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Prevalence of risk factors for chronic kidney disease in South African youth with perinatally acquired HIV

  • Lisa Frigati
  • Sana Mahtab
  • Peter Nourse
  • Patricio Ray
  • Sofia Perrazzo
  • Takwanisa Machemedze
  • Nana-Akua Asafu Agyei
  • Mark Cotton
  • Landon Myer
  • Heather Zar
Original Article
Part of the following topical collections:
  1. What’s New in Chronic Kidney Disease

Abstract

Background

Little is known about renal pathology among perinatally HIV-infected children and adolescents in Africa. We assessed the prevalence of risk factors for chronic kidney disease in South African children and adolescents with perinatally acquired HIV-1 (HIV+) on antiretroviral therapy (ART) and HIV-negative children and adolescents.

Methods

HIV+ youth aged 9–14 years, on ART for > 6 months and age-matched HIV-negative children and adolescents were eligible for assessment of proteinuria and microalbuminuria using urine dipstick and Vantage analyser method. Blood pressure, estimated glomerular filtration rate, HIV-related variables and metabolic co-morbidities were assessed at enrolment.

Results

Among 620 children and adolescents, 511 were HIV+. The median age was 12.0 years and 50% were female. In HIV+ children and adolescents, 425 (83.2%) had a CD4 count > 500 cells/mm3 and 391 (76.7%) had an undetectable viral load. The median duration of ART was 7.6 years (IQR 4.6–9.3) with 7 adolescents receiving Tenofovir. The prevalence of any proteinuria, microalbuminuria and hypertension was 6.6%, 8.5% and 13.9%, respectively, with no difference between HIV+ and negative children and adolescents. All participants had a normal glomerular filtration rate. There was no association between metabolic co-morbidities and microalbuminuria.

Conclusions

Proteinuria and microalbuminuria appear to be uncommon in this population. Follow up of those with microalbuminuria may inform long-term outcomes and management of this growing population of HIV+ youth.

Keywords

HIV Perinatal Children Adolescents Microalbuminuria South Africa 

Notes

Funding

The Cape Town Adolescent Antiretroviral Cohort is supported by National Institutes of Health grant R01HD074051 and the South African Medical Research Council. Lisa Frigati is supported by the South African Medical Research Council.

Compliance with ethical standards

Ethical approval was given by the Faculty of Health Sciences, University of Cape Town and Stellenbosch University, Human Research Ethics Committee (051/2013). Parents gave informed consent and assent was taken from all adolescents.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    UNAIDS W (2017) Fact sheet: world AIDS day 2017. Global HIV statisticsGoogle Scholar
  2. 2.
    McCulloch MI, Ray PE (2008) Kidney disease in HIV-positive children. Semin Nephrol 28:585–594CrossRefGoogle Scholar
  3. 3.
    Purswani M, Patel K, Kopp JB, Seage IIIGR, Chernoff MC, Hazra R, Siberry GK, Mofenson LM, Scott GB, Van Dyke RB (2013) Tenofovir treatment duration predicts proteinuria in a multi-ethnic United States cohort of children and adolescents with perinatal HIV-1 infection. Pediatr Infect Dis J 32:495CrossRefGoogle Scholar
  4. 4.
    Lim Y, Lyall H, Foster C (2015) Tenofovir-associated nephrotoxicity in children with perinatally-acquired HIV infection: a single-centre cohort study. Clin Drug Invest 35:327–333CrossRefGoogle Scholar
  5. 5.
    Nachman SA, Chernoff M, Gona P, Van Dyke RB, Dankner WM, Seage GR, Oleske J, Williams PL (2009) Incidence of noninfectious conditions in perinatally HIV-infected children and adolescents in the HAART era. Arch Pediatr Adolesc Med 163:164–171CrossRefGoogle Scholar
  6. 6.
    Naicker S, Fabian J (2010) Risk factors for the development of chronic kidney disease with HIV/AIDS. Clin Nephrol 74:S51–S56PubMedGoogle Scholar
  7. 7.
    Ramsuran D, Bhimma R, Ramdial PK, Naicker E, Adhikari M, Deonarain J, Sing Y, Naicker T (2012) The spectrum of HIV-related nephropathy in children. Pediatr Nephrol 27:821–827CrossRefGoogle Scholar
  8. 8.
    Ray PE, Rakusan T, Loechelt BJ, Selby DM, Liu X-H, Chandra RS (1998) Human immunodeficiency virus (HIV)-associated nephropathy in children from the Washington, DC area: 12 years’ experience. Semin Nephrol 18:396–405PubMedGoogle Scholar
  9. 9.
    Anochie IC, Eke FU, Okpere AN (2008) Human immunodeficiency virus-associated nephropathy (HIVAN) in Nigerian children. Pediatr Nephrol 23:117–122CrossRefGoogle Scholar
  10. 10.
    Szczech LA, Gupta SK, Habash R, Guasch A, Kalayjian R, Appel R, Fields TA, Svetkey LP, Flanagan KH, Klotman PE (2004) The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection. Kidney Int 66:1145–1152CrossRefGoogle Scholar
  11. 11.
    Kim PS, Woods C, Dutcher L, Georgoff P, Rosenberg A, Mican JAM, Kopp JB, Smith MA, Hadigan C (2011) Increased prevalence of albuminuria in HIV-infected adults with diabetes. PLoS One 6:e24610CrossRefGoogle Scholar
  12. 12.
    Dimock D, Thomas V, Cushing A, Purdy JB, Worrell C, Kopp JB, Hazra R, Hadigan C (2011) Longitudinal assessment of metabolic abnormalities in adolescents and young adults with HIV-infection acquired perinatally or in early childhood. Metabolism 60:874–880CrossRefGoogle Scholar
  13. 13.
    Deyà-Martínez À, Noguera-Julian A, Vila J, Vila A, Valls A, Sánchez E, Jiménez R, Fortuny C (2014) The role of albuminuria in the follow-up of HIV-infected pediatric patients. Pediatr Nephrol 29:1561–1566CrossRefGoogle Scholar
  14. 14.
    Leão FVF, de Menezes Succi RC, Machado DM, Gouvêa AFTB, do Carmo FB, Beltrão SV, de Paula Cançado MA, de Abreu Carvalhaes JT (2016) Renal abnormalities in a cohort of HIV-infected children and adolescents. Pediatr Nephrol 31:773–778CrossRefGoogle Scholar
  15. 15.
    Sharma G, Mathai SS (2017) Prevalence of asymptomatic microalbuminuria in HIV positive children in India. Indian J Pediatr 84:417–419CrossRefGoogle Scholar
  16. 16.
    Mosten IK, Hamel BC, Kinabo GD (2015) Prevalence of persistent microalbuminuria and associated factors among HIV infected children attending a tertiary hospital in Northern Tanzania: a cross sectional, analytical study. Pan Afr Med J 20:251CrossRefGoogle Scholar
  17. 17.
    Eke F, Anochie I, Okpere A, Eneh A, Ugwu R, Ejilemele A, Ugboma H (2010) Microalbuminuria in children with human immunodeficiency virus (HIV) infection in Port Harcourt. Nigeria Niger J Med 19:298–301PubMedGoogle Scholar
  18. 18.
    Githinji LN, Gray DM, Hlengwa S, Myer L, Zar HJ (2017) Lung function in South African adolescents infected perinatally with HIV and treated long-term with antiretroviral therapy. Ann Am Thorac Soc 14:722–729CrossRefGoogle Scholar
  19. 19.
    Silverstein J, Klingensmith G, Copeland K, Plotnick L, Kaufman F, Laffel L, Deeb L, Grey M, Anderson B, Holzmeister LA (2005) Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care 28:186–212CrossRefGoogle Scholar
  20. 20.
    Babazono T, Takahashi C, Iwamoto Y (2004) Definition of microalbuminuria in first-morning and random spot urine in diabetic patients. Diabetes Care 27:1838–1839CrossRefGoogle Scholar
  21. 21.
    de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85:660–667CrossRefGoogle Scholar
  22. 22.
    Alpert BS (2007) Validation of the Welch Allyn spot vital signs blood pressure device according to the ANSI/AAMI SP10: 2002. Accuracy and cost-efficiency successfully combined. Blood Press Monit 12:345–347CrossRefGoogle Scholar
  23. 23.
    Falkner B, Daniels SR, Flynn JT, Gidding S, Green LA, Ingelfinger JR, Lauer RM, Morgenstern BZ, Portman RJ, Prineas RJ (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576CrossRefGoogle Scholar
  24. 24.
    Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute (2011) Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 128:S213CrossRefGoogle Scholar
  25. 25.
    Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637CrossRefGoogle Scholar
  26. 26.
    Unsal AB, Mattingly AS, Jones SE, Purdy JB, Reynolds JC, Kopp JB, Hazra R, Hadigan CM (2017) Effect of antiretroviral therapy on bone and renal health in young adults infected with HIV in early life. J Clin Endocrinol Metab 102:2896–2904CrossRefGoogle Scholar
  27. 27.
    Rosenberg AZ, Naicker S, Winkler CA, Kopp JB (2015) HIV-associated nephropathies: epidemiology, pathology, mechanisms and treatment. Nat Rev Nephrol 11:150CrossRefGoogle Scholar
  28. 28.
    Centers for Disease Control and Prevention (1996) The third National Health and Nutrition Examination Survey (NHANES III 1988–94) reference manuals and reports [CD-ROM]. Bethesda, MD: Centers for Disease Control and PreventionGoogle Scholar

Copyright information

© IPNA 2018

Authors and Affiliations

  • Lisa Frigati
    • 1
    • 2
    • 3
  • Sana Mahtab
    • 1
  • Peter Nourse
    • 1
  • Patricio Ray
    • 4
  • Sofia Perrazzo
    • 4
  • Takwanisa Machemedze
    • 1
  • Nana-Akua Asafu Agyei
    • 1
  • Mark Cotton
    • 2
  • Landon Myer
    • 5
    • 6
  • Heather Zar
    • 1
    • 3
    • 7
  1. 1.Department of Paediatrics and Child Health, Red Cross War Memorial Children’s HospitalUniversity of Cape TownCape TownSouth Africa
  2. 2.Department of Paediatrics and Child Health, Tygerberg HospitalStellenbosch UniversityCape TownSouth Africa
  3. 3.Research Centre for Adolescent and Child Health (REACH) and Medical Research (MRC) Unit on Child and Adolescent Health, Department of Pediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
  4. 4.Center for Genetic Medicine Research and Division of Nephrology, Children’s National Medical Center, and Department of PediatricsThe George Washington UniversityWashington DCUSA
  5. 5.Division of Epidemiology and Biostatistics, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
  6. 6.Centre for Infectious Diseases Epidemiology and ResearchSchool of Public Health and Family MedicineCape TownSouth Africa
  7. 7.MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa

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