Department of Infectious Diseases, Montpellier University Hospital, Montpellier, France.
AIDS. 2013 May 15;27(8):1295-302. doi: 10.1097/QAD.0b013e32835fac51.
To assess the frequency of glomerular and tubular proteinuria in a cohort of HIV-infected patients, and to determine the factors associated with each type of injury.
Cross-sectional study of 1210 consecutive HIV-infected adults followed in HIV outpatient unit (Montpellier/France).
Spot urine protein to creatinine (uPCR), albumin to creatinine (uACR) and albumin to protein (uAPR) ratios were assessed. Glomerular injury was defined as uACR at least 30 mg/g or uPCR at least 200 mg/g with uAPR at least 0.4. Tubular injury was defined as uPCR 200 mg/g or more with uAPR less than 0.4. Multivariate logistic regression identified independent factors of each type of proteinuria, in the 1158 patients with estimated glomerular filtration rate (eGFR) at least 60 ml/min per 1.73 m, using re-expressed modification of diet in renal disease equation.
Frequency of proteinuria was 18.2% among patients with eGFR at least 60 ml/min per 1.73 m consisting in tubular proteinuria for 50.7% of them. Factors associated with glomerular proteinuria were age [OR 1.34/10-year increment (95%CI: 1.08-1.66)], diabetes [OR 3.37 (95%CI: 1.53-7.44)], and arterial hypertension [OR 2.52 (95%CI: 1.36-4.66)]. Factors associated with tubular proteinuria were age [OR 1.43 (95%CI: 1.14-1.79)], current tenofovir use [OR 3.52 (95%CI: 1.86-6.65)], hepatitis C co-infection [OR 1.62 (95%CI: 1.00-2.65)], AIDS stage [OR 1.83 (95%CI: 1.18-2.82)], CD4 cell count less than 200 per μl [OR 2.48 (95%CI: 1.31-4.70)].
This study distinguished risk factors for tubular injury, mainly related to HIV disease and its treatment (tenofovir), and glomerular injury, linked to non HIV-related variables (age, diabetes, hypertension). Measuring uPCR, uACR and uAPR may help with the detection and specific management of early chronic kidney disease in HIV-infected patients having normal or sub-normal eGFR.
评估一组 HIV 感染患者的肾小球和肾小管蛋白尿频率，并确定与每种损伤类型相关的因素。
在 HIV 门诊单位（法国蒙彼利埃）连续随访的 1210 例 HIV 感染成人的横断面研究。
评估尿蛋白与肌酐（uPCR）、白蛋白与肌酐（uACR）和白蛋白与蛋白（uAPR）比值。肾小球损伤定义为 uACR 至少 30mg/g 或 uPCR 至少 200mg/g 且 uAPR 至少 0.4。肾小管损伤定义为 uPCR 至少 200mg/g 且 uAPR 小于 0.4。使用重新表达的肾脏病饮食改良方程，在估计肾小球滤过率（eGFR）至少 60ml/min/1.73m 的 1158 例患者中，多变量逻辑回归确定每种蛋白尿类型的独立因素。
在 eGFR 至少 60ml/min/1.73m 的患者中，蛋白尿发生率为 18.2%，其中 50.7%为肾小管蛋白尿。与肾小球蛋白尿相关的因素包括年龄[每 10 岁增加的 OR 1.34（95%CI：1.08-1.66）]、糖尿病[OR 3.37（95%CI：1.53-7.44）]和动脉高血压[OR 2.52（95%CI：1.36-4.66）]。与肾小管蛋白尿相关的因素包括年龄[OR 1.43（95%CI：1.14-1.79）]、当前使用替诺福韦[OR 3.52（95%CI：1.86-6.65）]、丙型肝炎合并感染[OR 1.62（95%CI：1.00-2.65）]、艾滋病期[OR 1.83（95%CI：1.18-2.82）]和 CD4 细胞计数小于 200/μl[OR 2.48（95%CI：1.31-4.70）]。
本研究区分了肾小管损伤的危险因素，主要与 HIV 疾病及其治疗（替诺福韦）有关，以及与非 HIV 相关变量（年龄、糖尿病、高血压）有关的肾小球损伤。测量 uPCR、uACR 和 uAPR 可能有助于检测和特异性管理 eGFR 正常或亚正常的 HIV 感染患者的早期慢性肾脏病。
