Gravemann Sophia, Brinkkoetter Paul T, Vehreschild Jörg J, Franke Bernd, Ehren Kathrin, Bünemann Elisabeth, Orbach Henning, Weiß Verena, Hellmich Martin, Benzing Thomas, Fätkenheuer Gerd
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.
AIDS. 2014 Jul 31;28(12):1783-9. doi: 10.1097/QAD.0000000000000324.
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.
Cross-sectional study.
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.
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.
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.
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。
横断面研究。
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。
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。
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。
