Proteinuria is common among HIV patients: what are we missing?
Open Access
- 1 October 2015
- journal article
- Published by Elsevier BV in Clinics
- Vol. 70 (10), 691-695
- https://doi.org/10.6061/clinics/2015(10)06
Abstract
HIV-related renal diseases are the leading causes of chronic kidney diseases worldwide. The present study aimed to investigate the prevalence of pathological proteinuria and its risk factors among HIV patients. A review of the medical records of 666 HIV-infected individuals aged 18 years or older in an urban HIV/AIDS clinic based in Porto Alegre in southern Brazil. Overt proteinuria was defined as a protein-to-creatinine ratio greater than 150 mg/g according to Kidney Disease: Improving Global Outcomes. The prevalence of pathological proteinuria in the present study cohort was 20%. Characteristics associated with pathological proteinuria after univariate analysis included alcohol abuse, hepatitis C virus coinfection, the occurrence of diabetes and therapy including tenofovir. Adjusted residuals analysis indicated an association between pathological proteinuria and both a CD4 lymphocyte count below 200 cells/mm3 and a viral load higher than 1000 copies/mL. Additionally, an absence of pathological proteinuria was associated with a CD4 lymphocyte count higher than 500 cells/mm3. After adjustment for variables with p<0.2 in the univariate analysis using a Poisson regression model, tenofovir-containing regimens and a CD4 lymphocyte count below 200 cells/mm3 were significantly associated with pathological proteinuria. The risk of chronic kidney diseases in this large contemporary cohort of HIV-infected individuals appeared to be attributable to a combination of HIV-related risk factors. In addition to the traditional risk factors cited in the literature, both regimens containing tenofovir and HIV disease severity seem to be associated with chronic kidney diseases in patients with HIV. Assessment of proteinuria constitutes a novel method for chronic kidney disease staging in HIV-infected individuals and may be effectively used to stratify the risk of progression to end-stage renal disease.Keywords
This publication has 18 references indexed in Scilit:
- Predictors of HIV-associated nephropathyExpert Review of Anti-infective Therapy, 2014
- 2014 Evidence-Based Guideline for the Management of High Blood Pressure in AdultsJAMA, 2014
- Hepatitis C Viremia and the Risk of Chronic Kidney Disease in HIV-Infected IndividualsThe Journal of Infectious Diseases, 2013
- The significance of antiretroviral-associated acute kidney injury in a cohort of ambulatory human immunodeficiency virus-infected patientsNephrology Dialysis Transplantation, 2013
- Tubulointerstitial Nephropathies in HIV-Infected Patients over the Past 15 YearsClinical Journal of the American Society of Nephrology, 2013
- Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine careAIDS, 2012
- Hepatitis B and C Co-Infection Are Independent Predictors of Progressive Kidney Disease in HIV-Positive, Antiretroviral-Treated AdultsPLOS ONE, 2012
- American Association of Clinical Endocrinologists' Guidelines for Management of Dyslipidemia and Prevention of AtherosclerosisEndocrine Practice, 2012
- Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patientsAIDS, 2010
- The safety of tenofovir disoproxil fumarate for the treatment of HIV infection in adults: the first 4 yearsAIDS, 2007