Abstract
Renal disease is a common complication of HIV-infected patients, associated with increased risk of cardiovascular events, progression to AIDS, AIDS-defining illness, and mortality. Early and accurate identification of renal disease is therefore crucial to improve patient outcomes. The use of serum creatinine, along with proteinuria, to detect renal involvement is essentially to screen for markers of glomerular disease and may not be effective in detecting earlier stages of renal injury. Therefore, more sensitive and specific markers are needed in order to early identify HIV-infected patients at risk of renal disease. This review article summarizes some new and important urinary markers of tubular injury in HIV-infected patients and their clinical usefulness in the renal safety follow-up of TDF-treated patients.
Highlights
Renal disease is a common complication of HIV-infected patients, associated with increased risk of cardiovascular events, progression to AIDS, AIDS-defining illness, and mortality [1,2,3,4]
The receiver operator characteristic (ROC) curve analysis of this study showed that urinary Cystatin C (CysC)/Creatinine CysC (Cr) had a high area under curve (AUC: 0.929) to distinguish a Fanconi positive patient from a Fanconi negative one, allowing to rule out a Fanconi syndrome, defects of proximal tubular transport function
Urinary excretions of the tubular proteins are significantly higher in HIV-infected patients compared with the uninfected controls and in the patients with rather than without tubular injury
Summary
Renal disease is a common complication of HIV-infected patients, associated with increased risk of cardiovascular events, progression to AIDS, AIDS-defining illness, and mortality (both all-cause and AIDS-related) [1,2,3,4]. Renal tubular abnormalities are common and a substantial proportion of HIV-infected patients on HAART could have prevalent renal tubular injury in the absence of glomerular defects, probably resulting in a near future decrease in glomerular function and a higher incidence of urinary protein [16,17,18]. Urinary markers of tubular injury could potentially be useful in the early identification of patients at risk for severe renal tubular disease as well as TDFinduced nephrotoxicity Several of these tubular markers increase in the urine of HIV-infected patients, even before diagnosis of proteinuria and/or a decrease in glomerular function representing early markers of renal disease [18, 23, 24]. The aim of this review is to summarize some new and important urinary markers of tubular injury associated with early renal damage or dysfunction in HIV-infected patients and their clinical usefulness in the renal safety follow-up of TDF-treated patients
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