Basic fibroblast growth factors as a biomarker of focal segmental glomerulosclerosis in HIV-positive and HIV-negative children

Background. HIV infection can lead to the development of HIV-associated nephropathy (HIVAN) with the majority of patients progressing to end-stage kidney disease. Previous studies have recognised basic fibroblast growth factor (bFGF) as a biomarker for HIVAN, since significant levels of bFGF low-affinity receptors have been found in the kidneys of HIV-infected children.Objective. To assess the association between bFGF and kidney disease in the development of focal segmental glomerulosclerosis (FSGS) in HIV-positive and negative children.Methods. The study group consisted of 31 children; HIVAN (n=11) and idiopathic FSGS (n=20). The control group consisted of both HIV-positive (n=20) and HIV-negative (n=20) children with no kidney disease. Serum samples from all patients in both the study and control groups were analysed for bFGF.Results. The concentration of bFGF was higher, in comparison with idiopathic FSGS children, in HIVAN children (p=0.0167). There was also a significant elevation of serum bFGF levels in children with HIVAN when compared with HIV-positive (p=0.0288) and HIV-negative (p=0.0043) control groups.Conclusion. This study demonstrated statistically significant differences between bFGF levels in children with HIVAN and a control group, although it failed to distinguish significant differences in bFGF levels between HIVAN and idiopathic FSGS children

Spectrum of clinical presentations in human immunodeficiency virus (HIV) infected patients with renal disease

HIV infection is a multiorgan disease with the kidney not spared. A variety of renal syndromes with varying clinical presentations has been reported amongst HIV infected patients. This study aims to highlight the spectrum of clinical presentations in HIV infected patients with renal disease. HIV infected patients presenting at University of Benin Teaching Hospital (UBTH) Benin City were the study population. A total of 383 patients were studied. Their biodata; clinical presentations and laboratory investigations including serum urea; creatinine and albumin; urine protein and creatinine were assessed. Their glomerular filtration rate (GFR) and protein urine excretion were calculated using six equations of modification of diet in renal disease (MDRD) and protein: creatinine ratio respectively. Patients were stratified according to their renal functions into normal; mild; moderate and severe renal function impairment. The data was analysed using statistical software program SPSS Vs 15.0. 53.3of 383 patients screened had renal function impairment; 40.2mild; 37.7moderate and 22.28.3 years for mild; 9.9 and 36.3 8.3; 36.0 severe impairment. Mean age was 35.6 moderate and severe renal function impairment (RFI) respectively. Easy fatigability was the commonest symptoms occurring in 47.5; 30.0; 37.5and 22.5of control; mild RFI; moderate RFI and severe RFI subjects respectively (p = 0.568). Oliguria; facial and body swelling occurred more in patients with RFI especially in patients with severe renal impairment. The difference is statistically significant (p = 0.046; 0.041; and 0.033 respectively). Pallor was the commonest clinical sign occurring in 32.5; 50.0; 35.0and 62.5of control and patients with mild; moderate; and severe RFI respectively; the difference was not statistically significant (p = 0.459). Ascites; facial puffiness and pedal oedema were commoner in patients with RFI especially those with severe RFI. The differences were statistically significant. (p = 0.048; 0.019; and 0.008 respectively). In conclusion spectrum of clinical presentations in HIV patients with renal impairment are many but few are specific to these patients

Clinical Characteristics of Human Immunodeficiency Virus (HIV) Seropositive Nigerian Patients Undergoing Dialysis

Renal failure is a common finding in human immunodeficiency virus infected patients; and it contributes significantly to their morbidity and mortality. Most dialysis centres in Nigeria currently do not accept HIV positive patients for dialysis therapy for many reasons. The prevailing high level of stigmatization of HIV positive patients and the lack of job security for infected staff are two major reasons for the non-acceptance of HIV infected patients for dialysis by these centres. Following a pathetic encounter with an HIV positive patient who required dialysis and the success of his treatment; our centre currently perform dialysis for HIV positive patients on routine basis. In this article; we present our clinical observations on the characteristics of HIV patients dialyzed in our unit between 1st January 2004 and 31st December 2004. A total of 142 patients dialyzed in our centre during this period. 24 (16.9) were HIV positive. Acute renal failure was significantly more common in the HIV positive patients. [14(31.8) of 44 patients who presented with acute renal failure. X2 = 8.95; p 0.05]. Aetiologically; septicaemia was the most common cause of acute renal failure [7(50) of 14 patients]. HIV associated nephropathy accounted for 8(80) out of 10 HIV positive patients dialyzed with chronic renal failure. Outcome of therapy was not significantly different when compared with the HIV negative patients. We conclude that renal function impairment is common in patients with HIV infection. Treatment outcomes are essentially similar to HIV seronegative patients. The main determining factor being the ability of the patient to finance dialysis therapy

Clinical characteristics of human Immunodefiency Virus (HIV) seropositive Nigerian patients undergoing dialysis

Renal failure is a common finding in human immunodeficiency virus infected patients; and it contributes significantly to their morbidity and mortality. Most dialysis centres in Nigeria currently do not accept HIV positive patients for dialysis therapy for many reasons. The prevailing high level of stigmatization of HIV positive patients and the lack of job security for infected staff are two major reasons for the non-acceptance of HIV infected patients for dialysis by these centres. Following a pathetic encounter with an HIV positive patient who required dialysis and the success of his treatment; our centre currently perform dialysis for HIV positive patients on routine basis. In this article; we present our clinical observations on the characteristics of HIV patients dialyzed in our unit between 1st January 2004 and 31st December 2004. A total of 142 patients dialyzed in our centre during this period. 24 (16.9) were HIV positive. Acute renal failure was significantly more common in the HIV positive patients. [14(31.8) of 44 patients who presented with acute renal failure. X2 = 8.95; p 0.05]. Aetiologically; septicaemia was the most common cause of acute renal failure [7(50) of 14 patients]. HIV associated nephropathy accounted for 8(80) out of 10 HIV positive patients dialyzed with chronic renal failure. Outcome of therapy was not significantly different when compared with the HIV negative patients. We conclude that renal function impairment is common in patients with HIV infection. Treatment outcomes are essentially similar to HIV seronegative patients. The main determining factor being the ability of the patient to finance dialysis therapy

Syndrome de nephropathie lie au VIH: une observation a Dakar

Cette etude concerne un patient de race noire age de 40 ans en consultation pour un syndrome oedemateux de type renal; et des signes d'immunodepression.Les resultats obtenus a l'issue de ce travail ont permis d'insister sur la necessite de penser a la nephropathie liee au VIH chez tout patient de race noire presentant un syndrome nephrotique impur rapidement progressif. Les auteurs souhaitent realiser des etudes prospectives pour determiner la place de la NVIH dans les aspects cliniques du VIH au Senegal

The Kidney : an Important Target for HIV Infection

HIV-infected patients may present with a variety of patterns of renal involvement. Acute renal failure is common and most often a result of sepsis; hypotension and nephrotoxic agents. It is potentially avoidable; and support through the period of renal failure may lead to resolution of the renal dysfunction. HIV-associated nephropathy is a unique pattern of sclerosing glomerulopathy that ranges in prevalence form 1 to 10 per cent of the HIV infected population in different geographic locales. This complication of HIV infection will likely present a growing challenge to the medical community as HIV infection continues to spread worldwide. Deciphering the pathogenitic mechanisms of this most rapidly progressive form of focal segmental glomerulosclerosis is not only clinically relevant; but will hopefully provide valuable insights into the medication of the more common idiopathic form of the disease. The potential for improved renal survival of patients with HIV-associated nephropathy ahs become more realistic with the development and the use of antiretroviral agents; as well as studies on the role of immunosuppression and Angiotensin Converting Enzyme (ACE) inhibition in this population