Falasca Katia, Di Nicola Marta, Porfilio Italo, Ucciferri Claudio, Schiaroli Elisabetta, Gabrielli Chiara, Francisci Daniela, Vecchiet Jacopo
Clinic of Infectious Diseases, Department of Medicine and Science of Aging, "G. d'Annunzio" University, School of Medicine, Via dei Vestini, 66013, Chieti, Italy.
Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio", Chieti- Pescara, Italy.
BMC Nephrol. 2017 Jul 28;18(1):255. doi: 10.1186/s12882-017-0672-9.
Renal dysfunction is a common problem in the HIV+ population, due to the effect of both the HIV virus and the several classes of ARV drugs such as tenofovir (TDF). It is also known that the presence of renal damage correlates with cardiovascular risk and therefore with the risk of mortality of the patients accordingly. The detection of early renal damage is very important. Albuminuria and microalbuminuria are markers of early kidney disease and cardiovascular risk. The aim of the study is to evaluate the prevalence of microalbuminuria in a large polycentric sample, of unselected and consecutive HIV-patients followed as outpatients, and to assess its association with different therapeutic regimens.
We studied 326 patients with a mean age of 48.4 ± 1.6 years, treated at the Infectious Diseases Clinics of Chieti and Perugia for 48 weeks. The main metabolic parameters and the microalbuminuria levels in a single sample of urine were evaluated.
Microalbuminuria was detected in 61.0% of patients at T0 and in 49.7% after 48 weeks of observation with a median values of 1.1 mg/L (IQR: 0-2.7) vs. 0 mg/L (IQR: 0-2.0). 70% of the enrolled population did not show changes in microalbuminuria levels over time, 19% showed improvement, and 11% of the population had a worsening of microalbuminuria levels without any alteration of creatinine, uric acid and GFR-MDRD. We also found a statistically significant association between the development of microalbuminuria and gender (p < 0.035), Arterial Hypertension (AH) (p < 0.028) and therapy with TDF (p < 0.050).
We showed a very high prevalence of microalbuminuria, much higher than the literature data; the use of TDF affects the renal function in a statistically significant way and should therefore be considered a risk factor for kidney damage, which can be early assessed with the measurement of microalbuminuria.
由于HIV病毒以及替诺福韦（TDF）等几类抗逆转录病毒药物的影响，肾功能障碍在HIV阳性人群中是一个常见问题。众所周知，肾脏损害的存在与心血管风险相关，因此也与患者的死亡风险相关。早期肾脏损害的检测非常重要。蛋白尿和微量白蛋白尿是早期肾脏疾病和心血管风险的标志物。本研究的目的是评估在一个大型多中心样本中，未经过筛选且连续作为门诊患者随访的HIV患者中微量白蛋白尿的患病率，并评估其与不同治疗方案的关联。
我们研究了326例平均年龄为48.4±1.6岁的患者，他们在基耶蒂和佩鲁贾的传染病诊所接受了48周的治疗。评估了单次尿液样本中的主要代谢参数和微量白蛋白尿水平。
在T0时，61.0%的患者检测到微量白蛋白尿，观察48周后这一比例为49.7%，中位数分别为1.1mg/L（四分位间距：0 - 2.7）和0mg/L（四分位间距：0 - 2.0）。70%的入组人群微量白蛋白尿水平未随时间变化，19%有所改善，11%的人群微量白蛋白尿水平恶化，而肌酐、尿酸和GFR - MDRD无任何改变。我们还发现微量白蛋白尿的发生与性别（p < 0.035）、动脉高血压（AH）（p < 0.028）以及TDF治疗（p < 0.050）之间存在统计学显著关联。
我们发现微量白蛋白尿的患病率非常高，远高于文献数据；TDF的使用对肾功能有统计学显著影响，因此应被视为肾脏损害的一个风险因素，可通过检测微量白蛋白尿进行早期评估。
