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- General: The Infectious Diseases Society of America recommends screening for kidney disease with a urinalysis, creatine test, and/or blood urea nitrogen (BUN) test when HIV is diagnosed. If laboratory tests suggest kidney damage, a kidney biopsy is conducted to confirm a diagnosis of HIV–associated nephropathy (HIVAN).
- Blood urea nitrogen (BUN) test: The blood urea nitrogen (BUN) test measures the amount of nitrogenous waste in the patient's blood. If a patient has high levels of waste products in the blood, it indicates that the kidneys are not able to filter the blood. Healthy individuals usually have 7–20 milligrams of waste per deciliter of blood. Elevated levels may indicate kidney disease.
- Creatine: A creatine test is used to measure the amount of creatine in a patient's blood or urine. This helps determine how well the kidneys are able to filter small molecules like creatine out of the blood. Healthy individuals usually have about 0.8–1.4 milligrams of creatine per deciliter of blood. Elevated levels may indicate kidney disease.
- A healthcare provider then uses the creatine test results, along with the patient's age, weight, and gender, to determine his/her estimated glomerular filtration rate (EGFR). This rate represents how well the kidneys are able to filter the blood over a period of time. Healthy men typically have EGFRs of 97–137 milliliters/minute, while females have rates of about 88–128 milliliters/minute. Lower–than–normal results may indicate kidney disease.
- Kidney biopsy: A kidney biopsy is the most definitive diagnostic test for HIVAN. During the procedure, which is performed at a hospital, a needle is inserted into the kidney and a small tissue sample is removed. Patients may be awake and receive medication to numb the area near the kidney or patients may be given general anesthesia so that they are asleep during the procedure. The tissue is then analyzed in a laboratory. A positive test will reveal scar tissue, which indicates HIVAN.
- Patients may have to stay overnight at the hospital. Most patients experience soreness near the biopsy site. Patients should tell their healthcare providers if there is blood in their urine more than 24 hours after the test, if they are unable to urinate, if they have a fever, if they experience increased pain at biopsy site or if they feel dizzy. In rare cases, an infection may develop.
- Urinalysis (analysis of the urine): A urinalysis, also called a urine sample test, is used to measure the levels of protein in the urine. Elevated levels of protein in the urine (with or without small amounts of blood) suggest kidney disease.
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