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Szymańska B, Marchewka Z, Knysz B, Piwowar A. Selected biochemical parameters in the urine of HIV-infected patients in monitoring of kidney function. Arch Med Sci 2021; 19:1289-1302. [PMID: 37732028 PMCID: PMC10507753 DOI: 10.5114/aoms/114635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/24/2019] [Indexed: 09/22/2023] Open
Abstract
Introduction For years, there has been an increase in the number of cases of chronic kidney disease (CKD) in human immunodeficiency virus (HIV)-infected patients. Renal dysfunction can be caused by direct effects of HIV on the kidneys but also of applied combined antiretroviral therapy (cART). Therefore there is a need of renal function diagnosis to monitor the development of kidney disturbances. In this study the urinary levels of selected low molecular weight proteins (LMWP) in HIV-infected patients were measured and related to current CD4+ T lymphocyte (LT CD4+) count, the glomerular filtration rate (eGFR) value and the applied cART. Material and methods The levels of 5 LMWP - kidney injury molecule-1 (KIM-1), neutrophil gelatinase associated lipocalin (NGAL), glutathione S-transferase α (GST-α) and π (GST-π) isoenzymes and neopterin (NPT) - in urine were measured in HIV-infected patients and healthy controls by enzyme-linked immunosorbent assay. Results Taking into account the current LT CD4+ count, KIM-1, NGAL and GST-α showed statistically significant differences between groups with the CD4+ count < 500 and ≥ 500 cells (< 0.001). Depending on the eGFR, apart from KIM-1 and NGAL, NPT showed statistically significant differences in the investigated groups with normal and lower eGFR values (< 0.001). In terms of applied cART, the best parameters in the assessment of kidney damage were NGAL, GST-π and NPT (< 0.001). Conclusions This research shows that the analyzed LMWP parameters are useful in the assessment of kidney damage in HIV patients during cART, especially NPT, NGAL and GST-π. However, future studies should be conducted on larger groups.
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Affiliation(s)
- Beata Szymańska
- Department of Toxicology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Zofia Marchewka
- Department of Toxicology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Brygida Knysz
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiencies, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Piwowar
- Department of Toxicology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
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Hikasa S, Shimabukuro S, Hideta K, Nishida S, Higasa S, Sawada A, Tokugawa T, Tanaka K, Yanai M, Kimura T. Decreased levels of urinary liver-type fatty acid-binding protein after switching from tenofovir disoproxil fumarate to tenofovir alafenamide: a prospective observational study. Int J STD AIDS 2019; 30:1311-1317. [PMID: 31726929 DOI: 10.1177/0956462419873772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A single-center, prospective, observational study was conducted between September 2016 and August 2018 in 33 HIV-positive Japanese patients who switched antiretroviral drug regimens from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF). The study assessed changes in urinary levels of liver-type fatty acid-binding protein (L-FABP) after switching from TDF to TAF and determined the potential of renal parameters to predict improvement in estimated glomerular filtration rate (eGFR). Median urinary levels of L-FABP were found to be 2.0, 1.4, and 1.3 µg/g creatinine before, at 6 months, and at 12 months after switching to TAF, respectively. The urinary levels of L-FABP, β2 microglobulin (β2MG), and eGFR and the protein-to-creatinine ratio (PCR) were not significantly related to the annual change in eGFR after switching from TDF to TAF. Our results demonstrate a significant decrease in urinary levels of L-FABP after switching from TDF to TAF. However, neither urinary L-FABP, β2MG, PCR, nor eGFR predicted the annual change in eGFR after the change in medication.
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Affiliation(s)
- Shinichi Hikasa
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Shota Shimabukuro
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Kyoko Hideta
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Sakurako Nishida
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Satoshi Higasa
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Akihiro Sawada
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tazuko Tokugawa
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kuniyoshi Tanaka
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Mina Yanai
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
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Abstract
Blood urea nitrogen and serum creatinine are imperfect markers of kidney function because they are influenced by many renal and nonrenal factors independent of kidney function. A biomarker that is released directly into the blood or urine by the kidney in response to injury may be a better early marker of drug-induced kidney toxicity than blood urea nitrogen and serum creatinine. Urine albumin and urine protein, as well as urinary markers kidney injury molecule-1 (KIM-1), β2-microglobulin (B2M), cystatin C, clusterin, and trefoil factor-3 (TFF-3) have been accepted by the Food and Drug Administration and European Medicines Agency as highly sensitive and specific urinary biomarkers to monitor drug-induced kidney injury in preclinical studies and on a case-by-case basis in clinical trials. Other biomarkers of drug-induced kidney toxicity that have been detected in the urine of rodents or patients include IL-18, neutrophil gelatinase-associated lipocalin, netrin-1, liver-type fatty acid-binding protein (L-FABP), urinary exosomes, and TIMP2 (insulin-like growth factor-binding protein 7)/IGFBP7 (insulin-like growth factor-binding protein 7), also known as NephroCheck, the first Food and Drug Administration-approved biomarker testing platform to detect acute kidney injury in patients. In the future, a combined use of functional and damage markers may advance the field of biomarkers of drug-induced kidney toxicity. Earlier detection of drug-induced kidney toxicity with a kidney-specific biomarker may result in the avoidance of nephrotoxic agents in clinical studies and may allow for earlier intervention to repair damaged kidneys.
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Affiliation(s)
- Benjamin R Griffin
- Division of Renal Diseases and Hypertension, University of Colorado at Denver, Aurora, Colorado
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Hikasa S, Shimabukuro S, Hideta K, Higasa S, Sawada A, Tokugawa T, Tanaka K, Yanai M, Kimura T. Urinary liver-type fatty acid-binding protein levels as a potential risk factor for renal dysfunction in male HIV-infected Japanese patients receiving antiretroviral therapy: a pilot study. Int J STD AIDS 2018; 29:1424-1431. [PMID: 30114996 DOI: 10.1177/0956462418788432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Renal dysfunction is recognized with increasing frequency among the non-infectious co-morbidities associated with human immunodeficiency virus (HIV) infection. Recently, urinary liver-type fatty acid-binding protein (L-FABP) was suggested to be a predictor of the progression of renal dysfunction in patients without HIV. However, little is known regarding the utility of urinary L-FABP as a predictor of renal dysfunction in patients with HIV. A retrospective, observational, single-centre study was conducted between July 2014 and December 2016. The primary outcome was renal dysfunction defined as decrease in estimated glomerular filtration rate to less than 60 ml/min/1.73 m2. To estimate the effect of urinary L-FABP, proteinuria category, and urinary β2 microglobulin (β2MG) on the time to the first event, a log-rank test was performed. Accuracy, determined by area under the curve and calculated from receiver operating characteristic curves, was also assessed. Thirty Japanese outpatients with HIV receiving antiretroviral therapy (ART) were enrolled. The primary outcome occurred in five patients during the follow-up period. Urinary L-FABP level and proteinuria category were significantly associated with renal dysfunction (p = 0.045 and p = 0.037, respectively). In contrast, urinary β2MG level was not significantly associated with renal dysfunction (p = 0.141). Urinary L-FABP was the most accurate predictor of renal dysfunction among the three urinary parameters. In conclusion, urinary L-FABP levels in HIV patients receiving ART were more accurate for predicting renal dysfunction than proteinuria and urinary β2MG. In addition, urinary L-FABP helped to discriminate those patients with a higher risk for renal dysfunction.
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Affiliation(s)
- Shinichi Hikasa
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Shota Shimabukuro
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Kyoko Hideta
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Satoshi Higasa
- 2 Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Akihiro Sawada
- 2 Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tazuko Tokugawa
- 2 Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kuniyoshi Tanaka
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Mina Yanai
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
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Kane-Gill SL, Smithburger PL, Kashani K, Kellum JA, Frazee E. Clinical Relevance and Predictive Value of Damage Biomarkers of Drug-Induced Kidney Injury. Drug Saf 2018; 40:1049-1074. [PMID: 28674842 DOI: 10.1007/s40264-017-0565-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nephrotoxin exposure accounts for up to one-fourth of acute kidney injury episodes in hospitalized patients, and the associated consequences are as severe as acute kidney injury due to other etiologies. As the use of nephrotoxic agents represents one of the few modifiable risk factors for acute kidney injury, clinicians must be able to identify patients at high risk for drug-induced kidney injury rapidly. Recently, significant advancements have been made in the field of biomarker utilization for the prediction and detection of acute kidney injury. Such biomarkers may have a role both for detection of drug-induced kidney disease and implementation of preventative and therapeutic strategies designed to mitigate injury. In this article, basic principles of renal biomarker use in practice are summarized, and the existing evidence for six markers specifically used to detect drug-induced kidney injury are outlined, including liver-type fatty acid binding protein, neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinase-2 times insulin-like growth factor-binding protein 7 ([TIMP-2]·[IGFBP7]), kidney injury molecule-1 and N-acetyl-β-D-glucosaminidase. The results of the literature search for these six kidney damage biomarkers identified 29 unique articles with none detected for liver-type fatty acid binding protein and [TIMP-2]·[IGFBP7]. For three biomarkers, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin and N-acetyl-β-D-glucosaminidase, the majority of the studies suggest utility in clinical practice. While many questions need to be answered to clearly articulate the use of biomarkers to predict drug-induced kidney disease, current data are promising.
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Affiliation(s)
- Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, 638 Salk Hall, 3501, Terrace St., Pittsburgh, PA, 15261, USA. .,The Center for Critical Care Nephology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Pamela L Smithburger
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, 638 Salk Hall, 3501, Terrace St., Pittsburgh, PA, 15261, USA.,University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - John A Kellum
- The Center for Critical Care Nephology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erin Frazee
- Department of Pharmacy and Medicine, Mayo Clinic, Rochester, MN, USA
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Sato E, Kamijo-Ikemori A, Oikawa T, Okuda A, Sugaya T, Kimura K, Nakamura T, Shibagaki Y. Urinary excretion of liver-type fatty acid-binding protein reflects the severity of sepsis. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0107-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Weber EJ, Himmelfarb J, Kelly EJ. Concise Review: Current and Emerging Biomarkers of Nephrotoxicity. CURRENT OPINION IN TOXICOLOGY 2017; 4:16-21. [PMID: 29057384 PMCID: PMC5647884 DOI: 10.1016/j.cotox.2017.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The kidney is a primary organ for filtration of the blood and elimination of drugs and xenobiotics. These active reabsorptive and secretory processes can result in acute kidney injury as a result of these concentrative properties. Classic measures of acute kidney injury are hampered by their ability to accurately assess function before irreversible damage has occurred. This review will discuss efforts to refine the clinical utility of standard biomarkers as well as the development of novel biomarkers of nephrotoxicity.
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Affiliation(s)
- Elijah J Weber
- Department of Pharmaceutics, University of Washington, Seattle, WA, 98195
| | | | - Edward J Kelly
- Department of Pharmaceutics, University of Washington, Seattle, WA, 98195
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Hikasa S, Yasuda M, Hideta K, Kawakami M, Higasa S, Sawada A, Tokugawa T, Kimura T. The association between urinary liver-type fatty acid-binding protein and chronic kidney disease classification in HIV-infected Japanese patients. Clin Exp Nephrol 2016; 21:971-977. [PMID: 27761670 DOI: 10.1007/s10157-016-1347-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 10/12/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Renal dysfunction is recognized with increasing frequency among the noninfectious comorbidities associated with human immunodeficiency virus (HIV) infection. Urinary liver-type fatty acid-binding protein (L-FABP) has been shown to be a new biomarker to screen for not only tubulointerstitial damage but also kidney dysfunction. METHODS We performed a cross-sectional study to determine the association between the urinary L-FABP and chronic kidney disease (CKD) among 77 HIV-infected Japanese patients by backward-stepwise multivariable logistic regression. RESULTS The prevalence of individuals in the low risk was 80 %. Urinary L-FABP level was not associated with antiretroviral therapy and tenofovir disoproxil fumarate. On the other hand, urinary L-FABP level was independently associated with the CKD classification. CONCLUSION Urinary L-FABP may be used as an adjunct to diagnose the CKD stage.
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Affiliation(s)
- Shinichi Hikasa
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Megumi Yasuda
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan
| | - Kyoko Hideta
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Mai Kawakami
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Satoshi Higasa
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Akihiro Sawada
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tazuko Tokugawa
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Urinary Markers of Tubular Injury in HIV-Infected Patients. Biochem Res Int 2016; 2016:1501785. [PMID: 27493802 PMCID: PMC4967446 DOI: 10.1155/2016/1501785] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022] Open
Abstract
Renal disease is a common complication of HIV-infected patients, associated with increased risk of cardiovascular events, progression to AIDS, AIDS-defining illness, and mortality. Early and accurate identification of renal disease is therefore crucial to improve patient outcomes. The use of serum creatinine, along with proteinuria, to detect renal involvement is essentially to screen for markers of glomerular disease and may not be effective in detecting earlier stages of renal injury. Therefore, more sensitive and specific markers are needed in order to early identify HIV-infected patients at risk of renal disease. This review article summarizes some new and important urinary markers of tubular injury in HIV-infected patients and their clinical usefulness in the renal safety follow-up of TDF-treated patients.
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Jufeng W, Lijun XU, Ying H, Yirui X, Jia S, Junwei SU, Biao Z. [Impact of long-term highly active antiretroviral therapy on bone metabolism in AIDS patients]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2016; 45:228-35. [PMID: 27651185 PMCID: PMC10396988 DOI: 10.3785/j.issn.1008-9292.2016.05.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/03/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the influence of long-term highly active antiretroviral therapy (HAART) on bone metabolism in patients with acquired immune deficiency syndrome (AIDS). METHODS A total of 82 AIDS patients who received HAART in the First Affiliated Hospital of Zhejiang University Medical School during January 2012 and May 2016 were enrolled in the study. Patients were divided into TDF group (n=41) and AZT group (n=41), and glomerular filtration rate (GFR), serum calcium, serum phosphate and serum ALP levels in 6, 12, 18, 24 and 30-month during the treatment were analyzed in both groups. RESULTS Both TDF-based and AZT-based therapies significantly improved CD4(+) T-cell levels of the patients, and no significant difference was observed between the groups. Compared with the baseline, GFR [(120.71±62.85) vs(110.08±39.18) mL/min] and serum phosphate [(1.25±0.19) vs(1.22±0.21) mmol/L] levels rose after 6-month treatment in TDF group, but the difference was not statistically significant (P>0.05); Serum ALP [99.0(79.5-124.0) U/L vs 80.0(60.5-96.0) U/L] and serum calcium [(2.32±0.12) vs(2.25±0.17) mmol/L] levels rose significantly (P<0.05). As treatment continued, the levels of GFR, serum calcium and serum phosphate declined, while the serum ALP number was still increasing. After 30 months of HAART, the level of serum calcium [(2.16±0.15) vs(2.25±0.17) mmol/L], serum phosphate [(1.06±0.17) vs(1.22±0.21) mmol/L], GFR [(98.13±30.43) vs (110.08±39.18) mL/min] declined significantly (P<0.05) in TDF group, while serum ALP [110.0(98.5-120.5) U/L vs 80.0(60.5-96.0) U/L, P<0.05] increased. In AZT group, serum calcium and serum ALP levels rose and GFR level was declined (P<0.05), while serum phosphate level was not significantly changed during the treatment (P>0.05). Compared with AZT group, there were greater changes on the levels of GFR, serum calcium, serum phosphate and serum ALP in TDF group. CONCLUSION HAART is effective for patients with AIDS, and TDF-based therapy may have significant impact on bone metabolism of the patients, which needs close monitoring and timely intervention or adjustment if necessary.
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Affiliation(s)
- Wang Jufeng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - X U Lijun
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Huang Ying
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xie Yirui
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Sun Jia
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - S U Junwei
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Zhu Biao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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Okazaki M, Oikawa T, Sugaya T. [The biomarker for CKD: urinary L-FABP - from molecular function to clinical significance]. Nihon Yakurigaku Zasshi 2015; 146:27-32. [PMID: 26165339 DOI: 10.1254/fpj.146.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
With the recent massive scale-up of access to antiretroviral therapy (ART) in resource-limited countries, HIV has become a chronic disease with new challenges. There is mounting evidence of an increased burden of renal and genitourinary diseases among HIV-infected persons caused by direct HIV viral effects and/or indirectly through the development of opportunistic infections, ART medication-related toxicities, and other noncommunicable diseases (NCDs). We review the epidemiology of HIV-associated renal and urogenital diseases, including interactions with kidney-related NCDs such as hypertension, diabetes mellitus, and cardiovascular disease. We also examine the current evidence regarding the impact of HIV infection on the development of urogenital diseases. Highly advisable in sub-Saharan Africa are the establishment of renal disease registries, reviews of existing clinical practice including cost-effectiveness studies, and the adoption and use of HIV-related NCD management, with training for different cadres of health providers. Epidemiological research priorities include prospective studies to evaluate the true prevalence and spectrum of HIV-related renal disease and their progression. Simple diagnostics tools should be evaluated, including urinary dipsticks and point-of-care urea and creatinine tests to screen for kidney injury in primary care settings. Study of urological manifestations of HIV can help determine the extent of disease and outcomes. As patients live longer on ART, the burden of renal and genitourological complications of HIV and of ART can be expected to increase with a commensurate urgency in both discovery and evidence-based improvements in clinical management.
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