Persistent proteinuria as an indicator of renal disease in HIV-infected children
Abstract: Persistent proteinuria (microalbuminuria) has
been reported to be a precursor of HIV-related renal disease. Screening allows
for early management in order to prevent the progression of renal disease and
decrease morbidity and mortality associated with chronic kidney disease in HIV.
Several studies have been done on renal manifestation in HIV-infected children
from American and African regions, but similar studies from Asia are lacking.
Objective To determine the prevalence of persistent proteinuria in
HIV-positive children on antiretroviral therapy (ARV) in Dr. Soetomo Hospital,
Surabaya.
Methods A cross-sectional study on children with HIV and treated
with highly active antiretroviral
therapy (HARRT) was done from August 2014 to February 2015. Microalbuminuria
was measured by the ratio of urine albumin to creatinine (ACR), while
proteinuria was measured by dipstick. Measurements were performed 3 times in
4-8 weeks. All subjects underwent complete evaluation of blood tests, serum
creatinine, blood urea nitrogen (BUN), CD4 counts, and urinalysis. Data were
analyzed using Chi-square and logistic regression tests.
Results Of 38 children on HARRT enrolled in this study, 2 subjects
developed acute kidney injury (AKI), 4 subjects were suspected to have urinary
tract infection (UTI), and 1 subject was suspected to have urinary tract
stones. The prevalence of persistent microalbuminuria was 2.6%. There was no
correlation between immunological status, WHO clinical stage, or duration of
ARV and the incidence of persistent proteinuria (P>0.05).
Conclusion The prevalence of persistent proteinuria is lower in younger HIV-infected children at a
non-advanced stage and HIV-infected children with normal immunological status
who are on HAART. We provide baseline data on the renal conditions of
HIV-infected children in the era of HAART, before tenovofir is increasingly used as an antiretroviral
therapy regimen in Indonesia.
Keywords: HIV children;
proteinuria; CD4; HIV-associated chronic nephropathy
Author: Yuni Hisbiiyah, Risky
Vitria Prasetyo, Dwiyanti Puspitasari, Ninik Asmaningsih Soemyarso,
Ismoedijanto Moedjito, Mohammad Sjaifullah Noer
Journal Code: jpkedokterangg160195
