Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany.
Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany.
HIV Med. 2020 Sep;21(8):481-491. doi: 10.1111/hiv.12881. Epub 2020 Jun 17.
Medium-grade proteinuria (100-500 mg/g creatinine) is common among people living with HIV/AIDS (PLWHA) but is often undetected or ignored. This prospective, observational cohort study examined medium-grade proteinuria as a risk factor for markers of chronic kidney disease (CKD).
Quantitative urine samples were collected from 241 PLWHA without known renal disease at baseline between January 2009 and February 2011 and at follow-up 240 weeks later. Multivariate analysis was performed to assess medium-grade proteinuria as a risk factor for incident markers of CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m , albuminuria, phosphaturia).
Incident markers of CKD were identified in 33 patients (14%), of whom 24 (74%) had medium-grade proteinuria at baseline. Of these, 22 even had proteinuria of < 200 mg/g creatinine. Multivariate analysis showed an adjusted relative risk (aRR) of 2.4 for patients with baseline medium-grade proteinuria to develop signs of CKD. Age was identified as an additional independent predictor. By testing for interaction, tenofovir disoproxil fumarate (TDF)-independent proteinuria was strongly associated with incident CKD markers (aRR = 12.1).
Medium-grade proteinuria of 100-500 mg/g creatinine is both frequent in PLWHA and a significant risk factor for developing markers of CKD, especially in the absence of TDF. Relevant risk seems to be associated with proteinuria levels as low as 100-200 mg/g creatinine. Current guidelines recommend specific action for proteinuria exceeding 135-200 mg/g but still will miss a relevant number of PLWHA potentially at risk for CKD. An even lower cut-off to trigger nephrological work-up and potentially renoprotective interventions appears to be indicated.
中等级蛋白尿（100-500mg/g 肌酐）在 HIV/AIDS 感染者（PLWHA）中较为常见，但常被漏诊或忽视。本前瞻性观察队列研究旨在探讨中等级蛋白尿是否为慢性肾脏病（CKD）标志物的风险因素。
2009 年 1 月至 2011 年 2 月期间，共纳入 241 例无已知肾脏疾病的 PLWHA，收集其基线时和 240 周随访时的定量尿液样本。采用多变量分析评估中等级蛋白尿是否为 CKD 标志物（肾小球滤过率<60mL/min/1.73m 、白蛋白尿、磷尿）发生的风险因素。
33 例（14%）患者出现 CKD 标志物，其中 24 例（74%）基线时即存在中等级蛋白尿。其中 22 例患者甚至存在蛋白尿<200mg/g 肌酐。多变量分析显示，基线时存在中等级蛋白尿的患者发生 CKD 的相对风险（aRR）为 2.4。年龄也是一个额外的独立预测因素。通过检验交互作用，发现非替诺福韦二吡呋酯（TDF）相关性蛋白尿与 CKD 标志物的发生显著相关（aRR=12.1）。
100-500mg/g 肌酐的中等级蛋白尿在 PLWHA 中较为常见，也是发生 CKD 标志物的重要风险因素，尤其是在无 TDF 的情况下。相关风险似乎与低至 100-200mg/g 肌酐的蛋白尿水平相关。目前的指南建议对蛋白尿>135-200mg/g 采取具体措施，但仍会遗漏相当一部分可能存在 CKD 风险的 PLWHA。似乎需要一个更低的截断值来触发肾脏科评估和潜在的肾脏保护干预。
