Brief Report: Subclinical Kidney Dysfunction in HIV-Infected Children. (1st December 2020)

• Record Type: Journal Article
• Authors: Bk, Kruthika; Tiwari, Soumya; Chhapola, Viswas; Debnath, Ekta; Seth, Anju; Jain, Anju
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 85:Number 4(2020)
• Publication Date: 2020-12-01
• Subjects: child -- HIV infection -- albuminuria -- proteinuria -- β2-microglobulin; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000002470
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Objective: Most of the kidney dysfunction in HIV-positive children receiving antiretroviral therapy (ART) is attributed to tenofovir. There is a paucity of data on kidney dysfunction in tenofovir-naive children. The primary objective was to know the point prevalence of albuminuria and β2 -microglobulinuria in HIV-infected children aged 3–18 years receiving ART. Albuminuria and β2 -microglobulinuria were used as surrogates for glomerular and tubular dysfunction, respectively. The secondary objective was to determine their predictors. Design: Cross-sectional study-design. Methods: One hundred consecutive HIV-positive children (3–18 years) on ART were included. Spot urine sample was analyzed for urinary creatinine, total protein, microalbumin, and β2 -microglobulin. Albuminuria was defined as albumin to creatinine ratio of >30 mg/g; proteinuria as urine dipstick ≥trace or spot urine protein to creatinine ratio (uPCR) of ≥0.2. β2 -microglobulinuria was defined as β2 -microglobulin levels of >350 µg/L. Results: There were 71 boys and 29 girls. Most of the children had WHO clinical stage I and were getting zidovudine-based regimen. Only 7 children were getting tenofovir. estimated Glomerular Filtration Rate and serum creatinine were normal in all children. Approximately half (48%) had renal dysfunction in the form of glomerular dysfunction (26%), tubular dysfunction (27%), or both (5%). Age at diagnosis was significantly associated with β2 -microglobulinuria ( P = 0.044). None of the selected variables were associated with albuminuria. Conclusions: HIV-associated glomerular and tubular dysfunction is common in children receiving ART other than tenofovir. The standard guidelines should consider including routine urinary biomarker monitoring in children on ART.