Renal abnormalities in a cohort of HIV-infected children and adolescents.

Abstract

This study aimed to identify the prevalence of renal abnormalities and the evolution of glomerular filtration rate (GFR) among human immunodeficiency virus (HIV)- infected children and adolescents followed up in an infectious disease outpatient pediatric clinic. We performed a cohort study of 115 children and adolescents. Outcomes of two evaluations for urinalysis, microalbuminuria/urinary creatinine ratio, urinary retinol-binding protein (uRBP) concentration, and estimated GFR (eGFR) were obtained for each patient, with an average interval of 6 months between evaluations. These changes were correlated with gender, age, race, body mass index (BMI), height-for-age (H/A) percentile, clinical and immunological classification of HIV infection, use of antiretroviral therapy (ART), HIV viral load (VL), and CD4+ T-lymphocyte count. Mean patient age at the time of inclusion in the study was 12.6 ± 3.2years; 50.4% were male, 81.7% had acquired immune defeciency syndrome (AIDS), 80.9% had CD4+ < 500 cells/mm(3), and 87.8% were on ART. Urinary changes included hematuria (11.3%), proteinuria (7%), and microalbuminuria (11.6%); uRBP was present in 3.8%; and mean eGFR was 163 ± 32ml/min/1.73m(2). The subclinical renal abnormalities found in this study may indicate early manifestations of a broad spectrum of renal dysfunction associated with HIV and involves the decision to initiate or modify ART.