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Item Relevance of microalbuminuria in screening for HIV-Associated Nephropathy(2010-03-09T12:54:45Z) Mistry, Bhadrish JayantkumarIntroduction 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.