Background HIV-infected individuals have an increased risk of chronic kidney disease.
Purpose To evaluate the prevalence of different types of proteinuria and associated factors in a HIV-infected population with a high percentage (92%) of Caucasian origin.
Materials and Methods Cross-sectional study of all HIV-infected adults seen at the Montpellier University Hospital HIV outpatients unit over 6 months. Demographics, treatment history, co-morbidities and laboratory data were collected from an electronic database and manual review chart. Spot urine protein to creatinine (uPCR) and albumin to creatinine (uACR) ratios, estimated glomerular filtration rate using the MDRD equation (eGFR) were assessed. Three types of proteinuria were defined: tubular proteinuria (uPCR > 200 mg/g and albuminuria/proteinuria <0.5), glomerular proteinuria (uPCR > 200 mg/g and albuminuria/proteinuria > 0.5), microalbuminuria (uPCR < 200 mg/g and uACR 30–300 mg/g). Multivariate logistic regression was used to identify independent factors of proteinuria for patients with eGFR> 60 mL/min/1.73 m².
Results Characteristics for 1210 patients were: median age 48 years, 26% women, 7.1% black, 93% on HAART, 54% on tenofovir, median CD4 cell count 488 cell/μl, 73% with HIV viral load <20 copies/ml, 7.8% hypertensive, 3.4% diabetic, 18.2% HCV positive, 2.1% with history of kidney disease.eGFR was >90 for 59.5%, 60 to 90 for 36% and <60 for 4.5%. Of 1156 patients with eGFR> 60 mL/min/1.73 m2, proteinuria was observed in 159 patients (13.7%) [tubular: 124 (10.7%), glomerular: 35 (3%)] and microalbuminuria for 51 patients (4.4%)]. Factors associated with tubular proteinuria were: current regimen with tenofovir (OR 2.70), diabetes (OR 2.54), HCV+ (OR 1.62), AIDS stage (OR 1.54), older age (OR 1.46/10-year increment). Diabetes (OR 5.15) and hypertension (OR 3.74) were associated with glomerular proteinuria.
Conclusions The prevalence of proteinuria or microalbuminuria was 18.1% in this predominantly white, cART (current antiretroviral therapy)-experienced cohort. Measuring uPCR and albuminuria may assist in the diagnosis of early renal disease.
No conflict of interest.
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