ABSTRACT
INTRODUCTION: HIV-associated nephropathy (HIVAN) has been strongly linked to African ancestry. However, studies have demonstrated wide variability in the prevalence of HIVAN in different sub-Saharan African populations. Accurate assessment of the disease burden is important because antiretroviral therapy (ART) is increasingly available and may prevent progression to end-stage renal disease. METHODS: We prospectively screened ART-naïve, afebrile, nonhypertensive, and nondiabetic adults attending a large HIV care program in Western Kenya for the presence of albuminuria (dipstick albumin ≥ trace or urine albumin to creatinine ratio [UACR] ≥ 30 mg/g). Those with albuminuria confirmed on 2 occasions, subject to consent, underwent kidney biopsy. RESULTS: Among 523 subjects screened, 85 (16.3%) had albuminuria on the initial screen, and persistent albuminuria was confirmed in 32 of the 53 (60%) who returned for confirmatory testing. A total of 27 subjects with persistent albuminuria underwent biopsy. The median age was 34 years (interquartile range [IQR] 30-42 years), and 63% were female. The median CD4 count was 369 cells/µl (IQR 89-492 cells/µl). Renal function was normal in 92%. Median UACR was 257.5 mg/g (IQR 93.5-543 mg/g), and 92% had UACR < 1 g/g. No subject had histologic features consistent with HIVAN; 41% had acute interstitial nephritis (AIN); 33% had nonspecific findings, and 2 patients had arteriosclerosis. Focal segmental glomerulosclerosis, acute postinfectious glomerulonephritis, chronic interstitial nephritis, pyelitis, and papillary sickling were seen in 1 patient each. DISCUSSION: Among ART-naïve adults with persistent albuminuria at a referral center in Western Kenya, we observed no cases of HIVAN. AIN was the most common cause of persistent proteinuria in this setting.
ABSTRACT
OBJECTIVES: To describe the prevalence, treatment and control of hypertension among type 2 diabetic patients at Moi Teaching and Referral Hospital (MTRH) and to determine predictors of blood pressure (BP) control. DESIGN: A cross-sectional study. SETTING: Diabetic Outpatient Clinic at MTRH, Eldoret, Kenya. SUBJECTS: Type 2 diabetic patients. INTERVENTIONS: The study collected socio-demographic (age, gender, employment status, monthly income, education level, marital status, cigarette smoking and alcohol use), clinical (BP, weight, height and waist circumference) and laboratory (serum fasting lipids and creatinine, urine proteins) data from type 2 diabetic patients. Good BP control was defined as < 130mmHg systolic and < 80mmHg diastolic. Association between BP control and social demographic, clinical and laboratory variables of study subjects was determined using the chi-square, T-test, fisher's exact test and logistic regression. RESULTS: We studied 218 type 2 diabetics: mean age 57 ± 9 years; 122 (56%) were females. Average duration of diabetes was 11 ± 7 years. Prevalence of hypertension was 185/218 (85%) out of who 40 (21%) had good BP control. Average duration of hypertension was 7 ± 5 years. Of the 185 hypertensive diabetics: 92 (50%) had total cholesterol at goal; 102 (55%) had low density lipoproteins (LDL) at goal; 74 (40%) had triglycerides at goal; 65 (35%) had high density lipoprotein (HDL) at goal and 85(45%) had Proteinuria. All hypertensive patients had > 1 anti-hypertensive agent prescribed. Good BP control was associated with compliance to anti-hypertensives (OR = 0.342, 95% CI: 0.105- 1.432) and having HDL at goal (OR = 0.247, 95% CI: 0.126-0.845). Poor BP control was associated with a higher number of prescribed anti-hypertensive agents (OR = 1.377, 95% CI: 1.112- 2.302). CONCLUSION: Prevalence of hypertension among type 2 diabetic patients in MTRH is high and BP control is poor despite anti-hypertensive treatment. Significant predictors of BP control include compliance to anti-hypertensives and control of HDL.
