Koech M K, Owiti M O G, Owino-Ong'or W D, Koskei A K, Karoney M J, D'Agati V D, Wyatt C M
Moi University School of Medicine, Eldoret, Kenya.
Academic Model Providing Access to Healthcare, Eldoret, Kenya.
Kidney Int Rep. 2016 Nov 30;2(2):159-164. doi: 10.1016/j.ekir.2016.11.007. eCollection 2017 Mar.
HIV-associated nephropathy (HIVAN) has been strongly linked to African ancestry. However, studies have demonstrated wide variability in the prevalence of HIVAN in different sub-Saharan African populations. Accurate assessment of the disease burden is important because antiretroviral therapy (ART) is increasingly available and may prevent progression to end-stage renal disease.
We prospectively screened ART-naïve, afebrile, nonhypertensive, and nondiabetic adults attending a large HIV care program in Western Kenya for the presence of albuminuria (dipstick albumin ≥ trace or urine albumin to creatinine ratio [UACR] ≥ 30 mg/g). Those with albuminuria confirmed on 2 occasions, subject to consent, underwent kidney biopsy.
Among 523 subjects screened, 85 (16.3%) had albuminuria on the initial screen, and persistent albuminuria was confirmed in 32 of the 53 (60%) who returned for confirmatory testing. A total of 27 subjects with persistent albuminuria underwent biopsy. The median age was 34 years (interquartile range [IQR] 30-42 years), and 63% were female. The median CD4 count was 369 cells/μl (IQR 89-492 cells/μl). Renal function was normal in 92%. Median UACR was 257.5 mg/g (IQR 93.5-543 mg/g), and 92% had UACR < 1 g/g. No subject had histologic features consistent with HIVAN; 41% had acute interstitial nephritis (AIN); 33% had nonspecific findings, and 2 patients had arteriosclerosis. Focal segmental glomerulosclerosis, acute postinfectious glomerulonephritis, chronic interstitial nephritis, pyelitis, and papillary sickling were seen in 1 patient each.
Among ART-naïve adults with persistent albuminuria at a referral center in Western Kenya, we observed no cases of HIVAN. AIN was the most common cause of persistent proteinuria in this setting.
HIV相关性肾病（HIVAN）与非洲血统密切相关。然而，研究表明，撒哈拉以南非洲不同人群中HIVAN的患病率差异很大。准确评估疾病负担很重要，因为抗逆转录病毒疗法（ART）越来越普及，且可能预防疾病进展至终末期肾病。
我们对肯尼亚西部一个大型HIV护理项目中未接受过ART治疗、无发热、无高血压且无糖尿病的成年人进行前瞻性筛查，以检测是否存在蛋白尿（试纸法白蛋白≥微量或尿白蛋白与肌酐比值[UACR]≥30mg/g）。那些经两次确认存在蛋白尿且同意的受试者接受了肾活检。
在523名接受筛查的受试者中，85名（16.3%）在初次筛查时存在蛋白尿，53名返回进行确认检测的受试者中有32名（60%）被确诊为持续性蛋白尿。共有27名持续性蛋白尿受试者接受了活检。中位年龄为34岁（四分位间距[IQR]30 - 42岁），女性占63%。中位CD4细胞计数为369个/μl（IQR 89 - 492个/μl）。92%的受试者肾功能正常。中位UACR为257.5mg/g（IQR 93.5 - 543mg/g），92%的受试者UACR < 1g/g。没有受试者具有与HIVAN一致的组织学特征；41%患有急性间质性肾炎（AIN）；33%有非特异性表现，2名患者患有动脉硬化。局灶节段性肾小球硬化、急性感染后肾小球肾炎、慢性间质性肾炎、肾盂炎和乳头镰状化各在1名患者中出现。
在肯尼亚西部一家转诊中心未接受过ART治疗且存在持续性蛋白尿的成年人中，我们未观察到HIVAN病例。在这种情况下，AIN是持续性蛋白尿最常见的原因。
