Abstract
BackgroundTubular dysfunction is common in HIV-infected people and detection of proteinuria is essential to identify this problem. In low-income countries, resources for detection of proteinuria using the Kidney Disease Improve Global Outcomes (KDIGO) gold standard urinary protein/creatinine ratio (uPCR) is rarely possible, and use of the protein reagent strip (PRS) could be an option in these places. The aims of this study were to establish the concordance between PRS and uPCR to detect tubular proteinuria in HIV-infected people, and to assess the sensitivity and specificity of PRS as a diagnostic method in this group.MethodsA cross-sectional study was conducted to evaluate the correlation between the two techniques to detect protein in urine. Participants were enrolled for a period of 6 months. The measurements were performed in participants who were on highly active antiretroviral therapy (HAART) or prior to the start of treatment. Proteinuria was defined as uPCR ≥ 150 mg/g, and/or ≥ trace on PRS. A phi coefficient was calculated to establish the degree of correlation. We assessed the sensitivity and specificity of PRS compared with uPCR using standard methods.ResultsA total of 799 subjects were included. Of these, 737 (92%) were men. The mean age was 32.9 years (±10.1 years). Most (561, 70%) were on antiretroviral treatment. The mean estimated glomerular filtration rate (eGFR) calculated according to Modification of Diet in Renal Disease (MDRD)-4 was 113.0 mL/min (±22.6). Comorbidities included diabetes mellitus (10, 1.3%) and hypertension (17, 2.1%). The prevalence of proteinuria detected by PRS was 8.3% (n = 66) and by uPCR 10.6% (n = 85). The concordance assessed by phi correlation coefficient was 0.70, p < 0.001, with a sensitivity of 51.7% (95% confidence interval [CI] 41%–62%) and specificity 97% (95% CI 39%–97%).ConclusionsThere is a high concordance between detection of proteinuria by PRS and uPCR. Therefore, in low-income countries PRS can be helpful for detecting tubular damage in people infected with HIV.
Highlights
Tubular dysfunction is common in human immunodeficiency virus (HIV)-infected people and detection of proteinuria is essential to identify this problem
The median estimated glomerular filtration rate (eGFR) calculated according to Modification of Diet in Renal Disease (MDRD)-4 was 113.06 mL/min (±22.62 mL/min), with 691 (86.48%) participants in Modification of Diet and in Renal Disease-4 (MDRD-4) stage 1, 104 (13.01%) in stage 2, and 4 (0.50%) in stage 3
The prevalence of proteinuria detected by dipstick was 8.3% (n = 66) and by urinary protein/creatinine ratio (uPCR) was 10.6% (n = 85) [Table 2]
Summary
Tubular dysfunction is common in HIV-infected people and detection of proteinuria is essential to identify this problem. The aims of this study were to establish the concordance between PRS and uPCR to detect tubular proteinuria in HIV-infected people, and to assess the sensitivity and specificity of PRS as a diagnostic method in this group. Kidney disease is a complication that is observed in 10%–30% of patients infected with human immunodeficiency virus (HIV), and is a common cause of morbidity and mortality [1,2]. The increased survival of HIV-infected patients has changed the course of the disease, with renal complications related to HIV the fourth most common cause of mortality [4]. Persistent proteinuria is the principal marker of glomerular and tubular disease in people with HIV/acquired immune. The Infectious Disease Society of America recommends that at the time of HIV diagnosis, all individuals should be assessed for kidney disease by a screening urine analysis for proteinuria, and that those with proteinuria should be referred for early treatment to prevent kidney failure [11]
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