Relevance of microalbuminuria in screening for HIV-Associated Nephropathy
Date
2010-03-09T12:54:45Z
Authors
Mistry, Bhadrish Jayantkumar
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Introduction
HIV-Associated Nephropathy (HIVAN) is the commonest cause of proteinuria, especially in
black HIV seropositive children. This chronic nephropathy is a late complication of untreated
HIV that requires earlier intervention to prevent progression of renal disease.
Microalbuminuria is an early marker of the presence of subclinical renal disease in systemic
diseases such as diabetes mellitus and hypertension. This study assessed the prevalence
and clinical significance of a single screening test for microalbuminuria in a cohort of HIV
seropositive children without any symptoms of renal disease at Chris Hani Baragwanath
hospital situated in Johannesburg, South Africa.
Methods
A prospective study was undertaken at Chris Hani Baragwanath hospital (a major tertiary
facility that serves the people of Soweto and the surrounding areas of southern Gauteng).
HIV seropositive and seronegative patients from both an inpatient and outpatient ambulatory
setting were screened for qualitative proteinuria and microalbuminuria. Those on antiretroviral
therapy, anti tuberculosis treatment, known chronic kidney disease, hypertension, fever,
acute illness and urinary tract infection were excluded from the study.
Results
180 patients were enrolled into the study, of which 110 were HIV positive and 70 HIV
negative. Majority of the patients were black (98%) with 100 (56%) males and 80 (44%)
females. Microalbuminuria was present in 27(25%) of HIV positive patients and 1 (1%) HIV
negative patient, p=0.00003. The mean age at presentation of microalbuminuric HIV positive
patients was 6 ± 3.2 years. With normal renal function and no proteinuria; microalbuminuria
was present in 21 (19%) patients, p=0.03. Microalbuminuric patients were moderately
immunosuppressed (mean CD4 % of 16.8 ± 8%, mean viral load 8 ± 18 x 105 RNA copies/ml)
and had WHO clinical stage 2 and 3 disease. Absolute CD4 counts appear to correlate better
with microalbuminuria than CD4 percentage as the mean CD4 absolute count in HIV positive
patients with microalbuminuria (493 ± 330 x 106/l) was significantly lower than those without
microalbuminuria (780 ± 702 x 106/l), p=0.03.
Conclusion
Microalbuminuria screening of HIV positive patients is a more sensitive screening test
compared to standard urine dipsticks as it is present in patients with normal renal function
who have no proteinuria. This may allow for early identification of subclinical renal disease in
patients with some evidence of immunosuppression; thus possibly preventing the
deterioration of renal function and severity of HIV disease with early initiation of antiretroviral
therapy.
Description
MMed (Paediatrics), Faculty of Health Sciences, University of the Witwatersrand, 2009
Keywords
microalbuminuria, HIV, children