Albuminuria and HIV-infection in pediatric patients

Abstract

HIV infection increases the risk of developing chronic kidney disease (CKD). Diagnosis at an early stage of HIV associated kidney disease in children is of particular importance, given its prevalence. Determination of the concentration of albumin and creatinine in a single portion of urine, followed by the calculation of the albumin/creatinine ratio (ACR) is used for early diagnosis and assessment of the progression of CKD. Purpose - to study the frequency and risk factors of albuminuria in children with HIV infection, depending on the stage of the disease, immunosuppression, and viral load. Materials and methods. 73 children with HIV infection were examined. Albumin was analyzed in the morning urine sample twice (during the first and third months of observation) using a Beckman Coulter AU 480 series analyzer. Albuminuria was assessed by ACR. The criterion for a moderately elevated level of albuminuria was considered as ACR ≥3 mg/mmol in both measurements and was interpreted as the presence of microalbuminuria (MAU). Results. A steady increase in ACR was noted in 19 (26.0%) patients. The influence of the stage of HIV-infection on the level of albuminuria has not been established. Non-significant immunosuppression (IS) sharply reduced the chances of MAU - OR=0.019 (CI: 0.002-0.159), the presence of a very severe stage of IS significantly increased them - OR=18.89 (CI: 4.33-82.32). There was a pronounced inverse correlation between the ACR and the CD4+ count, both absolute (ρ=-0.51; p<0.001) and relative (ρ=-0.53; p<0.001). It was found that against the background of viral load, the average ACR was twice as high, and the percentage of MAU was nine times higher. In the case of normal viral overload, the chances of moderately elevated albuminuria were significantly reduced - OR=0.048 (CI: 0.012-0.194). The highest rates of ACR were observed in children with a viral load of more than 100,000 copies of RNA/ml, among these patients, MAU was stated in ¾ of cases. A high viral load increased the risks of MAU by one and a half orders of magnitude - OR=15.30 (CI: 3.51-66.68). Elevated ACR was recorded 3.6 times more often in children with progressive HIV-infection than in other patients (OR=14.13; CI: 1.47-136.12; p<0.02). Conclusions. More than a quarter of children with HIV-infection have moderately elevated albuminuria. Renal dysfunction in children with HIV infection has been most closely associated with very severe immunosuppression, RNA HIV viral load >100,000 copies/ml, and progressive course of HIV-infection, as evidenced by albuminuria studies. The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was adopted by the Local Ethics Committee of the institution specified in the work. The informed consent of the parents or guardians of the children was obtained for the study. The authors declare no conflict of interest. Key words: HIV infection, children, albuminuria, risk factors.