BackgroundMicroalbuminuria is a marker of early kidney disease and high cardiovascular risk in various populations, including HIV positive patients. However, the diagnostic value of qualitative (dipstick) proteinuria and the burden of microalbuminuria in HIV positive patients living in sub-Saharan Africa are relatively unclear.MethodsIn a cross-sectional study, 235 HIV- positive outpatients were screened for proteinuria in 3 HIV-clinics in Bukavu. A spot urine sample from each subject was tested both by a dipstick and albumin-creatinine-ratio (ACR) assay. The performance of dipstick proteinuria exceeding 1+ was compared with that of microalbuminuria (≥30 mg/g creatinine).ResultsThe prevalence of microalbuminuria and dipstick proteinuria ≥ (1+), ≥ (2+) and ≥ (3+) was 11%, 41%, 3.5% and 0.7%, respectively.Compared to microalbuminuria, the dipstick (proteinuria of 1+ or greater) had an overall sensitivity of 60% and a specificity of 61%. The positive predictive value was 15.4% and the negative predictive value 92.8%.ConclusionProteinuria is highly prevalent in HIV positive patients. The limited sensitivity and specificity of the dipstick to detect significant microalbuminuria make it unattractive as a screening tool in HIV positive patients.

Background: The prevalence of chronic kidney disease (CKD) in African American individuals is high but whether this applies to native populations in sub-Saharan Africa is unclear. Methods: In a cross-sectional study, we assessed the prevalence and risk factors of CKD in rural and urban adults in South Kivu, Democratic Republic of Congo. Glomerular filtration rate (GFR) was estimated using the CKD-Epidemiology Collaboration (CKD-EPI) equations based on serum creatinine (eGFRcr), cystatin C (eGFRcys), or both markers (eGFRcr-cys), without ethnic correction factor. CKD was defined as an eGFR <60 ml/min per 1.73 m 2 and/or albuminuria (albumin-to-creatinine ratio $30 mg/g). Results: A total of 1317 participants aged 41.1 AE 17.1 years (730 rural, 587 urban) were enrolled. The prevalence of hypertension (20.2%; 95% confidence interval [CI], 18-22.3), diabetes mellitus (4.3%; 95% CI, 3.2-5.4) and obesity (8.9%; 95% CI, 7.4-10.5) was higher in urban than rural participants (all P < 0.05). HIV infection prevalence was 0.41% (95% CI, 0.05-0.78). The prevalence of eGFRcr <60 ml/min per 1.73 m 2 was 5.4% (95% CI, 4.2-6.7). The prevalence of albuminuria was 6.6% (95 % CI, 5.1-8.1). The overall prevalence of CKD was 12.2% (95% CI, 10.2-14.2) according to CKD-EPIcr. Factors independently associated with CKD-EPIcr were older age (adjusted odds ratio [aOR], 1.05 [1.04-1.07]), urban residence (aOR 1.86 [1.18-2.95]), female sex (aOR 1.66 [1.04-2.66]), hypertension (aOR 1.90 [1.15-3.12]), diabetes (aOR 2.03 [1.02-4.06]), and HIV infection (10.21 [2.75-37.85]). The results based on eGFRcys or eGFRcr-cys were largely consistent with the preceding. Conclusion: Overall, the burden of CKD is substantial (>11%), predominantly in the urban area, and largely driven by classic risk factors (gender, aging, HIV, hypertension, and diabetes).