Thank you for your post.
The elevated serum creatinine in your patient is suggestive of underlying renal dysfunction. In addition to confirming the abnormal value, it would be recommended that the patient have urinalysis to evaluate for protein/creatinine ratio or microscopic albuminuria. If positive, patients should be monitored closely for progession and considered for treatment with angiotensin converting enzyme (ACE) inhibitors.
All patients with HIV infection should have their renal function estimated using the
Cockcroft-Gault or MDRD formulae.
Depending on your patient's age, race, gender and weight, his renal function may be significantly impaired. In such patients, we typically avoid the use of tenofovir, so long as other antiretroviral options exist.
The doses of many NRTI medications need to be adjusted when creatinine clearance is less than 50-60 mL/min. d4T (stavudine) and 3TC (lamivudine) dose needs to be down adjusted when CrCl is less than 50 mL/min.
I hope that this is helpful,
BY
