Prevalence of persistent microalbuminuria and associated factors among hiv infected children attending a Tertiary Hospital in Northern Tanzania: a cross sectional, analytical study

Abstract

IntroductionHuman Immunodeficiency Virus (HIV) infection is a significant cause of paediatric morbidity and mortality especially in Sub-Saharan Africa. It affects the kidney by injuring the glomerular and tubular epithelial cells causing leakage of albumin in urine. Microalbuminuria is known to be an early indicator of kidney injury including HIVAN. The purpose of this study was to identify the prevalence and factors associated with microalbuminuria among HIV infected children receiving care and treatment at Kilimanjaro Christian Medical Centre (KCMC).MethodsWe conducted a cross sectional hospital based analytical study at KCMC from December 2012 to April 2013. It involved children who are HIV infected attending child centred family care clinics (CCFCC). Patients’ demographic and clinical characteristics were extracted from the file; physical examination performed. Urine samples were analysed for by HemoCue Albumin 201 system analyzer. Statistical package for social sciences (SPSS) version 16.0 was be used to process and analyze the data.ResultsThree hundred thirty HIV-infected children under 18 years were recruited during the study period. Mean age was 119.4 (5-218) months. Prevalence of microalbuminuria by using HemoCue Albumin 201 analyzer was 28.8% (n = 95). Presence of microalbuminuria was significantly associated with severity of HIV disease progression according to WHO disease stage (p = 0.0015) and CD4 count less than 350 cells/µL (p = 0.044).ConclusionThe study has shown that microalbuminuria is common in HIV infected children. Early screening and treatment of microalbuminuria is important to minimize the risk of developing end stage kidney disease. Children with advanced HIV disease and those with CD4 count less than 350cells/µL should be given priority for urinary albumin screening in a setting without routine screening for microalbuminuria.

Prevalence of Microalbuminuria and associated factors among HIV−infected ART naïve patients at Mulago hospital, Kampala, Uganda.

“…This high prevalence of microalbuminuria highlights the magnitude of early renal dysfunction in HIV-infected patients before ART initiation. This was different from most of the studies conducted in recent times [5][6][7][8][9][10][11][12][13].…”

“…Higher prevalence of microalbuminuria found in other areas of SSA; in South Africa the prevalence of microalbuminuria was found to be 24.0% [9], however, they included in-patients who have been reported to be at higher risk of microalbuminuria due to advanced HIV [14] compared to our study participants who were outpatients. Another study in Tanzania demonstrated that advanced HIV disease was significantly associated with microalbuminuria at 28.8%, however, they included patients who were already on ART [12]. The only study done in Africa that looked at participants with similar characteristics (adult HIV ART naïve patients attending an outpatient clinic was in Tanzania demonstrated the highest recorded microalbuminuria at 70.2% [13].…”

Prevalence of microalbuminuria and associated factors among HIV − infected ART naïve patients at Mulago hospital: a cross-sectional study in Uganda

“…This study looked at HIV − infected ART naïve patients attending the Mulago ISS clinic and the prevalence of microalbuminuria reported was different from most of the studies conducted in recent times [5,6,[8][9][10][11][12][13][14]. It was challenging to compare this study with those conducted earlier due to several factors which include differing study participants and sample sizes, in addition to varying assay techniques and methodologies.…”

HIV-Associated Nephropathy in Africa: Pathology, Clinical Presentation and Strategy for Prevention

“…Therefore, to decrease the risk of emerging ESRD, early screening and treatment of microalbuminuria is required, especially for those at high risk (advanced HIV disease and those with a CD4 count below 350 cells/µL). Urinary albumin screening can be done in a situation where routine screening for microalbuminuria is not available [ 21 ].…”