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Background 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.
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2. Ross MJ. Advances in the pathogenesis of HIV-associated kidney diseases. Kidney Int. 2014;86:266-74.
3. Anochie IC, Eka FU, Okpere AN. Human immunodeficiency virus-associated nephropathy (HIVAN) in Nigerian children. Pediatr Nephrol. 2008;23:117-22.
4. Lai S, Mariotti A, Lai C, Testorio M, Carta M, Innico G, et al. Nephropathies in HIV-infected patients: an overview. OA Nephrol. 2013;1:15-28.
5. Ray PE, Xu L, Rakusan T, Liu XH. A 20-year history of childhood HIV-associated nephropathy. Pediatr Nephrol. 2004;19:1075-92.
6. Strauss J, Abitbol C, Zilleruelo G, Scott G, Paredes A, Malaga S, et al. Renal disease in children with the acquired immunodeficiency syndrome. N Engl J Med. 1989;321:625-30.
7. Shah I, Gupta S, Shah DM, Dhabe H, Lala M. Renal manifestations of HIV infected highly active antiretroviral therapy naive children in India. World J Pediatr. 2012;8:252-5.
8. Roscioni S, Heerspink H, de Zeeuw D. Microalbuminuria: target for renoprotective therapy PRO. Kidney Int. 2014;86:40–9.
9. Han TM, Naicker S, Ramdial PK, Assounga AG. A cross-sectional study of HIV-seropositive patients with varying degrees of proteinuria in South Africa. Kidney Int. 2006;69:2243-50.
10. Gupta SK, Eustace JA, Winston JA, Boydstun II, Ahuja TS, Rodriguez RA, et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2005;40:1559-85.
11. Fredrick F, Ruggajo P, Maro EE, Iversen BM, Basu G. Renal manifestations and associated factors among HIV infected children at Muhimbili National Hospital, Dar es Salaam, Tanzania. BMC Infect Dis. 2012;12:O11.
12. Mudi A, Alhaj BU, Hassan-Hanga F, Yahaya IA. Persistent microalbuminuria in human immunodeficiency virus infected children in Kano, Nigeria. Int J Nephrol. 2014;2014:567838.
13. Nilima KR, Gafencu M, Doros G, Thanki CN, Lesovici M, Serban M. Renal consequences in HIV infected children. Jurnalul Pediatrului. 2009;12:27-32.
14. Dondo V, Mujuru HA, Nathoo KJ, Chirehwa M, Mufandaedza Z. Renal abnormalities among HIV-infected, antiretroviral naive children, Harare, Zimbabwe: a cross-sectional study. BMC Pediatr. 2013;13:1-9.
15. Agarwal D, Chakravarty J, Sundar S, Gupta V, Bhatia BD. Correlation between clinical features and degree of immunosuppression in HIV infected children. Indian Pediatr. 2008;45:140-3.
16. Sinha U, Sengupta N, Mukhopadhyay P, Roy KS. Human immunodeficiency virus endocrinopathy. Indian J Endocrinol Metab. 2011;15:251-60.
17. Uzoma EB, Uchenna OH, Nnaemeka IA, Tagbo O. Screening for microalbuminuria in HIV-positive children in Enugu. Int J Nephrol. 2012;2012:805834.
18. Chaparro AI, Mitchell CD, Abitbol CL, Wilkinson JD, Baldarrago G, Lopez E, et al. Proteinuria in children infected with the human immunodeficiency virus. J Pediatr. 2008;152:844-9.
19. Iduoriyekemwen NJ, Sadoh WE, Sadoh AE. Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy. Saudi J Kidney Dis Transpl. 2013;24:172-77.
20. Roe J, Campbell LJ, Ibrahim F, Hendry BM, Post FA. HIV Care and the incidence of acute renal failure. Clin Infect Dis. 2008;47:242-9.
21. Nelson M, Azwa A, Sokwala A, R RH, Stebbing J. Fanconi syndrome and lactic acidosis associated with stavudine and lamivudine therapy. AIDS. 2008;22:1374-6.
22. AIDS Info. Guidelines for the use of antiretroviral agents in pediatric HIV infection. 2014. [cited 2014 September 6]. Available from: http://aidsinfo.nih.gov/guidelines
23. Linda A Thanyawee P. Review of tenofovir use in HIV-infected children. Pediatr Infect Dis J. 2015;34:383-91.
24. Chadwick DR, Sarfo FS, Kirk ESM, Owusu D, Bedu-Addo G, Parris V, et al. Tenofovir is associated with increased tubular proteinuria and asymptomatic renal tubular dysfunction in Ghana. BMC Nephrol. 2015;16:1-5.
25. Reid A, Stöhr W, Walker AS, Williams Ian G, Kityo C, Hughes P, et al. Severe renal dysfunction and risk factors associated with renal impairment in HIV‐infected adults in Africa initiating antiretroviral therapy. Clin Infect Dis. 2008;46:1271-81.
26. Shamu T, Wellington M, Pascoe M, Gwanzura L, Ndhlovu CE. Incidence of nephropathy in HIV infected patients receiving highly active antiretroviral therapy at Newlands Clinic: a retrospective study. World J AIDS. 2015;5:113-23.
27. Michael IO, Abel O Ukoh G. Urinary tract infection in adolescent/young adult Nigerians with acquired human immunodeficiency disease in Benin City. J Med Biomed Res. 2006;5:55-60.
28. Trihartono PP, Pardede SO. Batu saluran kemih pada anak. In: Alatas H, Tambunan T, Trihartono PP, Pardede SO, editors. Buku Ajar Nefrologi Anak. 2nd ed. Jakarta: Balai Penerbit FKUI; 2002. p. 212-29.
29. Alon US, Srivasta T. Urolithiasis. In: Kher K, Schnaper H, Makker S, editors. Clinical pediatric nephrology. London: Oxon Informa UK Ltd; 2007. p. 539-51.
30. Izzedine H, Valantin MA, Daudon M, Mohand HA, Caby F, Katlama C. Efavirenz urolithiasis. AIDS. 2007;21:1992.
31. Esezobor CI, Iroha E, Onifade E, Akinsulie AO, Temiye EO, Ezeaka C. Prevalence of proteinuria among HIV-infected children attending a tertiary hospital in Lagos, Nigeria. J Trop Pediatr. 2010;56:187-90.
32. McCulloch MI, Ray PE. Kidney disease in HIV-positive children. Semin Nephrol. 2008;28:585-94.
33 Mistry BJ. Relevance of microalbuminuria in screening for HIV-associated nephropathy [Electronic theses and Dissertations (ETD)], WIReDSpace, http://hdl.handle.net/10539/7650. [Johannesburg]: University of Witwatersrand; 2009.
34. Ikpeme EE, Ekrikpo UE, Akpan MU, Ekaidem SI. Determining the prevalence of human immunodeficiency virus-associated nephropathy (HIVAN) using proteinuria and ultrasound findings in a Nigerian paediatric HIV population. Pan Afr Med J. 2012;11:13.
35. Winston JA, Bruggeman LA, Ross MD, Jacobson J, Ross L, D'Agati VD, et al. Nephropathy and establishment of a renal reservoir of HIV type 1 during primary infection. N Engl J Med. 2001;344:1979-84.
36. Bruggeman LA, Ross MD, Tanji N, Cara A, Dikman S, Gordon RE, et al. Renal epithelium is a previously unrecognized site of HIV-1 infection. J Am Soc Nephrol. 2000;11:2079-87.
37. Greka A, Mundel P. Cell biology and pathology of podocytes. Annu Rev Physiol. 2012;74:299-323.
38. Kerjaschki D. Caught flat-footed: podocyte damage and the molecular bases of focal glomerulosclerosis. J Clin Invest. 2001;108:1583-7.
39. Parakh P, Bhatta NK, Mishra O, Shrestha P, Budhathoki S, Majhi S, et al. Urinary screening for detection of renal abnormalities in asymptomatic school children. Nephrourol Mon. 2012;4:551-5.
40. Permpalung N, Chaiwatcharayut W, Korpaisarn S, Cheungpasitporn W, Chongnarungsin D, Bischof EF. In-depth review of human immunodeficiency virus-associated nephropathy. Am Med J. 2013;4:82-90.