Regular kidney function monitoring is the best way to prevent kidney problems whilst taking antiretroviral therapy. Such monitoring should include, at minimum, measurement of serum creatinine and phosphate, as well as analysing the content of the urine. However, many experts prefer more sophisticated measures such as creatinine clearance and glomerular filtration rate.

Kidney function screening should be performed before starting antiretroviral therapy; the Infectious Diseases Society of America (IDSA) recommends that this be done at the time of HIV diagnosis^[1]. Ongoing monitoring should then be performed regularly during treatment with potentially toxic drugs.

The IDSA recommends periodic kidney function monitoring during the first six months, then twice annually for patients taking indinavir. The European Medicines Agency (EMEA) guidelines advise that patients receiving tenofovir should be monitored every month for the first year, then every three months. Patients who have pre-existing kidney impairment, are taking other potentially nephrotoxic drugs, or are otherwise at increased risk should receive more frequent monitoring, as often as every few weeks.

It is important that kidney function monitoring continue throughout the course of treatment. Whilst drug-related kidney toxicity typically emerges during the first six to twelve months, later emergence of kidney stones and tenofovir-induced nephrotoxicity has been reported^[2]. More frequent kidney function monitoring is recommended for children.