Acompanhamento do comportamento do HIV através de exames laboratoriais em portadora do vírus: relato de caso / Monitoring of HIV behavior through laboratory tests in a virus carrier: case report

O vírus da imunodeficiência humana é o agente etiológico da AIDS, doença crônica que destrói o sistema imunológico e é caracterizada pela baixa contagem de células TCD4, alta contagem de partículas virais no sangue e manifestações clínicas da doença. O diagnóstico se dá com o aparecimento de infecções oportunistas, que levam a contagem de TCD4 a níveis menores que 200 céls/mm³. Os exames laboratoriais para o diagnóstico do HIV foram os principais avanços para o início do tratamento, reduzindo a transmissão. Detecção de anticorpos, detecção de antígenos e amplificação do genoma do vírus são alguns dos exames laboratoriais utilizados para diagnóstico. Os dois principais biomarcadores são os exames de contagem de células TCD4, que verifica o sistema imune, e a quantificação de carga viral, que informa a quantidade de partículas virais, mostrando a progressão da infecção. Quanto maior a carga viral, maior o dano ao sistema imune. Uma carga viral indetectável é inferior a 50 cópias/mL, mas valores menores ou iguais a 200 cópias/mL também impedem a transmissão. Uma declaração de consenso afirma que Indetectável é igual a Intransmissível. Portanto, quando indetectável, a transmissão inexiste. O presente estudo relata e discute o caso clínico de uma paciente diagnosticada com HIV/AIDS aos 28 anos, que sobreviveu, apesar do diagnóstico tardio, e sob presença de doença oportunista com um grave grau de diminuição de células TCD4 (22 cél/mm³). Por meio do diagnóstico, introdução e adesão correta da terapia antirretroviral e monitorização de exames laboratoriais, conseguiu evitar a morte e ter uma vida semelhante à de um HIV negativo. Ultrapassou a expectativa de vida que na descoberta era de 10 anos, com uma qualidade de vida considerável, não sendo transmissora do vírus, diminuindo assim o estigma e preconceito. O biomédico é peça fundamental nesse contexto, considerando que deve fornecer informações precisas e fidedignas, tão necessárias ao acompanhamento de pessoas vivendo com HIV, para que autoridades e profissionais de saúde adotem medidas adequadas, tanto na prevenção, quanto no diagnóstico e monitoramento da doença.

The human immunodeficiency virus is the etiological agent of AIDS, a chronic disease that destroys the immune system and is characterized by low TCD4 cell count, high viral particle count in blood and clinical manifestations of the disease. The diagnosis is due to the appearance of opportunistic infections, which lead to TCD4 counts below 200 cells / mm³. Laboratory tests for the diagnosis of HIV were the main advances in starting treatment, reducing transmission. Antibody detection, antigen detection and virus genome amplification are some of the laboratory tests used for diagnosis. The two main biomarkers are the TCD4 cell count tests, which checks the immune system, and viral load quantification, which reports the number of viral particles, showing the progression of infection. The higher the viral load, the greater the damage to the immune system. An undetectable viral load is less than 50 copies / mL, but values less than or equal to 200 copies / mL also prevent transmission. A consensus statement states that Undetectable equals Non-Transmissible. Therefore, when undetectable, transmission does not exist. The present study reports and discusses the clinical case of a patient diagnosed with HIV / AIDS at age 28, who survived despite late diagnosis and under the presence of opportunistic disease with a severe degree of TCD4 cell reduction (22 cells / mm³). Through the diagnosis, introduction and correct adherence of antiretroviral therapy and monitoring of laboratory tests, she was able to avoid death and have a life similar to that of an HIV negative. Exceeded the life expectancy that in the discovery was 10 years, with a considerable quality of life, not transmitting the virus, thus reducing the stigma and prejudice. The biomedical is a key player in this context, considering that he must provide accurate and reliable information, which is so necessary for the monitoring of people living with HIV, so that authorities and health professionals adopt appropriate measures, both in prevention, diagnosis and monitoring of the disease.

HIV-related nephropathy: new aspects of an old paradigm

SUMMARY The scenario of infection by the human immunodeficiency virus (HIV) has been undergoing changes in recent years, both in relation to the understanding of HIV infection and regarding the treatments available. As a result, the disease, which before was associated with high morbidity and mortality, is now seen as a chronic disease that can be controlled, regarding both transmission and symptoms. However, even when the virus replication is well controlled, the infected patient remains at high risk of developing renal involvement, either by acute kidney injury not associated with HIV, nephrotoxicity due to antiretroviral drugs, chronic diseases associated with increased survival, or glomerular disease associated to HIV. This review will cover the main aspects of kidney failure associated with HIV.

RESUMO O panorama da infecção pelo vírus da imunodeficiência humana (HIV) vem sofrendo alterações nos últimos anos, tanto em relação ao entendimento da infecção pelo HIV quanto aos tratamentos disponíveis. Como resultado, a doença, que antes estava associada a alta morbimortalidade, é agora considerada uma doença crônica que pode ser controlada, tanto em relação à transmissão quanto aos sintomas. No entanto, mesmo quando a replicação viral é bem controlada, o paciente infectado tem um alto risco de desenvolver complicações renais, seja através de lesão renal aguda não relacionada ao HIV, por nefrotoxicidade causada por drogas antirretrovirais, por doenças crônicas associadas com o aumento da sobrevida ou por doença glomerular associada ao HIV. Esta revisão abordará os principais aspectos da insuficiência renal associada ao HIV.

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

Nueva ecuación CAPA dependiente de Cistatina-C: mayor detección de filtrado glomerular disminuido en pacientes VIH / New CAPA-dependent Cystatin C Equation: increased detection of decreased glomerular filtration in HIV-infected patients

INTRODUCCIÓN: Creatinina y sus ecuaciones presentan claras limitaciones en relación a su baja sensibilidad para identificar etapas iniciales de disfunción renal. Cistatina-c ha sido propuesta como un marcador prometedor, pero hasta ahora, no hay evidencia que demuestre la superioridad de sus ecuaciones por sobre las de creatinina. Sin embargo, no existen estudios que comparen el rendimiento de la última ecuación de cistatina desarrollada por Grubb y colaboradores en 2014, la ecuación "CAPA". OBJETIVOS: Analizar el rendimiento de CAPA para detectar disminución temprana del filtrado glomerular en pacientes VIH, en comparación con ecuaciones dependientes de creatinina: Cockroft-Gault, MDRD-4, CKD-EPI y MCQ. MATERIAL Y MÉTODOS: Estudio analítico, observacional, transversal. Realizado entre julio y noviembre de 2017, en un hospital de tercer nivel de Argentina. Incluyó pacientes VIH realizando antirretrovirales, ≥18 años. Se excluyeron casos con creatinina ≥1,2 mg/dl. RESULTADOS: Se reclutaron 100 pacientes, y se incluyeron 89: 47 (52,8%) fueron mujeres. CAPA detectó disminuciones más pronunciadas del FG que las ecuaciones dependientes de creatinina. Las medias de FG por CAPA mostraron diferencias con las medias por Cockroft-Gault (p<0,0001); MDRD-4 (p=0,005); CKD-EPI (p<0,0001) y MCQ (p<0,0001). De los 46 casos (51,7%) con FG <90ml/min detectados a través de cualquier ecuación utilizada CAPA detectó 82,6% vs. 71,7% detectados por las cuatro fórmulas de creatinina en conjunto (p<0,0001), y que cada ecuación de creatinina individualmente: CAPA vs. Cockroft-Gault (p=0,01); vs. MDRD-4 (p<0,0001); vs. CKD-EPI (p=0,005). CONCLUSIONES: CAPA detectó disminuciones más marcadas del FG que las ecuaciones dependientes de creatinina en pacientes VIH

INTRODUCTION: Creatinine and its equations have clear limitations regarding their low sensitivity to identify initial stages of renal dysfunction. Cystatin C has been proposed as a promising marker, but so far, there has been no evidence showing the superiority of its equations over the creatinine ones. However, there are no studies which compare the performance of the latest cystatin equation developed by Grubb and collaborators in 2014: the "CAPA" equation. OBJECTIVES: To analyze the performance of CAPA equation to detect early reduction of glomerular filtration in HIV-infected patients, in comparison with creatinine-dependent equations: Cockroft-Gault, MDRD-4, CKD-EPI and MCQ. METHODS: An analytical, observational, cross-sectional study was conducted between July and November 2017, at an Argentinian specialty hospital. ≥18-year old HIV-infected patients undergoing antiretroviral therapy were included. Cases with creatinine ≥1.2 mg/dL were excluded. RESULTS: 100 patients were recruited, and 89 were included: 47 (52.8%) were women. CAPA equation detected more pronounced decreases in GFR than the creatinine-dependent equations. The mean values of GFR obtained by CAPA showed differences with the ones found through Cockroft-Gault (p <0.0001); MDRD-4 (p = 0.005); CKD-EPI (p <0.0001) and MCQ (p <0.0001). Of the 46 cases (51.7%) with GFR <90 ml/min detected through the use of any equation, CAPA detected 82.6% vs. 71.7% detected by the four creatinine formulas together (p <0.0001) and by each creatinine equation individually: CAPA vs. Cockroft-Gault (p = 0.01); vs. MDRD-4 (p <0.0001); vs. CKD-EPI (p = 0.005). CONCLUSIONS: CAPA equation detected more marked decreases in GFR than the creatinine-dependent equations in HIV-infected patients

Avaliação da função renal de pacientes com vírus da imunodeficiência humana / Evaluation of renal function in patients with human immunodeficiency virus

Objetivo: avaliar a função renal de pacientes em uso de terapia antirretroviral. Métodos: estudo documental, analítico e transversal com 150 pacientes Human Immunodeficiency Virus positivos, em uso de terapia antirretroviral, aos quais se ofertaram exames de creatinina sérica e de elementos e sedimentos anormais da urina, calculou-se a taxa de filtração glomerular estimada pela equação Chronic Kidney Disease Epidemiology Collaboration e estratificou-se a disfunção renal. Resultados: 11,3% dos participantes apresentaram taxa de filtração glomerular inferior a 90 ml/min/1,73m². Desses, 8,0% com disfunção renal estágio 2, e 3,3%, em estágio 3. As variáveis, maior idade e exposição prolongada à terapia antirretroviral, apresentaram significância estatística para alteração da função renal. Conclusão: estimativas da taxa de filtração glomerular por meio da equação Chronic Kidney Disease Epidemiology Collaboration mostrou-se medida efetiva de detecção precoce de alteração da função renal em pessoas vivendo com Human immunodeficiency virus/Acquired immunodeficiency syndrome em uso de terapia antirretroviral (AU).

Diagnóstico de infección por VIH por el hallazgo incidental de alteraciones ultraestructurales en una biopsia renal: Report of one case / Ultrastructural alterations in renal biopsy leading to the diagnosis of HIV infection

HIV infection has different clinical presentations. We report a 21-year-old male with longstanding isolated microscopic hematuria attributed to thin glomerular basement membrane disease, who after 15 years of follow-up presented with significant proteinuria. A kidney biopsy was performed, revealing the presence of tubulo-reticular inclusions in the glomerular endothelial cells. This finding led to suspect an HIV infection, which was verified. Antiretroviral therapy, angiotensin-converting enzyme and angiotensin II receptor blockers were prescribed. At 6 years of diagnosis the patient is asymptomatic and has normal kidney function. Microscopic hematuria and low level proteinuria persists.

Multiple facets of HIV-associated renal disease

HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003). In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up.

Urine alpha1-microglobulin is a better marker for early tubular dysfunction than beta2-microglobulin among tenofovir-exposed human immunodeficiency virus-infected men who have sex with men

Objectives: Men who have sex with men are at risk of tenofovir nephrotoxicity due to its wide use in both treatment and prophylaxis for human immunodeficiency virus infection, but little is known about the urinary biomarkers of early renal dysfunction in this population. This study aims to identify useful biomarkers of early renal dysfunction among human immunodeficiency virus-infected men who have sex with men exposed to tenofovir.Methods: In a cross-sectional study urinary alpha1-microglobulin, beta2-microglobulin, N-acetyl-B-n-glucosaminidase and albumin were measured and expressed as the ratio-to-creatinine in 239 human immunodeficiency virus-infected men who have sex with men who were treatment naïve or receiving antiretroviral therapy with tenofovir-containing or non-tenofovir-containing regimens. Additionally, 56 patients in the non-antiretroviral therapy group started a tenofovir-containing regimen and were assessed after 3 and 6 months on antiretroviral therapy.Results: Both the frequency of alpha1-microglobulin proteinuria (alpha1-microglobulin-creatinine ratio >25.8 mg/g) and the median urinary alpha1-microglobulin-creatinine ratio were higher in the tenofovir disoproxil fumarate group than the other two groups (all p< 0.05). A higher frequency of beta2-microglobulin proteinuria (beta2-microglobulin-creatinine ratio >0.68 mg/g) was also observed in the tenofovir group (28.9%) compared to the non-tenofovir group (13.6%, p= 0.024). There were no significant differences between groups for N-acetyl-β-n-glucosaminidase and albumin. In the longitudinal study, the median urinary alphat-microglobulin-creatinine ratio after 3 and 6 months on tenofovir-containing therapy (16.8 and 17.3 mg/g) was higher than baseline (12.3 mg/g, p= 0.023 and 0.011, respectively), while no statistically important changes were observed in urinary beta2-microglobulin-creatinine ratio or in the other biomarkers after 3 and 6 months on antiretroviral therapy (all p> 0.05).Conclusion: Urinary alphat-microglobulin seems to be a more sensitive and stable indicator of tubular dysfunction than urinary beta2-microglobulin for assessing tenofovir-related nephrotoxicity and can be significantly altered after tenofovir exposure.

Estudo comparativo entre os meios de contraste iodixanol e ioversol na indução de nefropatia em pacientes HIV positivos / Comparative study on contrast induced nephopathy between the contrast medias iodixanol e ioversol in HIV positive patients

Introdução: Em seu acompanhamento, os pacientes HIV positivos, necessitam de diagnóstico por imagem, geralmente tomografias computadorizadas, com a injeção endovenosa do meio de contraste,expondo-os ao risco de desenvolvimento de nefropatia.... Objetivos: Verificar a ocorrência de NIC em pacientes HIV positivos internados no Instituto de Infectologia Emílio Ribas e comparar a ocorrência com o uso dos meios de contrastes: iodixanol e ioversol Pacientes e Métodos: Este estudo foi realizado entre abril de 2010 a marçode 2013,... Resultados:Conforme classificação da KDIGO, seis pacientes (12%)desenvolvem nefropatia induzida pelos meios de contraste, sendo cinco nogrupo que foi injetado iodixanol (iso-osmolar) e um no grupo que foi injetadoioversol (baixa osmolalidade). Portanto, o meio de contraste, ioversol, debaixa osmolaridade apresentou menos NIC que o contraste iso-osmolar,iodixanol.Discussão e Conclusão:Houve elevada ocorrência de NIC em pacientes HIV positivos, porém a maioria das disfunções foram leves (Estadio I e II). Não houve diferença significativa na indução de NIC entre os meios decontraste. Todos os pacientes recuperaram função renal após 7 dias..

Introduction: Imaging is commonly used to diagnose and monitor HIV positive patients. Usually CTscans with intravenous contrast injection are performed, exposing the patients to a higher risk developing nephropathy...Patients and Methods: This study was conducted from April 2010 to March2013,..Objectives: This study aims to determine the incidence of contrast induced nephropathy in HIV positive patients admitted to the Institute of Infectious Diseases Emilio Ribas and the variation using iodixanol and ioversol agents .Results: Following KDIGO classification, six patients develop contrastinduced nephropathy, five in the iodixanol (iso-osmolar) group and one in theioversol (low osmolality) group. Therefore, Low-osmolar contrast mediaioversol was littler associated of CIN than iso-osmolar.Discussion and Conclusion: There was elevated CIN occurrence in HIVpositive patients, yet the majority of dysfunctions were minor (stage I or II).CIN rate was not different between .

Alteraciones urinarias asintomáticas en pacientes con infección por Virus de Inmunodeficiencia Humana y Síndrome de Inmunodeficiencia Humana Adquirida(VIH-SIDA) del Servicio de Enfermedades Infecciosas y Tropicales (SEIT) - Santa Rosa II del Hospital Nacional Dos de Mayo. Julio - Agosto del 2011 / Asymptomatic urinary disorders in patients infected with Human Immunodeficiency Virus and Human Immunodeficiency Syndrome (HIV-AIDS) of the Service of Infectious and Tropical Diseases (SEIT) - Santa Rosa II at the National Hospital Dos de Mayo. July-

El presente estudio se llevo a cabo en el Servicio de Enfermedades Infecciosas y Tropicales (SEIT)-Santa Rosa II del Hospital Nacional Dos de Mayo en el período del 01 Julio-31 de Agosto del 2011 tomando como población de estudio los pacientes con diagnóstico de infección por VIH, que voluntariamente acepten participar del mismo y que al momento de la entrevista no se encuentren padeciendo de alguna otra patología. El objetivo principal del estudio fue identificar la prevalencia de alteraciones urinarias asintomáticas en dicha población y establecer su posible relación con las siguientes variables: edad, sexo, estado civil, forma de contagio, tiempo de enfermedad, categoría de la enfermedad VIH, presencia o no de tratamiento anti-retroviral (TARGA) y antecedente de enfermedad considerada de riesgo para el desarrollo de patología renal. Durante el período de estudio (descrito anteriormente) se logró incluir un total de 105 individuos con infección VIH que voluntariamente desearon participar del mismo, los cuales fueros divididos a su vez en dos grupos, según reciban tratamiento TARGA (75 personas) o se encuentren sin tratamiento antirretroviral (30 pacientes). Se logró identificar un total de 23 casos de alteraciones urinarias asintomáticas (22 por ciento de la población total estudiada) de los cuales el 65 por ciento (15 casos) se registraron en la población que recibe tratamiento TARGA mientras que sólo el 35 por ciento de ellos se registraron en los pacientes sin tratamiento antirretroviral. Para el caso de la población que recibe tratamiento TARGA, la mayoría de casos de alteraciones urinarias asintomáticas se registraron en la categoría 3 de la enfermedad VIH sin que esto represente una relación estadísticamente significativa, hecho que si se estableció al evaluar la variable tiempo de enfermedad no lográndose establecer algún otro tipo de relación estadística válida con las demás variables consideradas en el presente estudio. En el caso de la población...

This study was conducted at the Department of Infectious and Tropical Diseases (SEIT)-Santa Rosa II National Hospital Dos de Mayo in the period from July 1-August 31, 2011 using as a study population of patients diagnosed with HIV infection, who voluntarily agree to participate and at the same time of the interview are not suffering from any other disease. The main objective of the study was to identify the prevalence of asymptomatic urinary abnormalities in this population and to establish their possible relation to the following variables: age, sex, marital status, mode of transmission, duration of disease, HIV disease status, presence or absence antiretroviral treatment (HAAR T) and history of relevant disease risk for developing kidney disease. During the study period (described above) was included as a total of 105 HIV - infected individuals who voluntarily wanted to participate in it, which charters divided into two groups according to receive HAART (75 people) or are not antiretroviral therapy (30 patients). We identified a total of 23 cases of asymptomatic urinary abnormalities (22 per cent of the total study population) of which 65 per cent (15 cases) were recorded in the population receiving HAART while only 35 per cent of them were in treatment-naive patients. In the case of the population receiving HAART treatment, most cases of asymptomatic urinary abnormalities occurred in a Category 3 HIV disease without this representing a statistically significant, a fact that was established to assess whether the time variable disease achieving not establish any other valid statistical relationship with the other variables considered m this study. For treatment-naive population, failed to establish a valid relationship between the presence of asymptomatic urinary abnormalities and the variables studied. About what was the prevalent asymptomatic urinary disturbance in this study found that the microhematuria was asymptomatic urinary disturbance most...

Evolución de un paciente infectado por el VIH-SIDA en hemodiálisis: experiencia en el centro asistencial / Evolution of a patientinfected by VIH-SIDA in hemodialysis: experience in the assistencial center

La afectación renal en el SIDA es un tema poco abordado a pesar de su frecuencia, la misma depende de la acción directa e indirecta del virus, así como de las complicaciones y del tratamiento. La más frecuente de las complicaciones es la Insuficiencia Renal Aguda. La forma más típica de nefropatía asociada al virus de la inmunodeficiencia humana se caracteriza por alto grado de proteinuria con progresión rápida a Insuficiencia Renal Terminal. En el SIDA se presentan diversas formas de glomerulopatías cuya expresión clínica va desde el Síndrome Nefrítico hasta el Síndrome Nefrótico. Se presenta la experiencia de un caso infectado por el VIH-SIDA con 5 años de evolución, en tratamiento hemodialítico donde se mostró una alta morbilidad en el proceder.

Renal involvement in AIDS is an issue not too much spoken In spite of its frequency, this condition depends on direct and indirect virus action, just as the complications and treatment. The most frecuent complication is the acute renal insufficiency. The most typic way of aids-associated nephropathy is characterized by high level of proteinuria with faster progresión to chronic kidney failure. Different forms of glomerulopathies are presented in aids, clinic expression of which goes from nephritic syndrome to nephrotic syndrome. Following an experience case infected by HIV-AIDS with five years progressing in hemodialitic treatment is presented where it showed a high morbidity.

Fatores de risco associados a alterações renais em pacientes infectados por HIV-1 / Risk factors related to renal disorders in HIV-1 infected patients

INTRODUÇÃO: A doença renal é uma das principais comorbidades envolvendo pacientes infectados com o HIV, em razão da melhora da sobrevida proporcionada pela terapêutica antirretroviral. O objetivo deste estudo foi detectar fatores de risco, possivelmente correlacionados com função renal alterada, em pacientes infectados pelo HIV. MÉTODOS: Estudo transversal foi realizado em 254 pacientes infectados pelo HIV, atendidos em ambulatório na Santa Casa de Vitória. Eles foram entrevistados e submetidos a coletas de amostras de sangue para contagem de células CD4, quantificação de carga viral do HIV-1, dosagens de glicose, lipídeos e creatinina. A proteinúria foi avaliada em amostra de primeira urina da manhã. A filtração glomerular foi estimada com as fórmulas de modified diet in renal disease (MDRD) simplificada e Cockcroft-Gault. RESULTADOS: Cento e três (40,6 por cento) pacientes tinham alguma anormalidade no exame de urina, sendo proteinúria o achado mais comum (46; 18,1 por cento pacientes). Vinte e cinco (9,8 por cento) pacientes tinham filtração glomerular estimada inferior a 60ml/min/1.73m² de acordo com MDRD. A análise de regressão logística multivariada mostrou que baixa filtração glomerular foi positivamente correlacionada com raça negra [OR 9,6 (IC95 por cento 1,28-23,80)], hipertensão arterial sistêmica [OR 3,3 (IC95 por cento 1,28-23,81)], idade acima de 51 anos [OR 3,3 (IC95 por cento1,11-9,90)], proteinúria [OR 5,2 {IC95 por cento 1,67-16,25}]; hematúria [OR 3,2 (1,12-9,29)] e negativamente com pacientes em uso de zidovudina [OR 0,2 (0,04-0,78)]. CONCLUSÕES: Os fatores de risco tradicionais para doença renal como raça negra, hipertensão arterial e idade avançada foram correlacionados com menor filtração glomerular estimada em nossos pacientes.

INTRODUCTION: Renal disease has emerged as one of the primary comorbid conditions affecting HIV-infected patients, mainly because antiretroviral therapy has improved survival. This study aimed to detect risk factors possibly associated with altered renal function in HIV-infected patients. METHODS: A cross-sectional study was conducted involving 254 HIV-infected patients attending an outpatient clinic at Santa Casa de Vitoria< They were interviewed and blood samples were collected for CD4 cell counts, HIV-1 viral load, glucose, lipids and creatinine measurements. Urine protein was evaluated in the first voiding urine sample. Glomerular filtration was estimated by simplified modified diet in renal disease (MDRD) and Cockcroft-Gault formulas. RESULTS: One hundred and three (40.6 percent) patients presented some urinary abnormality, and proteinuria was the most common finding (46; 18.1 percent patients). Twenty-five (9.8 percent) patients showed estimated glomerular filtration below 60ml/min/1.73m² by MDRD. Multivariate logistic regression showed that low glomerular filtration was positively correlated with black race [OR 9.6 (IC95 percent 1.28-23.80)], arterial hypertension [OR 3.3 (IC95 percent 1.28-23.81)], age over fifty-one years-old [OR 3.3 (IC95 percent1.11-9.90)], proteinuria [OR 5.2 {IC95 percent 1.67-16.25}]; hematuria [OR 3.2 (1.12-9.29)] and negatively correlated with patients using zidovudine [OR 0.2 (0.04-0.78)]. CONCLUSIONS: Traditional risk factors for renal disease, such as black race, arterial hypertension and advancing age were correlated with low estimated glomerular filtration in the present patient sample.

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

Acute kidney injury in AIDS: frequency, RIFLE classification and outcome

The objective of the present study was to evaluate the characteristics of acute kidney injury (AKI) in AIDS patients and the value of RIFLE classification for predicting outcome. The study was conducted on AIDS patients admitted to an infectious diseases hospital inBrazil. The patients with AKI were classified according to the RIFLE classification: R (risk), I (injury), F (failure), L (loss), and E (end-stage renal disease). Univariate and multivariate analyses were used to evaluate the factors associated with AKI. A total of 532 patients with a mean age of 35 ± 8.5 years were included in this study. AKI was observed in 37 percent of the cases. Patients were classified as "R" (18 percent), "I" (7.7 percent) and "F" (11 percent). Independent risk factors for AKI were thrombocytopenia (OR = 2.9, 95 percentCI = 1.5-5.6, P < 0.001) and elevation of aspartate aminotransferase (AST) (OR = 3.5, 95 percentCI = 1.8-6.6, P < 0.001). General mortality was 25.7 percent and was higher among patients with AKI (40.2 vs17 percent, P < 0.001). AKI was associated with death and mortality increased according to RIFLE classification - "R" (OR 2.4), "I" (OR 3.0) and "F" (OR 5.1), P < 0.001. AKI is a frequent complication in AIDS patients, which is associated with increased mortality. RIFLE classification is an important indicator of poor outcome for AIDS patients.

Compromiso renal en pacientes HIV+ / Renal abnormalities in HIV infected patients

Varias complicaciones nefrológicas pueden ocurrir durante la infección por el virus de la inmunodeficiencia humana (HIV) especialmente en estadios avanzados de la enfermedad o relacionadas con otras infecciones o drogas. Poco conocida es la prevalencia de alteraciones renales subclínicas de pacientes HIV+ surgidas como complicación o relacionadas a la infección y/o tratamiento. Realizamos un corte transversal de pacientes asintomáticos HIV+ referidos en forma consecutiva al consultorio de nefrología para la detección de alteraciones nefrológicas. Se estudiaron 52 pacientes adultos mediante exámenes de sangre y orina, ultrasonido y biopsia renal. Edad media 39.9 ± 10.6 años, 88% varones, tiempo de diagnóstico de la infección: 53.2 ± 41.2 (2-127) meses. El 71% tenían síndrome de inmunodeficiencia adquirida (HIV-sida) y el 77% recibían con antirretrovirales. La carga viral al momento del estudio fue 7043 ± 3322 copias y el recuento de CD4+ 484 ± 39 cel/mm³. El 30.7% presentó alteraciones del sedimento urinario: albuminuria: 16.6%, hematuria microscópica: 11.5%, hipercalciuria: 10.8% y cristaluria 6%. La media del filtrado glomerular fue 102.2 ± 22.9 ml/min (rango: 34-149). El 41% presentó anormalidades que corresponderían a enfermedad renal crónica (estadios 1 a 3). Los pacientes con alteraciones tenían mayor edad, con duración más prolongada de la infección. Las anomalías renales no se asociaron con mayor prevalencia de HIV-sida. Dos pacientes fueron biopsiados, con hallazgos de nefritis túbulo-intersticial crónica con cristales y glomerulonefritis por IgA. No hubo hallazgos de nefropatía por HIV. El amplio espectro y la alta prevalencia de anormalidades nefrológicas subclínicas encontradas sugieren que los pacientes asintomáticos HIV+ deberían realizar evaluaciones nefrológicas de rutina.

Several renal complications may occur during HIV infection, especially in advanced stages related to HIV, to other infectious agents and/or drugs. Little is known about the prevalence of renal diseases that may occur as a complication of or related to HIV infection in asymptomatic patients. This is a single center cross-sectional study of asymptomatic HIV+ patients referred to a nefrology care service at an Argentine hospital to look for the presence of renal abnormalities. Fifty two consecutive patients were studied between April and November 2008. Patients underwent plasma and urine analysis, ultrasound, and kidney biopsy as needed. Mean age was 39.9 ± 10.6 years, 88% were male, time from HIV diagnosis 53.2 ± 41.2 months (2-127); 71% had HIV-disease and 77% were on antiretroviral therapy. Mean plasma HIV-RNA copies number was 7.043 ± 3.322 and CD4+ cell count: 484 ± 39. Pathologic findings in urine analysis were present in 30.7% of patients: albuminuria 16.6%, microscopic hematuria 11.5%, hypercalciuria 10.8% and crystalluria 6%. Mean glomerular filtration rate was 102.2 ± 22.95 ml/min (34-149) and 41% of patients could be classified in stages 1 to 3 of chronic kidney disease. Renal abnormalities prevaled in older patients without relationship with presence of HIV-disease. Two patients were biopsied and the findings included: tubulointerstitial nephritis with presence of crystal deposition in one and IgA nephropathy in the other. No HIV-associated nephropathy was detected. The broad spectrum and the high prevalence of lesions found in this series suggest that asymptomatic HIV-infected patients should routinely undergo renal evaluation.

Chronic renal failure in Jamaican children: an update (2001-2006) / Insuficiencia renal crónica en niños jamaicanos: actualización (2001-2006)

OBJECTIVE: This study evaluated the incidence, epidemiology, aetiology and outcome of chronic renal failure (CRF) in Jamaican children < 12 years old between 2001 and 2006. METHODS: The required data on all children who fulfilled inclusion criteria were obtained from their medical records at the University Hospital of the West Indies, Bustamante Hospital for Children and from practitioners in hospitals serving children islandwide. RESULTS: Eighteen new children (72.2% male) presented with CRF. The cumulative annual incidence was 4.61/million child population under age 12 years or 1.14/million total population. Congenital urological disease (44.5%) was the commonest cause of CRF, followed by glomerulonephritis (33.3%). Half of the cases of glomerulonephritis were secondary to HIV-associated nephropathy. Although all children with posterior urethral valves were diagnosed before age 6 months and promptly treated, renal failure present at birth proved irreversible. The mean age at diagnosis of CRF was 6.72 years. Ten children (55.6%) were already in CRF at first presentation with renal disease. Of these, the five with non-urological disease were already in End Stage Renal Disease (ESRD). Mortality was 44.4%. Five children died in ESRD without the benefit of dialysis. CONCLUSION: The incidence of CRF has increased from the 1985-2000 local study and is mainly due to urological pathology which progresses despite early diagnosis and treatment. Non-urological renal disease is presenting too late for therapeutic intervention. Greater public awareness of symptoms of renal disease is needed. Children's access to dialysis is unpredictable. A paediatric dialysis and transplantation programme is needed.

OBJETIVO: Este estudio evaluó la incidencia, epidemiología, etiología y resultado de la insuficiencia renal crónica (IRC) en niños jamaicanos menores de 12 años entre 2001 y 2006. MÉTODOS: Los datos requeridos sobre los niños que satisfacían los criterios de inclusión, fueron obtenidos a partir de sus historias clínicas en el Hospital Universitario de West Indies y en el Hospital Pediátrico Bustamante, así como a partir de médicos en hospitales que prestan atención a niños en todo el país. RESULTADOS: Dieciocho nuevos niños (72.2% varones) presentaron IRC. La incidencia acumulada anual fue de 4.61 por millón de población infantil menor de 12 años de edad o 1.14 por millón de población total. La enfermedad urológica congénita (44.5%) fue la causa más común de IRC, seguida por la glomerulonefritis (33.3%). La mitad de los casos de glomerulonefritis fueron secundarios a la nefropatía asociada al VIH. Aunque todos los niños con válvulas uretrales posteriores fueron diagnosticados antes de los 6 meses de edad y puestos bajos tratamiento, la insuficiencia renal presente al nacer resultó irreversible. La edad promedio al momento del diagnóstico de la IRC fue 6.72 años. Diez niños (55.6%) se hallaban ya con IRC desde que se les presentara inicialmente la enfermedad renal. De estos, los cinco con enfermedad no urológica se hallaban ya en la fase terminal de la enfermedad renal (ERT). La mortalidad fue de 44.4%. Cinco niños murieron en la ERT sin el beneficio de la diálisis. CONCLUSIÓN: La incidencia de la IRC ha aumentado desde el estudio local de 1985-2000, principalmente debido a patologías urológicas que progresan a pesar del diagnóstico precoz y el tratamiento. La enfermedad renal no urológica se está presentando demasiado tarde para una intervención terapéutica. Se requiere mayor conciencia pública de los síntomas de la enfermedad renal. El acceso de los niños a la diálisis es imprescindible. Hace falta una diálisis infantil y un programa de transplante.

Compromiso renal e infección por VIH/SIDA en pacientes atendidos en un hospital pediátrico chileno / Renal compromise in HIV/AIDS in patients attended at a Chilean children hospital

The aim of this study was to determine the frequency of renal abnormalities in HIV positive children hospitalized in one pediatric hospital in Chile. Method: a cross sectional study was performed during April 2007. Results: A total of 18 patients were evaluated, ten male and eight female ranging in age from 4 to 19 years. The average age at the time of HIV diagnosis and nephrologic evaluations were 2,69 and 10,7 years respectively. All patients had acquired HIV infection by vertical transmission. Uriñe samples of two children had microalbuminuria; two had monosymptomatic hematuria, and ten had ¿squamous? cells. Hypercalciuria was detected in one patient, renal lithiasis in another and two patients had abnormal renal ultrasonography. All 19 patients had normal blood pressures. Overall 7 patients (39 percent) had a renal abnormality. Conclusions: The relatively high incidence of renal abnormalities in our series support the need for a nation-wide screening program to assess the incidence of renal impairment in pediatric HIV positive patients.

El objetivo de este estudio fue evaluar la función renal de pacientes infectados con virus de inmuno-deficiencia humana (VIH) que se controlan en un hospital pediátrico chileno. Método: estudio de corte transversal. Resultados: Se evaluaron 18 pacientes, 10 varones y 8 mujeres; edad: entre 4 y 19 años, la edad promedio al diagnóstico de la infección por VIH y al momento de la evaluación fue 2,69 y 10,7 años, respectivamente. Todos nuestros pacientes adquirieron la infección vía vertical. Dos presentaron microalbuminuria y dos hematuria monosintomática. En 10 (55 por ciento) se encontraron células descamativas, en uno hiper-calciuria y en otro litiasis renal. Todos tuvieron presión arterial normal. La ecotomograña renal fue anormal en dos. Se han descrito varias anormalidades renales en pacientes con infección por VIH; en nuestro estudio, 7 pacientes (39 por ciento) tuvieron alteraciones en los exámenes de laboratorio. Conclusión: La alta frecuencia de afectación renal encontrada en pacientes pediátricos con infección por VIH hace necesario plantear un tamizaje nacional para determinar la incidencia de nefropatía asociada en nuestros pacientes.

A Case of Lupus-like Glomerulonephritis in an HIV-infected Patient

Many types of glomerulonephritis are associated with human immunodeficiency virus (HIV) infection. We present a case of a 50-year-old Korean man with an HIV infection, who developed nephrotic syndrome and progressive renal failure. Renal biopsy showed lupus-like glomerulonephritis without clinical or serologic evidence of systemic lupus erythematosus. After the administration of antiretroviral agents and steroids, there was reduction in the amount of proteinuria and improvement in renal function.

A Case of Lupus-like Glomerulonephritis in an HIV-infected Patient

Many types of glomerulonephritis are associated with human immunodeficiency virus (HIV) infection. We present a case of a 50-year-old Korean man with an HIV infection, who developed nephrotic syndrome and progressive renal failure. Renal biopsy showed lupus-like glomerulonephritis without clinical or serologic evidence of systemic lupus erythematosus. After the administration of antiretroviral agents and steroids, there was reduction in the amount of proteinuria and improvement in renal function.

A Case of Collapsing Glomerulopathy in Renal Allograft / 대한신장학회지

Collapsing glomeruopathy (CG) is a clinicopathologic variant of focal segmental glomerulosclerosis (FSGS) and is characterized by severe nephrotic syndrome, rapid progression to end stage renal disease, and features of visceral epithelial cell injury and glomerular capillary collapse. Such characteristics closely resemble those of HIV associated nephropathy. The frequency of CG has increased over the last decade. The cause of CG is unknown. The lesion has rarely been described in renal allografts with features similar to CG in native kidney. We recently identified allograft CG in a 44 year-old male patient who underwent biopsy for graft dysfunction after autodermic graft. The biopsy showed typical characteristics of CG. Serologically, the patient had no evidence of HIV infection. The renal function was not restored to normal in spite of methylprednisolone pulsing therapy. Now he is on conservative treatment with a functioning graft.