Renal disease in HIV-seropositive patients in Nigeria: an assessment of prevalence, clinical features and risk factors

Abstract

In order to determine the pattern of renal disease and risk factors for renal disease in HIV-infected Nigerians, we studied 400 consecutive HIV/AIDS patients (210 males, 190 females) aged between 18 and 65 years (mean +/- SD; 34.6 +/- 9.4 years), and examined renal disease factors attributable to the infection. Diagnosis of renal disease was based on the consistent presence of at least 1+ albuminuria and/or elevated serum creatinine (>132 micromol/l) as well as the absence of other identifiable causes of chronic kidney disease (CKD). We determined socio-demography and clinical findings, as well as full laboratory work-ups including haemogram, CD4+ cell count, serum electrolytes, urea, creatinine, protein, cholesterol and urine analysis. Renal biopsies were taken in 10 patients who had moderate to massive proteinuria and had consented to the procedure. Finally, we compared HIV/AIDS cases with and without renal disease to determine the risk factors for nephropathy. We observed a high prevalence of renal disease (proteinuria and/or elevated serum creatinine), which was present in 152 (38%) of the patients. This subgroup included 74 males and 78 females with a M:F ratio of 1:1. The mean age (+/-SD) was 35.8 (+/-10.01) years. Systolic and/or diastolic hypertension was seen in 13.2% of these patients while the mean (+/- SD) body mass index (BMI) and packed cell volume (PCV) were 18.5 (+/-3.1) kg/m(2) and 25.26 (+/-6.81)%, respectively. The mean (+/-SD) CD4+ count was 246.49 (+/-192.8) cells/microl, while the mean (+/-SD) serum creatinine and 24-h urine protein excretion rates were 210.11 (+/-337.8) micromol/l and 2.57 (+/- 2.42) g/day, respectively. In subjects with and without nephropathy, there were significant differences in age, BMI, serum cholesterol, serum albumin and CD4+ counts, suggesting that these parameters may be risk factors for nephropathy. Histology revealed mainly focal glomerulosclerosis (FGS) with glomerular collapse. We conclude that the prevalence of proteinuria in HIV-seropositive patients is high in Nigeria. Such subjects show an equal male:female distribution, and glomerular histology revealed that a majority of biopsied patients had the collapsing FSGS variant. The risk factors for renal disease included severity of the HIV infection (inferred from the generally low CD4+ count), anaemia, malnutrition and increasing age.

Prevalence of Chronic Kidney Failure and Associated Factors in Patients Treated by Antiretroviral in the National Teaching Hospital of Cotonou

“…According to Emem et al a low Body Mass Index was associated with kidney disease in HIV infected patients (p<0.001) [9]. Indeed, more than half of patients (59.2%) in this study were thin.…”

“…Emem had found that age was associated with chronic kidney failure (p=0.016). He noted that more patients are older; more the risk to chronic kidney failure appears [9].…”

“…According to Naicker, the prevalence of chronic kidney disease in Sub-Saharan Africa varied between 6% and 48.5% [8]. Emem studying kidney disease defined by the presence of proteinuria positive dipstick and/or serum creatinine higher than or equal to 132 μmol/L (15 mg/L) in seropositive-HIV patients in Nigeria had found a prevalence of 38% [9]. Similarly, in Uganda, Andia had found a prevalence of chronic kidney disease to 48.5% in Patients with HIV [10].…”

“…In this Rwandan study led by Wyatt et al, [11] [9]. However, in recent years, socioeconomic factors are recognized as major determinants of general population health status [13].…”

“…We can explain that by many patients had acute kidney injury at the initiation of antiretroviral therapy which has evolved favorably after care. The HIVAN (HIV-Associated Nephropathy) is the first diagnosed kidney disease in people living with HIV in most studies [9,15]. These polymorphic clinical manifestations appear rare in Europe due to the early management of these patients [16].…”