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Medium-grade tubular proteinuria is common in HIV-positive patients and specifically associated with exposure to tenofovir disoproxil Fumarate

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Abstract

Objectives

The aim of this cross-sectional study was to evaluate the prevalence and risk factors of medium-grade proteinuria (100–500 mg/g creatinine) among HIV-positive adults.

Methods

Spot urine samples of HIV-positive adults without known renal disease were analyzed quantitatively between January 2009 and February 2011. Demographic and medical data were collected. Multivariate regression models for different patterns of proteinuria were constructed.

Results

Among 411 patients, 18 (4.4 %) presented albuminuria >300 mg/g creatinine and/or proteinuria >500 mg/g creatinine and were excluded from further analyses. Among the study population of 393 patients, 181 (46.1 %) had no significant proteinuria or albuminuria (<100 and <30 mg/g creatinine, respectively), 60 (15.3 %) had moderate albuminuria, while 152 (38.7 %) had proteinuria without albuminuria, suggesting tubular proteinuria. Independent predictors for medium-grade tubular proteinuria in multivariate analysis were exposure to tenofovir (DF), a CD4 nadir <500/µl, older age, and anti-HCV-antibodies. There was no association with classic renal risk factors like diabetes mellitus and arterial hypertension, or with estimated glomerular filtration rate (eGFR).

Conclusions

We detected significant proteinuria in 230 (56.0 %) of 411 HIV-positive patients. Among this group, 152 (66.1 %) had medium-grade proteinuria without albuminuria, which was significantly associated with exposure to tenofovir, older age, a lower CD4 nadir and Hepatitis C. Nephrologic or HIV treatment guidelines fail to detect most of these patients but rather identify patients with high cardiovascular risk. In the absence of an association with eGFR the role of medium-grade tubular proteinuria as a potential early marker of chronic kidney disease remains unclear. Prospective studies are needed.

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Acknowledgments

The authors wish to thank all the physicians and staff of our outpatient clinic for their help in data collection and support of the study. Data management for this study was supported by Deutsches Zentrum für Infektionsforschung (DZIF) Grant Number TI 02.001.

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Authors and Affiliations

  1. Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Pettenkoferstraße 8a, 80336, Munich, Germany

    A. J. Zeder, S. Schrader, J. R. Bogner & U. Seybold

  2. Klinik für Gastroenterologie, Klinikum Dritter Orden München-Nymphenburg, Menzinger Straße 44, 80638, Munich, Germany

    A. J. Zeder

  3. Klinik für Nephrologie, Klinikum Harlaching, Städtisches Klinikum München, Sanatoriumsplatz 2, 81545, Munich, Germany

    R. Hilge

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  1. A. J. Zeder
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Correspondence to A. J. Zeder.

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Conflict of interest

Robert Hilge and Svenja Schrader declare no conflicts of interest. Andreas J. Zeder has received a travel grant and congress sponsoring from Janssen. Johannes R. Bogner has reveived honoraria for lectures from AbbVie, Boehringer Ingelheim, Gilead, MSD, Janssen and ViiV. Ulrich Seybold has received travel and conference support from Boehringer Ingelheim, Gilead and ViiV and has received honoraria for lectures and educational material from Gilead and Janssen and has carried out advisory board and speakers’ bureau activity for Gilead, MSD and ViiV.

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Zeder, A.J., Hilge, R., Schrader, S. et al. Medium-grade tubular proteinuria is common in HIV-positive patients and specifically associated with exposure to tenofovir disoproxil Fumarate. Infection 44, 641–649 (2016). https://doi.org/10.1007/s15010-016-0911-1

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  • DOI: https://doi.org/10.1007/s15010-016-0911-1

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