Departments of Pediatrics; and.
Biochemistry, Lady Hardinge Medical College, New Delhi, India.
J Acquir Immune Defic Syndr. 2020 Dec 1;85(4):470-474. doi: 10.1097/QAI.0000000000002470.
Most of the kidney dysfunction in HIV-positive children receiving antiretroviral therapy (ART) is attributed to tenofovir. There is a paucity of data on kidney dysfunction in tenofovir-naive children. The primary objective was to know the point prevalence of albuminuria and β2-microglobulinuria in HIV-infected children aged 3-18 years receiving ART. Albuminuria and β2-microglobulinuria were used as surrogates for glomerular and tubular dysfunction, respectively. The secondary objective was to determine their predictors.
Cross-sectional study-design.
One hundred consecutive HIV-positive children (3-18 years) on ART were included. Spot urine sample was analyzed for urinary creatinine, total protein, microalbumin, and β2-microglobulin. Albuminuria was defined as albumin to creatinine ratio of >30 mg/g; proteinuria as urine dipstick ≥trace or spot urine protein to creatinine ratio (uPCR) of ≥0.2. β2-microglobulinuria was defined as β2-microglobulin levels of >350 µg/L.
There were 71 boys and 29 girls. Most of the children had WHO clinical stage I and were getting zidovudine-based regimen. Only 7 children were getting tenofovir. estimated Glomerular Filtration Rate and serum creatinine were normal in all children. Approximately half (48%) had renal dysfunction in the form of glomerular dysfunction (26%), tubular dysfunction (27%), or both (5%). Age at diagnosis was significantly associated with β2-microglobulinuria (P = 0.044). None of the selected variables were associated with albuminuria.
HIV-associated glomerular and tubular dysfunction is common in children receiving ART other than tenofovir. The standard guidelines should consider including routine urinary biomarker monitoring in children on ART.
在接受抗逆转录病毒疗法（ART）的 HIV 阳性儿童中，大多数肾功能障碍归因于替诺福韦。在未使用替诺福韦的儿童中，肾功能障碍的数据很少。主要目的是了解接受 ART 的 3-18 岁感染 HIV 的儿童白蛋白尿和β2-微球蛋白尿的现患率。白蛋白尿和β2-微球蛋白尿分别作为肾小球和肾小管功能障碍的替代指标。次要目标是确定其预测因素。
横断面研究设计。
纳入了 100 例连续接受 ART 的 HIV 阳性儿童（3-18 岁）。分析尿液标本中的尿肌酐、总蛋白、微量白蛋白和β2-微球蛋白。白蛋白尿定义为白蛋白与肌酐比值>30mg/g；蛋白尿定义为尿试纸≥痕迹或尿液蛋白与肌酐比值（uPCR）≥0.2。β2-微球蛋白尿定义为β2-微球蛋白水平>350μg/L。
有 71 名男孩和 29 名女孩。大多数儿童处于 WHO 临床分期 I 期，且使用齐多夫定为基础的方案。只有 7 名儿童使用替诺福韦。所有儿童的估算肾小球滤过率和血清肌酐均正常。约一半（48%）的儿童存在肾小球功能障碍（26%）、肾小管功能障碍（27%）或两者兼有（5%）的肾功能障碍。诊断时的年龄与β2-微球蛋白尿显著相关（P=0.044）。所选变量均与白蛋白尿无关。
在接受非替诺福韦的 ART 的儿童中，HIV 相关的肾小球和肾小管功能障碍很常见。标准指南应考虑在接受 ART 的儿童中常规进行尿液生物标志物监测。
