who presides over Fort Wayne’s nondenominational New World Church and chants down HIV denial and stigma at black congregations around the country. “Talking to my doctor and doing my own research taught me to keep a close eye on my kidneys.”
More folks need to pay attention to their kidneys. After all, roughly 20 million Americans—one in nine U.S. adults—have kidney disease, and another 20 million are at increased risk, according to the National Kidney Foundation. Step one is to understand what these bean-shaped vital organs do for you.
A Tale of Two Kidneys
The kidneys are located halfway up the back, on either side of the spine. Each fist-size kidney houses about a million nephrons, tiny filtration units made up of blood vessels called glomeruli and fluid-collecting tubules. Over a 24-hour period, all of the blood in the body flows through the kidneys about 30 to 40 times. The nephrons siphon off waste products and excess water for removal in the form of urine.
In addition to waste disposal, the kidneys regulate various chemicals in the blood and, if necessary, release hormones including renin, which helps control blood pressure; erythropoietin, which stimulates red blood cell production; and calcitriol, the active form of vitamin D.
When doctors talk about kidney health, they usually refer to renal function. People with two healthy kidneys have 100% renal function, which is actually more than you need. This is why people do well with just one kidney. However, if renal function falls below 25%, serious health problems can occur.
During the early stages of kidney disease, people usually don’t feel sick. If the illness worsens, their need to urinate may increase or decrease, they may have trouble concentrating and they may experience fatigue, darkened skin, muscle cramps, and swollen feet or hands. Those who suffer end-stage renal disease (ESRD)—total and permanent kidney failure—won’t live long without dialysis or transplantation.
According to the Infectious Disease Society of America (IDSA), up to 30% of HIV positive people have abnormal renal function. “African Americans are particularly susceptible to kidney damage because of traditional factors like hypertension and diabetes, as well as HIV,” notes Stephen Symes, MD, program director of the Division of Infectious Diseases at Jackson Memorial Medical Center in Miami, Florida.
Because the kidneys play a critical role in processing many medications, including HIV drugs, “kidney health is very important,” says Dr. Symes. If the kidneys aren’t working correctly, levels of these meds remain elevated in the body and can result in serious side effects.
Thankfully, the two leading causes of kidney disease—hypertension and diabetes—can be managed and, in many cases, prevented, with the help of a doctor.
One out of three American adults has hypertension, or high blood pressure. Although this disease is most often associated with heart health, it can do damage to the tiny blood vessels in the kidneys, preventing them from filtering waste properly. High blood pressure can also be a sign that kidney health is already impaired.
The jury is still out on whether HIV positive people are more likely to suffer hypertension than their HIV negative counterparts. Whatever your status, you can improve your health odds by keeping blood pressure in check. “Controlling blood pressure will reduce the likelihood of heart attack, stroke and kidney disease,” says Antonio Urbina, MD, medical director of HIV and AIDS education at St. Vincent’s Medical Center in New York City.
The Sweetest Taboo
Diabetes is a disease that prevents the body from breaking down glucose correctly, causing sugar levels to remain high in the bloodstream. As sweet as this may sound, excess glucose can poison the body and damage the nephrons in the kidneys, leading to a condition called diabetic nephropathy, the most common cause of chronic and end-stage kidney disease in the United States.
HIV positive people, especially those on protease inhibitor (PI) therapy, are at an elevated risk of glucose-related problems. According to Dr. Urbina, you can reduce the likelihood of developing kidney disease by 50% by maintaining tight control of glucose levels. Your doctor can show you how.
Of the diseases that can attack the tiny filtration units in your kidneys, HIV-associated nephropathy (HIVAN) is perhaps the most sinister. HIVAN develops when HIV enters the kidneys and multiplies, wearing away at the lining of the glomeruli and tubules in the process. Left untreated, the disease can lead to kidney failure in six to 12 months.
While researchers aren’t sure how many HIV positive people have HIVAN, they do know that people of African descent are at much greater risk, that HIVAN is seven to ten times more common in men and that up to 60% of HIVAN patients have a history of intravenous drug use. Low CD4 counts and a family history of renal disease also place people at a heightened risk for HIVAN.
Because HIVAN is a direct result of virus replication in the kidneys, HIV treatment is believed to reduce the risk of its occurrence. “We are seeing less HIVAN in general,” notes Dr. Symes, “but it still occurs in areas like Miami, where HIV prevalence is high, a large percentage of patients are minorities and many patients [arrive] with the disease in its advanced stages.”
Given the considerable risk of kidney disease in positive people, experts in the field have done their part to raise awareness among positive people and their doctors. For example, the IDSA has developed recommendations that focus on chronic kidney disease (CKD) in people living with HIV.
Published in 2005, these guidelines urge folks to get screened for kidney disease as soon as they test positive for HIV (see “The Big Screen,” below, for more information). They also recommend that patients at high risk for renal impairment—such as those with high blood pressure, diabetes, CD4 counts below 200, viral loads above 4,000 or hep C—get their kidney function checked every year, even if everything seems fine. Finally, the IDSA encourages those who develop renal problems to get a referral for a kidney-specializing nephrologist.
When it comes time to select HIV meds, Dr. Urbina stresses that doctors should screen patients for kidney disease before reaching for the prescription pad. “Pretreatment analysis should include a urinalysis and [other lab tests],” he says. “In patients with kidney problems, I would avoid use of kidney-toxic agents and aggressively manage other risk factors, such as high blood pressure and diabetes. Keep in mind that simple, regular exercise and diet can have a profound effect on protecting the kidneys, but use of blood pressure and diabetic medications is most protective.”
So far, prevention has been the best medicine for Pastor Archey, who hasn’t developed renal problems despite his risks. He uses simple but effective strategies to stay diabetes- and hypertension-free, and his kidneys continue to thank him for it.
“I took sugary soda out of my diet and replaced it with water,” Archey explains. “I get my cholesterol and [glucose] levels checked every three months and my kidneys checked twice a year.”
Although Archey is busy—in addition to performing his pastoral duties at New World Church, he heads up the nonprofit Archey AIDS Foundation, and he’s touring to promote Pastor, How Did You Get AIDS?, a new memoir—he also makes time for physical activity.
About three times a week, Archey rides a stationary bike for 30 minutes, does push-ups and sit-ups and bench-presses weights, a throwback to his high school wrestling days.
“I don’t do it all the time, but I’ve been known to pump 260 pounds worth of iron, and I only weigh 140 pounds,” Archey says with a chuckle. “Exercise is an effort, but it’s something I know I have to do. It helps me maintain my physical health and keep my energy level high.”
The clergyman also remains in constant dialogue with his doctor. “It’s so important for me to take the medication as it’s prescribed,” says Archey. “But if I have any questions for my doctor, I just ask. I don’t wait around for her to tell me things. I just believe in being inquisitive about my health.”