Abstract
HIV infection is a multiorgan disease with the kidney not spared. A variety of renal syndromes with varying clinical presentations has been reported amongst HIV infected patients. This study aims to highlight the spectrum of clinical presentations in HIV infected patients with renal disease. HIV infected patients presenting at University of Benin Teaching Hospital (UBTH) Benin City were the study population. A total of 383 patients were studied. Their biodata, clinical presentations and laboratory investigations including serum urea, creatinine and albumin, urine protein and creatinine were assessed. Their glomerular filtration rate (GFR) and protein urine excretion were calculated using six equations of modification of diet in renal disease (MDRD) and protein: creatinine ratio respectively. Patients were stratified according to their renal functions into normal, mild, moderate and severe renal function impairment. The data was analysed using statistical software program SPSS Vs 15.0. 53.3% of 383 patients screened had renal function impairment, 40.2% mild, 37.7% moderate and 22.2% severe impairment. Mean age was 35.6±8.3, 36.0±9.9 and 36.3±8.3 years for mild, moderate and severe renal function impairment (RFI) respectively. Easy fatigability was the commonest symptoms occurring in 47.5%, 30.0%, 37.5% and 22.5% of control, mild RFI, moderate RFI and severe RFI subjects respectively (p = 0.568). Oliguria, facial and body swelling occurred more in patients with RFI especially in patients with severe renal impairment. The difference is statistically significant (p = 0.046, 0.041, and 0.033 respectively). Pallor was the commonest clinical sign occurring in 32.5%, 50.0%, 35.0% and 62.5% of control and patients with mild, moderate, and severe RFI respectively; the difference was not statistically significant (p = 0.459). Ascites, facial puffiness and pedal oedema were commoner in patients with RFI especially those with severe RFI. The differences were statistically significant. (p = 0.048, 0.019, and 0.008 respectively). In conclusion spectrum of clinical presentations in HIV patients with renal impairment are many but few are specific to these patients.
Highlights
In 1984, Rao et al reported that renal lesions were found in HIV infected patients
This study aims to highlight the spectrum of clinical presentations of HIV infected patients with renal disease
Patients with mild renal function impairment (RFI) were younger with mean age of 35.6 8.3years but patients with moderate and severe RFI had mean age of 36.0 9.9 and 36.3 8.3 years respectively
Summary
In 1984, Rao et al reported that renal lesions were found in HIV infected patients They further described a glomerulopathy, which was characterised by heavy proteinuria, biochemical features of nephrotic syndrome, renal impairment that rapidly progressed to end stage renal disease (Rao et al, 1984). Various presentations have been reported in these patients, varying from asymptomatic proteinuria to End Stage Renal Disease (ESRD) with different features of uraemia (Nochy et al, 1993; Winston and Klotman 1996; Seney et al, 1990; Weiner et al, 2002). Haematuria, and proteinuria has been reported as presentations in HIV patients with impaired renal function (Moro and Sidhartha 2006; Ijoma, 1996). Uraemia with its various presentations occur in these patients especially in those with severe renal functional impairment (Iglesias et al, 2006)
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