RENAL DISEASE IN HIV
This project is designed for use by doctors, clinical officers and nurses, all of whom can engage at a level determined by their own clinical comfort and the diagnostic and management resources available in their setting.
There are several limitations to diagnosing and treating renal disease in a primary care HIV/TB clinic.
- Renal disease presents in non-specific ways, so is not easily identified.
- Urine dipstick testing is not routinely performed as part of pre-antiretroviral therapy (pre-ART) work-up, so some renal disease is missed.
- When an elevated serum creatinine (Cr) result is encountered, the focus tends to be on avoiding tenofovir and reducing doses of other antiretroviral (ARV) medication, but the investigation and management of the renal disease is often overlooked.
- Even when identified, renal disease is generally not well understood, so it tends to be managed suboptimally.
- Improving understanding of renal disease
- Increasing detection of renal disease in primary care
- Providing practical steps, in algorithm format, for diagnosis and management of renal disease
HOW TO USE THIS TRAINING SERIES
All of the lecture presentations are designed to accompany the booklet, so it is recommended that the booklet either be printed beforehand (26 pages) or open on a separate laptop or tablet in front of the learner.
It is well recognized in clinical education that a series of lectures on a disease does not necessarily translate into increased clinical competence in the consulting room. A good theoretical foundation is of course essential but this needs to be followed by practical steps in order to apply it in the clinical setting. This renal training lecture series has been designed to try and attend to both. Learning will be optimized if it is supported by a clinician with some experience in renal disease. It can be studied individually or in a small group. Guidelines for this can be found in the booklet.
CONTENTS OF THE BOOKLET
i. AN OVERVIEW OF RENAL DISEASE IN HIV-POSITIVE PATIENTS
This is a comprehensive overview for the sake of completeness. When a certain condition is seen more commonly in the primary care setting, additional details are provided regarding the disease, diagnosis and management.
ii. IMPLEMENTING ROUTINE URINE DIPSTICK TESTING IN A PRIMARY CARE HIV CLINIC
Routine use of a urine dipstick test is essential to allow for early detection of renal screening, since some renal diseases can initially present with normal serum creatinine result.
iii. A FEW PRACTICAL POINTS IN THE USE OF THE ALGORITHMS
iv. ALGORITHM 1 FOR MANAGING ABNORMAL URINE DIPSTICKS, oriented primarily to nurses
v. ALGORITHM 2 FOR EVALUATING A SERUM CREATININE RESULT
vi. ALGORITHM 3A AND 3B FOR MANAGING AN ABNORMAL CREATININE RESULT
vii. DRUG DOSAGE CHARTS IN RENAL IMPAIRMENT
- Date September 4, 2015
- Tags HIV, Renal