Microalbuminuria associated with indicators of inflammatory activity in an HIV-positive population

Abstract

Background. The survival of human immunodeficiency virus (HIV)-infected patients has increased significantly since the introduction of combination antiretroviral therapy, leading to the development of important long-term complications including cardiovascular disease (CVD) and renal disease. Microalbuminuria, an indicator of glomerular injury, is associated with an increased risk of progressive renal deterioration, CVD and mortality. However, the prevalence of microalbuminuria has barely been investigated in HIV-infected individuals.Methods. Based on three prospective urine samples in an unselected nonhypertensive, nondiabetic HIV-positive cohort (n = 495), we analysed the prevalence of microalbuminuria and compared the Caucasian share with that of a nonhypertensive, nondiabetic population-based control group (n = 2091). Significant predictors for microalbuminuria were analysed within the HIV-positive cohort.Results. The prevalence of microalbuminuria was 8.7% in the HIV-infected cohort, which is three to five times higher than that in the general population. HIV-infected patients with microalbuminuria were older, and had higher blood pressure, longer duration of HIV infection, higher serum beta 2-microglobulin, higher serum creatinine and a reduced glomerular filtration rate of ≤90 mL/min, compared with those with normal albumin excretion. In multivariate analysis, systolic blood pressure, serum beta 2-microglobulin and duration of HIV infection were found to be independent predictors of microalbuminuria.Conclusions. Our findings indicate that in addition to haemodynamic effects, inflammatory activity may be implicated as a cause of the development of microalbuminuria. With respect to the increasing risk of developing CVD or renal diseases and mortality, the high prevalence of microalbuminuria in HIV-infected individuals warrants special attention.

Clinical Characteristics of Kidney Disease in Japanese HIV-Infected Patients

“…The prevalence of proteinuria among studies varied, ranging from 7 to 32% [19,20,21,22], while those of microalbuminuria and albuminuria were 9.4% (495 Caucasian HIV subjects in Norway) and 11% (Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM) cohort, representative of HIV patients in the USA), respectively [23,24]. In the USA, the reported prevalence of CKD in HIV-infected patients ranged between 15.5 and 23.7%, and of CKD ≥ stage 3 between 5.9 and 9.7% [10,11].…”

Epidemiological, clinical, and laboratory factors associated with chronic kidney disease in Mexican HIV-infected patients

“…1 The reported prevalence of CKD in patients infected with HIV in North America and Europe ranges from 4.7% to 9.7%, and higher rates have been reported when CKD is defined by either estimated glomerular filtration rate (eGFR) or proteinuria. [2][3][4] HIV infection is a well-established risk factor for CKD and endstage renal disease (ESRD).…”

Relationships Between Renal Parameters and Serum and Urine Markers of Inflammation in Those With and Without HIV Infection

“…Previous studies have suggested that HIV infection is associated with tubular or glomerular defects, therefore the urinary excretion of various proteins, including B2M, might be increased. [19][20][21] Surprisingly, the urinary levels of IP-10 and B2M were higher in healthy volunteers than in HIV-infected patients virally suppressed with TDF/FTC/EFV. Previous observational studies suggest that the urinary B2M level would be increased in patients receiving tenofovir-based regimens due to tenofovir-induced tubulopathy.…”