Validity of random urines to quantitate proteinuria in children with human immunodeficiency virus nephropathy

Abitbol, Carolyn; Strauss, José; Zilleruelo, Gastón; Montané, Brenda; Rodríguez, Elena Díaz

doi:10.1007/s004670050169

Cited by 15 publications

(9 citation statements)

References 16 publications

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“…In Port Harcourt, Nigeria, we found the prevalence of proteinuria among HIV-infected children in a pilot study to be 18.8% [22]. Although the definitive diagnosis of HIVAN requires a histological examination of renal tissues, clinical criteria can strongly suggest HIVAN in children [16,23].…”

Section: Introductionmentioning

confidence: 98%

Human immunodeficiency virus-associated nephropathy (HIVAN) in Nigerian children

2008

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Human immunodeficiency virus-associated nephropathy (HIVAN) has rarely been reported in African children. In this single-center study, we analyzed ten children diagnosed with HIVAN from January 2000 to October 2006. There were eight boys and two girls, with a male:female ratio of 4:1. Their ages were from 5 months to 15 years (mean 6.8+/-6.2 years), with a peak age of 5-9 years. The presenting complaints included generalized edema (60%) and hypertension (50%). All patients had proteinuria on urine dipstick, with four (40%) at nephrotic range (proteinuria >or=500 mg/dl). Nine (90%) patients were in renal failure, with elevated serum creatinine (6.3-24 mg/dl) and serum urea (70-120 mg/dl). Renal disease was the first manifestation of HIV infection in six patients, whereas the diagnosis was made on autopsy in three. The duration from HIV infection to development of HIVAN ranged from 5 months to 10 years. CD4(+) cell count, done in only three patients due to financial constraints, was below 200/mm(3). The kidneys were hyperechoic on abdominal ultrasound in all patients, and three (30%) showed grossly enlarged kidneys. Histology of renal tissues available by autopsy in three patients showed mainly collapsing focal segmental glomerulosclerosis. Treatments given were angiotensin-converting enzyme (ACE) inhibitors and highly active antiretroviral therapy (HAART) in four and two patients, respectively, and one patient underwent peritoneal dialysis. On outcome analysis, seven (70%) patients died, two were lost to follow-up, and one was alive on HAART therapy at the writing of this article. In conclusion, HIVAN occurs in Nigeria children, and the mortality is very high from uremia.

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Section: Introductionmentioning

confidence: 98%

Human immunodeficiency virus-associated nephropathy (HIVAN) in Nigerian children

2008

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“…Despite reports of this condition in the literature [43,44], typical HIVAN with enlarged kidneys and glomerular signs was virtually absent in our group. Only one child had mild proteinuria in a random first morning-voided urine, a method validated to quantify proteinuria in children with HIV nephropathy [1]. Ethnic differences between our Venezuelan population (a mix between European, mostly Spaniard, black African and Venezuela's native Indians) and those reported by others may, in part, explain our findings.…”

Section: Discussionmentioning

confidence: 68%

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

et al. 2007

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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.

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“…The progression to end stage renal disease is slow in children [3,5]. Strauss et al reported a less fulminant course in children compared to adults [2]. But some studies also show that HIVAN can progress to ESRD at a very rapid rate, varying from weeks to months.…”

Section: Discussionmentioning

confidence: 99%

“…Strauss et al reported a prevalence of childhood HIVAN of 10-15% in HIV-infected African American children [1]. Proteinuria is the first sign of HIVAN [2].…”

Section: Introductionmentioning

confidence: 99%

Human Immunodeficiency Virus-Associated Nephropathy (HIVAN) in Indian Children

Senguttuvan¹,

Gowtham²,

Soundararajan³

2014

TOUNJ

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Human immunodeficiency virus-associated nephropathy (HIVAN) in children has not been reported in India. In a single centre study, we analyzed 8 children diagnosed with HIVAN from 2007 to 2010. There were 6 boys and 2 girls with a male to female ratio of 3:1. Their ages ranged between 5 yrs to 11 yrs with a peak age of 8 years. The routes of HIV transmission were vertical in 5, blood transfusion in 2 and unknown in one. The presentation included generalized edema 100%, hypertension 2/8 (25%) and macroscopic hematuria 1/8 (12.5%). On evaluation by urine dipstick, all children had proteinuria and urine PCR showed nephrotic proteinuria (>3). 5/8 (62.5%) had extra renal involvement: 2 children had hepatosplenomegaly and 3/8 (37.5%) children had pulmonary tuberculosis and were on highly active antiretroviral therapy (HAART) and antituberculous treatment (ATT). Renal disease was the presenting problem in 4/8 (50%) and the remaining 4 (50%) were referred from the HIV clinic. The duration of HIV infection to the development of HIVAN was unknown in 4/8 (50%) nephrotic patients but in those referred from HIV clinic, it ranged between 5 months to 2 yrs. CD4 count ranged from 700 to 2465/mm 3 . All the children had enlarged kidneys bilaterally, except for one child who had normal sized kidneys with increased echogenicity and loss of corticomedullary distinction. He was not biopsied and he progressed to renal failure. Renal biopsy in other 7 children showed FSGS in 4 (57%) and collapsing FSGS in 2 (28.5%), and early segmental sclerosis with IgA deposits in one child (14.2%). 7/8 who had nephrotic proteinuria were initiated on steroids.

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Validity of random urines to quantitate proteinuria in children with human immunodeficiency virus nephropathy

Cited by 15 publications

References 16 publications

Human immunodeficiency virus-associated nephropathy (HIVAN) in Nigerian children

Human immunodeficiency virus-associated nephropathy (HIVAN) in Nigerian children

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

Human Immunodeficiency Virus-Associated Nephropathy (HIVAN) in Indian Children

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