Leão Flávia Vanesca Felix, de Menezes Succi Regina Célia, Machado Daisy Maria, Gouvêa Aída de Fátima Thomé Barbosa, do Carmo Fabiana Bononi, Beltrão Suenia Vasconcelos, de Paula Cançado Maria Aparecida, de Abreu Carvalhaes João Tomas
Pediatric Nephrology Division, Escola Paulista de Medicina-Universidade Federal de SãoPaulo, Rua Borges Lagoa, 442 Vl. Clementino, São Paulo, SP, CEP: 04038-030, Brazil.
Pediatric Infectious Disease Division, Escola Paulista de Medicina-Universidade Federal de SãoPaulo, São Paulo, Brazil.
Pediatr Nephrol. 2016 May;31(5):773-8. doi: 10.1007/s00467-015-3260-x. Epub 2015 Dec 4.
This study aimed to identify the prevalence of renal abnormalities and the evolution of glomerular filtration rate (GFR) among human immunodeficiency virus (HIV)- infected children and adolescents followed up in an infectious disease outpatient pediatric clinic.
We performed a cohort study of 115 children and adolescents. Outcomes of two evaluations for urinalysis, microalbuminuria/urinary creatinine ratio, urinary retinol-binding protein (uRBP) concentration, and estimated GFR (eGFR) were obtained for each patient, with an average interval of 6 months between evaluations. These changes were correlated with gender, age, race, body mass index (BMI), height-for-age (H/A) percentile, clinical and immunological classification of HIV infection, use of antiretroviral therapy (ART), HIV viral load (VL), and CD4+ T-lymphocyte count.
Mean patient age at the time of inclusion in the study was 12.6 ± 3.2 years; 50.4 % were male, 81.7 % had acquired immune defeciency syndrome (AIDS), 80.9 % had CD4+ < 500 cells/mm(3), and 87.8 % were on ART. Urinary changes included hematuria (11.3 %), proteinuria (7 %), and microalbuminuria (11.6 %); uRBP was present in 3.8 %; and mean eGFR was 163 ± 32 ml/min/1.73 m(2).
The subclinical renal abnormalities found in this study may indicate early manifestations of a broad spectrum of renal dysfunction associated with HIV and involves the decision to initiate or modify ART.
本研究旨在确定在一家传染病儿科门诊随访的人类免疫缺陷病毒（HIV）感染儿童和青少年中肾脏异常的患病率以及肾小球滤过率（GFR）的变化情况。
我们对115名儿童和青少年进行了一项队列研究。获取了每位患者两次尿液分析、微量白蛋白尿/尿肌酐比值、尿视黄醇结合蛋白（uRBP）浓度和估计肾小球滤过率（eGFR）评估的结果，两次评估的平均间隔时间为6个月。这些变化与性别、年龄、种族、体重指数（BMI）、年龄别身高（H/A）百分位数、HIV感染的临床和免疫分类、抗逆转录病毒疗法（ART）的使用、HIV病毒载量（VL）以及CD4 + T淋巴细胞计数相关。
纳入研究时患者的平均年龄为12.6±3.2岁；50.4%为男性，81.7%患有获得性免疫缺陷综合征（AIDS），80.9%的CD4 +＜500个细胞/mm³，87.8%正在接受ART治疗。尿液变化包括血尿（11.3%）、蛋白尿（7%）和微量白蛋白尿（11.6%）；uRBP阳性率为3.8%；平均eGFR为163±32 ml/min/1.73m²。
本研究中发现的亚临床肾脏异常可能表明与HIV相关的广泛肾功能障碍的早期表现，并涉及启动或调整ART治疗的决策。
