The use of estimated glomerular filtration rate in the evaluation of renal function in HIV-positive children in Enugu

Abstract

Background: Glomerular filtration rate (GFR) is a measure of renal function that estimates the volume of fluid filtered from the renal glomerular capillaries. An assessment of renal function in HIV-positive children is timely due to the high prevalence of HIV-associated nephropathy (HIVAN) in HIV-positive children that progresses to end-stage renal disease (ESRD). Objectives: To estimate the glomerular filtration rate using creatininebased Schwartz formula. To determine the renal function in HIV-positive children in UNTH, using the estimated glomerular filtration rate (eGFR). Materials and Method: A total of 159 HIV-positive children had serum creatinine estimation and GFR calculated using the Schwartz formula. Values of eGFR of 2SD below the normal for age and gender as determined by National Kidney Foundation (NKF) were taken as low renal function. Results: There were 80 males and 79 females enrolled. The mean eGFR for the study population was 109.44 ± 16.86 mls/min/1.73 m 2 . Ninety children (56.6%) had normal renal function while 69 (45.4%) had low renal function for their respective age groups. Those with low renal function were older (P < 0.001) and had lower CD4 cell counts (P = 0.01). The eGFR was inversely related to age (r = -0.30, P = < 0.001) and directly related to CD4 cell count (r = 0.30, P = < 0.001). Conclusion: There is derangement in renal function among HIV-infected children as seen from their eGFR.

Factors associated with abnormal glomerular filtration rate among HIV-positive children at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

“…In addition, our participants were older, implying longer exposure to the damaging effect of the virus. Furthermore, while 37.2% of the children in our study had advanced disease, only 4.4% of the children studied by Ezeonwu et al [25] had the same disease severity.…”

“…Childhood HIV and eGFR in Maiduguri between age and abnormal eGFR [16,25]. In our study there were very few children aged one year and below.…”

“…The low eGFR rate of 1 in 5 children which we report emphasises the high burden of renal disease among this group of children. An even higher prevalence of low eGFR (43.4%) was reported by Ezeonwu et al [25] from Enugu, Nigeria, among children of similar age. Moderate to severe renal impairment (eGFR < 60 mL/min/1.73 m 2 ) was very common in this study, accounting for 44.2% of those with low eGFR.…”

“…In contrast, Iduoriyekemwen et al [18] reported a substantially lower prevalence of 5.1% from Benin, whereas Ezeonwu et al [25] did not find any child with eGFR < 60 mL/min/1.73 m 2 in their study from Enugu. In both of these studies, most of the patients were on HAART (100% in the Iduorivekemwen study and 77.4% in that by Ezeonwu et al).…”

Profile of estimated glomerular filtration rate of children with Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome

“…This observation is similar to the reports of other studies on relationship between gender and glomerular filtration rate where gender specific values of eGFR were found to be higher in males than females. [29][30][31] This is because of a higher average muscle mass and generation rate of creatinine in males. 32 The eGFR was lower in males in the age group of 10-12 years.…”