低度蛋白尿在接受抗逆转录病毒治疗的HIV阳性患者中非常普遍。
Low-grade proteinuria is highly prevalent in HIV-positive patients on antiretroviral treatment.
作者信息
Gravemann Sophia, Brinkkoetter Paul T, Vehreschild Jörg J, Franke Bernd, Ehren Kathrin, Bünemann Elisabeth, Orbach Henning, Weiß Verena, Hellmich Martin, Benzing Thomas, Fätkenheuer Gerd
机构信息
aDepartment II of Internal Medicine bDepartment I of Internal Medicine, University Hospital of Cologne cInstitute of Medical Statistics, Informatics and Epidemiology, University of Cologne dGerman Centre for Infection Research (DZIF), Partner Site Bonn-Cologne eCenter for Molecular Medicine Cologne fCologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) gSystems Biology of Ageing Cologne, University of Cologne, Cologne, Germany. *Dr Sophia Gravemann and Dr Paul T. Brinkkoetter contributed equally to the writing of the article.
出版信息
AIDS. 2014 Jul 31;28(12):1783-9. doi: 10.1097/QAD.0000000000000324.
OBJECTIVES
HIV-positive patients are at an increased risk for chronic kidney disease. However, these data mainly derive from cohorts with a high percentage of African-American patients, representing a specific ethnical risk group for chronic kidney disease. The aim of this study was to estimate the prevalence and risk factors specifically for early signs of kidney dysfunction in a large, predominantly white cohort of HIV patients.
DESIGN
Cross-sectional study.
METHODS
Prevalence of low-grade proteinuria was measured by quantitative analysis of urinary protein-to-creatinine ratio (cutoff >70 mg/g) and further differentiated by assessing α1-microglobulin (tubular proteinuria) and albumin-to-creatinine ratio (glomerular proteinuria) of HIV patients attending the University Hospital in Cologne, Germany. Together with standard and HIV-related laboratory findings and medical history, risk factors for each form of proteinuria were identified using multivariate forward selection.
RESULTS
Of 945 enrolled patients, 55% were identified with low-grade proteinuria, 41% with tubular proteinuria, and 20% with glomerular proteinuria. Older age was a risk factor for all forms of proteinuria in multivariate analysis. Low-grade proteinuria was also associated with concomitant diabetes and exposure to nucleoside reverse transcriptase inhibitor [anytime during HIV infection, not tenofovir (TDF)-specific], whereas tubular proteinuria was linked to current and any exposure to nucleoside reverse transcriptase inhibitor (TDF-specific). Further risk factors for glomerular proteinuria were hypertension and diabetes in this cohort.
CONCLUSION
Low-grade, glomerular and tubular proteinuria are highly prevalent in this large white HIV cohort. Older age represents a nonmodifiable risk factor for all forms of proteinuria. Glomerular proteinuria is associated with modifiable cardiovascular, but not HIV-related risk factors, whereas tubular proteinuria is linked to TDF exposure.
目的
HIV 阳性患者患慢性肾脏病的风险增加。然而，这些数据主要来自非裔美国患者比例较高的队列，该群体是慢性肾脏病的一个特定种族风险群体。本研究的目的是在一个以白人为主的大型 HIV 患者队列中，评估肾功能不全早期迹象的患病率及危险因素。
设计
横断面研究。
方法
通过对尿蛋白与肌酐比值进行定量分析（临界值>70 mg/g）来测量低度蛋白尿的患病率，并通过评估德国科隆大学医院 HIV 患者的α1 -微球蛋白（肾小管性蛋白尿）和白蛋白与肌酐比值（肾小球性蛋白尿）进一步区分。结合标准及与 HIV 相关的实验室检查结果和病史，使用多变量向前选择法确定每种蛋白尿形式的危险因素。
结果
在 945 名登记患者中，55%被确定有低度蛋白尿，41%有肾小管性蛋白尿，20%有肾小球性蛋白尿。在多变量分析中，年龄较大是所有形式蛋白尿的危险因素。低度蛋白尿还与合并糖尿病及接触核苷类逆转录酶抑制剂有关[在 HIV 感染期间的任何时间，非替诺福韦（TDF）特异性]，而肾小管性蛋白尿与当前及任何时候接触核苷类逆转录酶抑制剂（TDF 特异性）有关。该队列中肾小球性蛋白尿的其他危险因素是高血压和糖尿病。
结论
在这个大型白人 HIV 队列中，低度、肾小球性和肾小管性蛋白尿非常普遍。年龄较大是所有形式蛋白尿的不可改变的危险因素。肾小球性蛋白尿与可改变的心血管危险因素有关，但与 HIV 相关危险因素无关，而肾小管性蛋白尿与 TDF 暴露有关。
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