Abstract:
Introduction: 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/ m l (IQR 89 492 cells/ m l).
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 glo-
merulosclerosis, 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.
