Treatment of HIV-Associated Nephropathies

Elewa, Usama; Sandri, Ana Maria; Rizza, Stacey A.; Fervenza, Fernando C.

doi:10.1159/000323666

Cited by 13 publications

(13 citation statements)

References 95 publications

(80 reference statements)

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“…Using HAART was not influencing the occurrence of microalbuminuria. This was also observed by other researchers [ 30 – 34 ]. Apparently kidneys may act as reservoir for HIV and even at suppressed viral load, HIV can still induce kidney damage.…”

Section: Discussionsupporting

confidence: 90%

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

2015

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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.

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Section: Discussionsupporting

confidence: 90%

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

2015

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“…It is crucial that HIVAN be diagnosed in its early stages given its rapid progression to end-stage renal disease over weeks and months if untreated. Highly active antiretroviral therapy (HAART) has proven to be an effective treatment and it can prevent the progression of this disease [5]. …”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Anti-GBM Antibody Elevation in HIV-Associated Nephropathy

Minocha

Makary

Poenariu

2014

Case Reports in Nephrology

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Introduction. The most commonly seen glomerular disease in HIV infected patients is HIV-associated nephropathy (HIVAN); however, a multitude of other nephropathies can occur in HIV infection with an almost equal cumulative frequency. We report an unusual case of a patient with clinical and histological evidence of HIVAN in which the diagnosis was initially confounded by the finding of an elevated serum anti-glomerular basement membrane (anti-GBM) antibody. Case Presentation. We present a case of a 27-year-old African American female with a history of schizophrenia, cocaine abuse, and HIV infection who upon admission to our hospital was found to have severe acute kidney injury requiring hemodialysis. Urine studies revealed nephrotic range proteinuria and a serological workup was positive for anti-GBM antibody elevation with a value of 91 units (normal: 0–20 units). A renal biopsy revealed HIVAN with no evidence of crescentic glomerulonephritis or anti-GBM disease. Conclusion. This case highlights the need for careful interpretation of anti-GBM antibody tests in HIV infected patients with kidney disease and, in particular, the need for biopsy confirmation of the diagnosis prior to starting therapy. More research is needed to study the prognostic correlation between the degree of anti-GBM antibody elevation in HIVAN and disease severity.

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“…391, 394, 411 There are recent comprehensive reviews of HIV and kidney disease that describe current knowledge and gaps therein. 424, 425 …”

Section: Rationalementioning

confidence: 99%