Evaluation of renal profile in asymptomatic HIV patients with special reference to proteinuria

Introduction: Renal disease has now become a well-recognised complication of HIV infection. If not recognized early it frequently progresses to end stage renal disease, thus becoming a major cause of morbidity and mortality.

Aim of the research: The purpose of this study was to know the prevalence of renal dysfunction in asymptomatic HIV patients in terms of proteinuria and various risk factors associated with it and to study the histopathological lesions associated in patients with nephrotic range proteinuria.

Material and methods: We conducted a cross-sectional, single-centre study on 100 asymptomatic HIV patients aged between 18 and 50 years. Baseline investigations including kidney function tests and CD4 count were done on in all patients. Proteinuria was defined as 1+ on urine dipstick in spot urine sample. Urine microalbumin was measured by immunoturbidimetry or nephelometry. 2-D ultrasonography was done to determine kidney size and echogenicity. Renal biopsy was done in patients with nephrotic range proteinuria.

Results: The total prevalence of proteinuria among the study subjects was 21%. It was significantly associated with older age, lower CD4 counts, higher serum creatinine, and lower haemoglobin levels. There were no significant differences between patients with and without proteinuria with regard to sex and concurrent antiretroviral therapy. Proteinuria was also associated with increased kidney size and echogenicity. In the patients with nephrotic syndrome focal segmental glomerulosclerosis was the most common histological pattern. A progressive decline in glomerular filtration rate was observed as the disease progressed in terms of duration of disease and decrease in CD4 count.

Conclusions: Renal dysfunction in HIV is dependent on a variety of host and immunological factors. Careful screening can help identify the subjects who are at higher risk. Various simple investigations such as 2D ultrasonography and urine dipsticks can serve as an effective screening tool.