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Title: | Absence of HIV-Associated Nephropathy Among Antiretroviral Naive Adults With Persistent Albuminuria in Western Kenya |
Authors: | Koech, Mathew Owiti, M.O.G. owino-ong'or, Willis M Wyatt, Christina |
Keywords: | Chronic kidney disease Epidemiology Focal segmental glomerulosclerosis HIV-associated nephropathy HIV-related kidney diseases Kenya |
Issue Date: | Nov-2016 |
Publisher: | ELSVIER |
Abstract: | 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. Methods: 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. Results: 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. Discussion: 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. |
URI: | 10.1016/j.ekir.2016.11.007 http://ir.mu.ac.ke:8080/jspui/handle/123456789/8825 |
Appears in Collections: | School of Medicine |
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1-s2.0-S2468024916301723-main.pdf | 2.3 MB | Adobe PDF | View/Open |
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