Introduction. End-stage renal disease exhibits a disproportionate prevalence among Black individuals and older adults within the United States and worldwide. A significant genetic contributor to this disparity is the Apolipoprotein L1 (APOL1) gene, found exclusively in populations of African ancestry. Materials and Method. We aim to perform a narrative review regarding the current understanding of APOL1 and its complex role in kidney disease pathogenesis. Results. The G1 and G2 APOL1 risk alleles are strongly associated with an elevated risk for non-diabetic chronic kidney disease (CKD), including hypertensive nephropathy, focal segmental glomerulosclerosis, and HIV-associated nephropathy, in individuals who are homozygous or compound heterozygous for these variants. While 10-15% of African Americans carry two APOL1 risk alleles, approximately 80% remain disease-free, suggesting incomplete penetrance and the involvement of additional risk factors. In this condition, renal damage could be induced through different mechanisms such as altered cellular ion transport, mitochondrial dysfunction, and the requirement for additional stressors or "second hits". Conclusion. The increased susceptibility to end-stage renal disease (ESRD) in individuals of African ancestry is influenced by variations in the APOL1 gene.

BackgroundChronic kidney disease (CKD) is a frequent non-communicable complication in people living with HIV (PLHIV), influenced by antiretroviral therapy (ART), comorbidities, and healthcare setting. The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) CKD risk score is widely applied internationally, while the Thai CKD risk score, developed for the general Thai population, has not been validated in HIV cohorts. This study compared the predictive accuracy of the DAD models and the Thai CKD risk score in Thai people living with HIV receiving ART.MethodsA retrospective cohort analysis was conducted using electronic medical records of adults (≥18 years) living with HIV at Warinchamrap Hospital between January 2020 and May 2024. Patients with pre-existing CKD or incomplete data were excluded. CKD was defined per Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Model calibration was assessed with the Hosmer-Lemeshow test, and discrimination with the C-statistic.ResultsAmong 901 PLHIV receiving ART, 104 (11.5%) developed incident CKD during a median follow-up of approximately 4 years. Patients who developed CKD were more likely to be male and have a lower baseline estimated glomerular filtration rate, and higher prevalence of proteinuria and comorbidities. All evaluated models stratified CKD risk; however, the full and short DAD scores showed moderate discrimination (C-statistics ≈0.76) with evidence of risk underestimation and suboptimal calibration. The Thai CKD risk score demonstrated higher discrimination (C-statistic 0.93), sensitivity (88.5%), and better calibration in this cohort.ConclusionsIn this Thai HIV cohort, all evaluated risk models provided CKD risk stratification, but the Thai CKD risk score showed more reliable discrimination and calibration than the DAD models. These findings highlight the importance of population-specific validation when applying CKD risk prediction tools in HIV care.

Biktarvy, a once-daily combination of bictegravir, emtricitabine, and tenofovir alafenamide (TAF), is a highly effective antiretroviral therapy for HIV management. Although well-tolerated, rare but serious complications such as lactic acidosis can occur, particularly in patients on nucleoside reverse transcriptase inhibitors. We present the case of a 36-year-old male with HIV/AIDS and chronic kidney disease, who was admitted with altered mental status and acute hypoxic respiratory failure. Imaging confirmed atypical pneumonia. Initial labs revealed elevated lactate and creatinine. He was treated with broad-spectrum antibiotics, and after clinical improvement, Biktarvy was resumed. Within 24 h, his lactate spiked to 21.8 mmol/L. Suspecting TAF-induced lactic acidosis, Biktarvy was discontinued. Continuous renal replacement therapy, along with L-carnitine and thiamine, was initiated based on a literature review. The patient's condition improved significantly. Upon discharge, lactate and creatinine returned to baseline. At outpatient follow-up, he remained clinically stable on Dolutegravir-Rilpivirine and Entecavir.

SUMMARYWith improved uptake and earlier initiation of effective antiretroviral therapy (ART), the landscape of chronic kidney disease (CKD) among people with HIV (PWH) has substantially evolved. HIV-driven kidney diseases, particularly HIV-associated nephropathy (HIVAN), have largely disappeared in regions with widespread ART availability. However, CKD remains an important comorbidity among PWH because of the increased prevalence of age-related conditions such as diabetes and hypertension, which are established CKD risk factors. Whether contemporary ART regimens that have lower metabolic and kidney toxicity will lower this burden over time remains unclear. In low-resourced areas, these age-related conditions are compounded by persistent disparities in access to ART, co-infections, and limited resources for CKD screening and management. Early detection and management of CKD are crucial to slowing CKD progression and averting its related cardiovascular complications. The past several years have ushered in several new therapies that both lower the risk for CKD progression and adverse cardiovascular events, underscoring the importance of kidney function and albuminuria testing in those at high risk of CKD or CKD progression. For PWH who unfortunately progress to end-stage kidney disease, kidney transplantation now offers improved survival but requires careful management of immunosuppressive regimens and infectious complications. This review will discuss the current understanding of the epidemiology, pathogenesis, diagnosis, and management of kidney diseases in PWH.