Hypercalciuria is the main renal abnormality finding in Human Immunodeficiency Virus-infected children in Venezuela

Abstract

Kidney involvement in children with Human Immunodeficiency Virus (HIV) infection is increasing in prevalence in parallel with the longer survival of HIV-infected patients and the side-effects of new antiretroviral drugs. However, there are only a few reports describing renal tubular disorders in HIV+ children. This is a cross-sectional, case series study evaluating kidney disease in 26 Venezuelan HIV-infected children. The study cohort consisted of 15 girls and 11 boys, with a median age of 5.9 years (25-75th percentile: 3.6-7.8), who had been treated with antiretrovirals for 2.8 +/- 0.4 years, Overall, the patients were short for their age and gender (Z-height: -3.1; 25-75th percentile: -4.94 to -1.98), and 15 showed signs of mild to moderate malnutrition. All of the children had a normal estimated glomerular filtration rate (136 +/- 22.6 ml/min/1.73 m2), and glomerular involvement was only observed in one patient with isolated proteinuria. None had nephromegaly. In contrast, tubular disorders were commonly found. Hypercalciuria was detected in 16 of the patients (UCa/Cr = 0.28; 25-75th percentile: 0.17-0.54 mg/mg), with five of these showing crystalluria. Eight children showed hyperchloremia, and three had frank metabolic acidosis. Kidney stones were absent in all, but one boy had bilateral medullary nephrocalcinosis. Conclusion, in Venezuelan children, HIV infection per se, or its specific treatment, was commonly associated with renal tubular dysfunction, especially hypercalciuria and acidosis, potentially leading to nephrocalcinosis and growth impairment. We recommend renal tubular evaluation during the follow-up of children with HIV infection.

Kidney Disease in HIV-Positive Children

“…A more recent study from Venezuela found that renal tubular disorders also are common in HIV-infected Hispanic children 23. Hypercalciuria was seen most frequently, with a potential for nephrocalcinosis, but crystalluria, hyperchloremia, and metabolic acidosis also are seen.…”

Urinary biomarkers of kidney diseases in HIV‐infected children

“…These markers included hyperaminoaciduria, phosphaturia, glucosuria in patients without diabetes, and increased fractional excretion of uric acid. In addition, hypercalciuria and acidosis were the most relevant complications seen in HIV‐infected children followed in Venezuela . Similar renal tubular features were seen in HIV‐infected children treated in the US during the early years of the AIDS epidemic .…”

Extracellular Calcium Receptor as a Target for Glutathione and Its Derivatives

“…Aside from possible roles in renal disease, changes in glutathionergics and CaSR function may also have roles pathology in HIV-AIDs, osteoporosis, pulmonary hypertension, and neurodegenerative diseases. HIV/AIDS is accompanied hypercalciuria and osteopenia [ 75 , 76 ] and, as already reviewed ( Figure 2 ), changes in plasma levels of GSH and its oxidized derivatives also occur in HIV/AIDS [ 15 ]. With respect to heart disease, mutations in promotor regions of subunits of glutamate-cysteine ligase (GCL, the rate-limiting enzyme for GSH synthesis) are associated with increased risk for myocardial infarction [ 77 ], which could be related to GSH-potentiation of endothelial nitric oxide release [ 78 ] and the extracellular calcium receptor (CaSR) in cardiac microvascular endothelial cells [ 79 ].…”