28 November 2012
Proteinuria proved twice as common in a study of 304 HIV-positive US adolescents than in the general population. Both proteinuria and elevated cystatin C, another marker of kidney dysfunction, were associated low CD4 counts.
Kidney dysfunction affects about 30% of HIV-positive people in the United States and independently predicts death. In the general population, proteinuria and elevated cystatin C are used as markers of kidney disease. Because prevalence of these markers in HIV-positive adolescents remains poorly understood, researchers undertook this study.
The analysis included 304 HIV-positive adolescents in the Reaching for Excellence in Adolescent Care and Health (REACH) cohort, an observational study of youngsters in 13 US cities. The investigators defined proteinuria as a urine protein-to-creatinine ratio of 200 mg/g or greater. They defined elevated cystatin C as a level at or above the 75th percentile for the study group.
The REACH team found that 19.1% of adolescents had proteinuria and 23.7% had elevated cystatin C. A CD4 count below 200 cells/µL was significantly associated with greater proteinuria in both linear and logistic regression models. A CD4 count below 500 cells/µL was significantly associated with greater serum cystatin C in linear models and with elevated cystatin C in logistic regresssion models.
Proteinuria in these HIV-positive adolescents was about 2-fold more common than in healthy US adolescents.
The REACH investigators call for further studies “investigating early markers of kidney disease and the association with immune status and inflammation in HIV-infected adolescents.”
Source: Kristal J. Aaron, Mirjam-Colette Kempf, Robert H. Christenson, Craig M. Wilson, Paul Muntner, Sadeep Shrestha. Prevalence of proteinuria and elevated serum cystatin C among HIV-infected adolescents in the Reaching for Excellence in Adolescent Care and Health (REACH) study. JAIDS. 2012; 61: 499-506.
For the study abstract
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