Masimango Mannix Imani, Sumaili Ernest Kiswaya, Jadoul Michel, Wallemacq Pierre, Mubagwa Dieudonné Kanigula, Makulo Rissassy Jean-Robert, Lepira François Bompeka, Nseka Nazaire Mangani
Department of Medicine, Université Catholique de Bukavu, Bukavu, DR Congo.
BMC Nephrol. 2014 Sep 5;15:146. doi: 10.1186/1471-2369-15-146.
Microalbuminuria is a marker of early kidney disease and high cardiovascular risk in various populations, including HIV positive patients. However, the diagnostic value of qualitative (dipstick) proteinuria and the burden of microalbuminuria in HIV positive patients living in sub-Saharan Africa are relatively unclear.
In a cross-sectional study, 235 HIV- positive outpatients were screened for proteinuria in 3 HIV-clinics in Bukavu. A spot urine sample from each subject was tested both by a dipstick and albumin-creatinine-ratio (ACR) assay. The performance of dipstick proteinuria exceeding 1+ was compared with that of microalbuminuria (≥ 30 mg/g creatinine).
The prevalence of microalbuminuria and dipstick proteinuria ≥ (1+), ≥ (2+) and ≥ (3+) was 11%, 41%, 3.5% and 0.7%, respectively.Compared to microalbuminuria, the dipstick (proteinuria of 1+ or greater) had an overall sensitivity of 60% and a specificity of 61%. The positive predictive value was 15.4% and the negative predictive value 92.8%.
Proteinuria is highly prevalent in HIV positive patients. The limited sensitivity and specificity of the dipstick to detect significant microalbuminuria make it unattractive as a screening tool in HIV positive patients.
微量白蛋白尿是包括HIV阳性患者在内的各类人群早期肾病和高心血管疾病风险的标志物。然而，定性（试纸法）蛋白尿的诊断价值以及撒哈拉以南非洲地区HIV阳性患者微量白蛋白尿的负担相对尚不明确。
在一项横断面研究中，对布卡武3家HIV诊所的235名HIV阳性门诊患者进行蛋白尿筛查。对每个受试者的随机尿样同时采用试纸法和白蛋白肌酐比值（ACR）测定法进行检测。将试纸法蛋白尿超过1+的检测性能与微量白蛋白尿（≥30mg/g肌酐）的检测性能进行比较。
微量白蛋白尿以及试纸法蛋白尿≥（1+）、≥（2+）和≥（3+）的患病率分别为11%、41%、3.5%和0.7%。与微量白蛋白尿相比，试纸法（蛋白尿1+及以上）的总体灵敏度为60%，特异度为61%。阳性预测值为15.4%，阴性预测值为92.8%。
蛋白尿在HIV阳性患者中高度流行。试纸法检测显著微量白蛋白尿的灵敏度和特异度有限，使其作为HIV阳性患者的筛查工具并不理想。
