Prevalence of Proteinuria and Elevated Serum Cystatin C among HIV-Infected Adolescents in the Reaching for Excellence in Adolescent Care and Health (REACH) Study

Abstract

Objective In the United States (US), kidney dysfunction is prevalent in almost 30% of HIV-infected patients and is an independent predictor of mortality. Proteinuria and elevated serum cystatin C (eCysC) are used as markers of kidney disease in the general population; however, the prevalence of these markers in HIV-infected adolescents is largely unknown. Methods This study includes 304 HIV-infected adolescents from the Reaching for Excellence in Adolescent Care and Health (REACH) cohort, an observational study of adolescents recruited from 13 US cities. Clinical and demographic characteristics of participants were evaluated as correlates of proteinuria, a urine protein to creatinine ratio (UP/Cr) of ≥200 mg/g. Select univariate predictors were assessed to determine the association with urinary protein excretion and serum cystatin C in multivariable linear regression models and proteinuria and elevated serum cystatin C (eCysC ≥ 75th percentile) in multivariable logistic regression models. Results Overall, 19.1% of the participants had proteinuria while 23.7% had an eCysC. Low CD4+ T-lymphocyte counts (<200 cells/mm3) were significantly associated with a greater UP/Cr in linear models and with proteinuria in logistic regression models. CD4+ T-lymphocyte counts <500 cells/mm3 were significantly associated with a greater serum cystatin C concentration in linear models and with eCysC in logistic regression models. Conclusion Proteinuria among HIV-infected adolescents in REACH was approximately two-fold greater than healthy US adolescents. Both proteinuria and eCysC are associated with CD4+ T-lymphocyte counts. Further studies investigating early markers of kidney disease and the association with immune status and inflammation in adolescents are needed.

Comparative Renal Function Tests between HIV Patients on and not on Antiretrovirals and HIV Negative individuals at Nyeri Provincial General Hospital, Nyeri County, Kenya.

“…(7). The findings were also in line with (8) who found out that suppression of viral load was associated with improved renal function in those patients who began ARVs and CD4 cell count was low with grade 2 or higher kidney disease in a subset of participants enrolled in US AIDS Clinical Trial Group studies.…”

Association of Urine α1-Microglobulin with Kidney Function Decline and Mortality in HIV-Infected Women

“…HIV-infected persons are at higher risk for proteinuria, CKD, and ESRD compared with uninfected individuals, even after controlling for traditional kidney disease risk factors (1)(2)(3)(4)(5)(6). However, standard clinical measures of kidney disease, such as serum creatinine and dipstick proteinuria, are inadequate in their ability to detect early kidney damage (7).…”