ABSTRACT
Human immunodeficiency virus (HIV)-related glomerular disease is a cause of end-stage renal disease, though there is no recent data from Brazil concerning this syndrome. Persistent proteinuria (PPt) is the main marker for glomerular disease, especially levels above 1.5 g. We examined the prevalence of and associated risk factors for PPt, along with the prevalence of HIV-associated nephropathy (HIVAN) among AIDS patients. We interviewed 411 patients who were attended at the HIV/AIDS section of the Clinical Hospital of the Federal University of Pernambuco (Brazil) from January through June 2004. PPt was defined as a positive urine dipstick exam on at least two occasions. The analyzed risk factors were: black race, a low CD4 lymphocyte count (<200 cells/mm³), an HIV RNA level of >100,000 copis/mL and patients on highly-active antiretroviral therapy (HAART). The patients were classified according to urineary protein/creatinine ratio (Up/Uc) < 1.0, 1.0-3.0 and > 3.0. Patients with Up/Uc >3.0 were submitted to renal biopsy. Among the 411 HIV/AIDS patients, the mean age was 37 years, 70 percent were male, 37.5 percent were black, the mean CD4 count was 363 cells/mm³ (± 95), the mean RNA HIV count was 44,475 copies/mL (± 40,369), and 92 percent were on HAART. The prevalence of PPt was 5.6 percent (95 percent CI = 3.6 to 8.3 percent), and it was significantly associated with a low CD4 lymphocyte count (p<0.048). HIVAN was found in just one patient, and two patients improved after HAART.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , AIDS-Associated Nephropathy/diagnosis , Proteinuria/diagnosis , Black People , AIDS-Associated Nephropathy/complications , Antiretroviral Therapy, Highly Active , Prevalence , Prospective Studies , Proteinuria/etiology , RNA, Viral , Viral LoadABSTRACT
Foi avaliado a excreçäo urinária de albumina em 337 pacientes com diabetes mellitus atendidos no Hospital das Clínicas da UFPE. Albuminúria foi encontrada em 118 deles (35por cento): em 16/36 (44,4por cento) diabéticos tipo 1, 101/295(34,2por cento) diabeticos tipo 2 e 1/6 pacientes (16,6por cento) com outros tipos de diabetes. Quanto ao grau de albuminúria, 56,8 por cento tinham microalbuminúria, 28,8por cento macroalbuminúria e 14,4por cento näo puderam ser classificados. Em comparaçäo aos pacientes sem albuminúria, o grupo com albuminúria apresentou tempo de diagnóstico, níveis plasmáticos de colesterol e frequencia de hipertensäo significante maiores, tanto no DM tipo 1 (p=0,031; p=0,36; p=0,012, respectivamente), como no DM tipo2 (p<0,001; p=0,035; p=0,050, respectivamente). Näo houve diferença dignificante entre valores de glicemia, índice de massa corpórea ou hábito de fumar. Entretanto, hiperglicemia estava presente em todos os pacientes analisados. Os resultados mostram uma elevada frequência de albuminúria nos diabéticos acompanhados no HC-UFPE, superior à citada na maioria dos estudos na literatura. Resalta-se a importância da hipertensäo, hipercolesterolemia e hiperglicemia como fatores de risco para a nefropatia diabética