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Diana NE, Naicker S. The changing landscape of HIV-associated kidney disease. Nat Rev Nephrol 2024; 20:330-346. [PMID: 38273026 DOI: 10.1038/s41581-023-00801-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/27/2024]
Abstract
The HIV epidemic has devastated millions of people globally, with approximately 40 million deaths since its start. The availability of antiretroviral therapy (ART) has transformed the prognosis of millions of individuals infected with HIV such that a diagnosis of HIV infection no longer automatically confers death. However, morbidity and mortality remain substantial among people living with HIV. HIV can directly infect the kidney to cause HIV-associated nephropathy (HIVAN) - a disease characterized by podocyte and tubular damage and associated with an increased risk of kidney failure. The reports of HIVAN occurring primarily in those of African ancestry led to the discovery of its association with APOL1 risk alleles. The advent of ART has led to a substantial decrease in the prevalence of HIVAN; however, reports have emerged of an increase in the prevalence of other kidney pathology, such as focal segmental glomerulosclerosis and pathological conditions associated with co-morbidities of ageing, such as hypertension and diabetes mellitus. Early initiation of ART also results in a longer cumulative exposure to medications, increasing the likelihood of nephrotoxicity. A substantial body of literature supports the use of kidney transplantation in people living with HIV, demonstrating significant survival benefits compared with that of people undergoing chronic dialysis, and similar long-term allograft and patient survival compared with that of HIV-negative kidney transplant recipients.
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Affiliation(s)
- Nina E Diana
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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2
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Morello M, Amoroso D, Losacco F, Viscovo M, Pieri M, Bernardini S, Adorno G. Urine Parameters in Patients with COVID-19 Infection. Life (Basel) 2023; 13:1640. [PMID: 37629497 PMCID: PMC10455209 DOI: 10.3390/life13081640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
A urine test permits the measure of several urinary markers. This is a non-invasive method for early monitoring of potential kidney damage. In COVID-19 patients, alterations of urinary markers were observed. This review aims to evaluate the utility of urinalysis in predicting the severity of COVID-19. A total of 68 articles obtained from PubMed studies reported that (i) the severity of disease was related to haematuria and proteinuria and that (ii) typical alterations of the urinary sediment were noticed in COVID-19-associated AKI patients. This review emphasizes that urinalysis and microscopic examination support clinicians in diagnosing and predicting COVID-19 severity.
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Affiliation(s)
- Maria Morello
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
- Department of Experimental Medicine, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Dominga Amoroso
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
| | - Felicia Losacco
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
| | - Marco Viscovo
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
| | - Massimo Pieri
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
- Department of Experimental Medicine, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Sergio Bernardini
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
- Department of Experimental Medicine, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Gaspare Adorno
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
- Department of Biomedicine and Prevention, University of Rome, 00133 Rome, Italy
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Mweemba A, Kelly P, Heimburger DC, Mutale W, Nzala S, Wester WC, Banda J, Mulenga L, Siwingwa M, Todd J. Effect of anti-retroviral regimen on proximal tubular function in Zambian adolescents and young adults living with HIV: A cross sectional study. Gates Open Res 2023. [DOI: 10.12688/gatesopenres.14458.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Background: Tenofovir regimens remain the preferred formulations in the HIV guidelines for adolescents and young adults in Zambia and globally. However, some adolescents and young adults are maintained on abacavir by clinicians because of anxiety about possible proximal tubular dysfunction from tenofovir. We assessed the effect of two regimens on proximal tubular function in adolescents and young adults living with HIV. Methods: This was a cross-sectional study involving 180 participants with HIV receiving either tenofovir or abacavir for ≥12 months at the largest tertiary teaching hospital. Two first-morning urine and blood specimens were collected and analyzed for proximal tubular markers, glomerular function, electrolytes, and routine monitoring tests. Proximal tubular function was determined by measuring the fractional excretion of phosphate (FePO4). Proximal tubular dysfunction was defined by FePO4 ≥20% regardless of serum phosphate and FePO4 ≥10-20% when serum phosphate was below 0.81mmol/L. Results: The prevalence of proximal tubular dysfunction was 6% and was higher in the tenofovir group than the abacavir (10% vs. 2%, p<0.058). However, after adjusting for potential confounders, tenofovir was not associated with worse proximal tubular function. Age, urine b2-microglobulin: creatinine ratio, C-reactive protein, and urine protein: creatinine ratio was all associated with worsening proximal tubular dysfunction. Reduced estimated glomelurar filtration rate (eGFR) was found in four (2.2%) participants; three of which were on tenofovir. Conclusions: Proximal tubular dysfunction defined by FePO4 was more prevalent in the tenofovir group than the abacavir group, but not after adjusting for age. Our findings should be interpreted with caution as age differences between the two groups confounded the results.
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4
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Liegeon G, Ngo-Giang-Huong N, Salvadori N, Bunpo P, Cressey R, Achalapong J, Kanjanavikai P, Na Ayudhaya OP, Prommas S, Siriwachirachai T, Sabsanong P, Mary JY, Jourdain G. Proximal tubular dysfunction in pregnant women receiving tenofovir disoproxil fumarate to prevent mother-to-child transmission of hepatitis B virus. J Antimicrob Chemother 2022; 77:1111-1118. [PMID: 35045168 DOI: 10.1093/jac/dkab490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Data evaluating the risk of proximal tubular dysfunction in women receiving tenofovir disoproxil fumarate for the prevention of mother-to-child transmission (PMTCT) of HBV are scarce. OBJECTIVES To assess the risk of proximal tubulopathy in pregnant women receiving tenofovir disoproxil fumarate for PMTCT of HBV. PATIENTS AND METHODS We used urine samples collected from HBV monoinfected pregnant women who participated in a Phase III, multicentre, randomized, double-blind, placebo-controlled clinical trial assessing a tenofovir disoproxil fumarate short course from 28 weeks gestational age (28-wk-GA) to 2 months post-partum (2-months-PP) for PMTCT of HBV in Thailand. Markers of tubular dysfunction, including retinol binding protein, kidney injury molecule-1, α1-microglobuin and β2-microglobulin, were assayed at 28- and 32-wk-GA and 2-months-PP visits. Proximal tubulopathy was defined as the presence of ≥2 of the following: tubular proteinuria, euglycaemic glycosuria and increased urinary phosphate. RESULTS A total of 291 women participated in the study. No kidney-related adverse events were severe, and none led to tenofovir disoproxil fumarate discontinuation. At 2-months-PP, 3 of the 120 (3%) evaluated women in the tenofovir disoproxil fumarate group experienced proximal tubulopathy versus 3 of 125 (2%) in the placebo group (P = 1.00). None of the six women met the criteria for proximal tubulopathy at 12-months-PP but proteinuria persisted in three of them. No growth abnormalities were found at 1 year of age in infants born to mothers with proximal tubulopathy at 2-months-PP. CONCLUSIONS In these HBV-infected pregnant and breastfeeding women, tenofovir disoproxil fumarate administered from 28-wk-GA to 2-months-PP was not associated with a higher risk of proximal tubulopathy.
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Affiliation(s)
- Geoffroy Liegeon
- Department of Infectious Diseases, Hôpital Saint-Louis et Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.,MIVEGEC, Université Montpellier, CNRS, IRD, Montpellier, France
| | - Nicole Ngo-Giang-Huong
- MIVEGEC, Université Montpellier, CNRS, IRD, Montpellier, France.,Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Nicolas Salvadori
- MIVEGEC, Université Montpellier, CNRS, IRD, Montpellier, France.,Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Piyawan Bunpo
- Division of Clinical Chemistry, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Ratchada Cressey
- Division of Clinical Chemistry, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | | | | | | | - Sinart Prommas
- Department of Obstetrics, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | | | - Prapan Sabsanong
- Department of Obstetrics, Samutsakhon Hospital, Samutsakhon, Thailand
| | - Jean Yves Mary
- INSERM U1153, Team ECSTRA, Université Paris Diderot - Paris 7, Hôpital Saint-Louis, Paris, France
| | - Gonzague Jourdain
- MIVEGEC, Université Montpellier, CNRS, IRD, Montpellier, France.,Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Abubakar B, Aliu-Isah O, Musa S, Abdulsalam K, Yahaya I. Microalbuminuria and its associated risk factors among human immunodeficiency virus-infected patients attending a tertiary care facility in Kano, Northwest Nigeria. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_86_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Le XQ, Liu DP, Chen J, Gong ZY, Xun JN, Wang JR, Sun JJ, Steinhart C, Liu L, Shen YZ, Qi TK, Wang ZY, Zhang X, Tang Y, Song W, Lu HZ, Zhang RF. Urinary biomarkers of early renal injury in antiretroviral-naïve HIV-positive persons in Shanghai, China: comparison with the general population. HIV Med 2021; 22:750-758. [PMID: 34114323 PMCID: PMC8453740 DOI: 10.1111/hiv.13123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/17/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
Objectives People living with HIV (PLWH) have a high risk of kidney injury. Measurement of serum creatinine, along with proteinuria, is not sensitive to detect early kidney injury. Here, we investigated novel urinary biomarkers of early renal injury in PLWH. Methods We performed a cross‐sectional study of 166 antiretroviral‐naïve PLWH and 99 HIV‐negative persons who all had an estimated glomerular filtration rate > 90 mL/min/1.73 m2. We compared the levels of seven urinary biomarkers between the two groups using the propensity score matching (PSM) approach and explored the risk factors associated with elevated urinary biomarkers in PLWH. Results Eighty‐three pairs were successfully matched based on PSM. Compared with the HIV‐negative group, the HIV‐positive group had higher ratios of N‐acetyl‐β‐D‐glucosaminidase (NAG) to urine creatinine (UCr), alpha1‐microglobulin (α1‐M) to UCr, kidney injury marker‐1 (KIM‐1) to UCr, neutrophil gelatinase‐associated lipocalin to UCr, and epidermal growth factor to UCr, whereas the Tamm–Horsfall protein to UCr ratio and the abnormal albumin to UCr ratio were not significantly different. Positive correlations were observed between HIV RNA level and NAG: UCr (rs = 0.32; P < 0.001) and α1‐M:UCr (rs = 0.24; P = 0.002) ratios, and negative correlations were observed between CD4 cell count and NAG:UCr (rs = –0.34; P < 0.001), KIM‐1:UCr (rs = –0.16; P = 0.042) and α1‐M:UCr (rs = –0.36; P < 0.001) ratios. In multivariate linear regression analyses, older age, lower total cholesterol and higher HIV RNA were independently associated with higher NAG:UCr; older age, lower total cholesterol and lower CD4 cell count were independently associated with higher α1‐M:UCr. Conclusions In comparioson with HIV‐negative participants, PLWH were more likely to have tubular injury. Early antiretroviral treatment might mitigate the development of kidney injury.
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Affiliation(s)
- X Q Le
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - D P Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - J Chen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Z Y Gong
- School of Clinical Medicine, Jiamusi University, Jamusi, China
| | - J N Xun
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - J R Wang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - J J Sun
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - C Steinhart
- CAN Community Health, Sarasota, FL, USA.,University of Central Florida College of Medicine, Orlando, FL, USA
| | - L Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Y Z Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - T K Qi
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Z Y Wang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - X Zhang
- Department of Implant Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Tang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - W Song
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - H Z Lu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - R F Zhang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Mashingaidze-Mano R, Bwakura-Dangarembizi MF, Maponga CC, Morse GD, Monera-Penduka TG, Mtisi TJ, Mudzviti T, Mujuru HA. Proximal renal tubular function in HIV-infected children on tenofovir disoproxil fumarate for treatment of HIV infection at two tertiary hospitals in Harare, Zimbabwe. PLoS One 2020; 15:e0235759. [PMID: 32634168 PMCID: PMC7340300 DOI: 10.1371/journal.pone.0235759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/23/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Renal abnormalities in HIV infected children may be due to the HIV infection or treatment among other factors. Tenofovir disoproxil fumarate (TDF) is associated with proximal renal tubular dysfunction, proteinuria and decrease in glomerular function. Studies in developed countries have shown variable prevalence of proximal renal tubular dysfunction in children on TDF. There are no known studies in developing countries, including Zimbabwe, documenting the proximal tubular function in HIV infected children on TDF. The aim of this study was to assess renal and proximal renal tubular function in HIV infected children receiving TDF and determine factors associated with proximal tubular dysfunction. METHODS A descriptive cross-sectional study was conducted in HIV infected patients below 18 years of age attending outpatient clinics at two tertiary hospitals in Harare, who received a TDF-containing antiretroviral regimen for at least six months. Dipstick protein and glucose, serum and urine phosphate and creatinine levels were measured. Fractional excretion of phosphate was calculated. Estimated glomerular filtration rate (eGFR) was calculated using the Schwartz formula. Tubular dysfunction was defined by at least two of the following characteristics: normoglycaemic glycosuria, hypophosphatemia and fractional excretion of phosphate > 18%. FINDINGS One hundred and ninety-eight children below 18 years of age were recruited over a period of six months. The prevalence of tubular dysfunction was 0.5%. Normoglycaemic glycosuria occurred in 1 (0.5%), fractional excretion of phosphate >18% in 4 (2%), and hypophosphatemia in 22 [11.1%] patients. Severe stunting was associated with increased risk of hypophosphatemia (OR 9.31 CI (1.18, 80.68) p = 0.03). Reduction in estimated glomerular filtration rate (eGFR) < 90ml/min/1.73m2 and proteinuria was evident in 35.9% and 32.8% of children, respectively. Concurrent TDF and HIV-1 protease inhibitor-based regimen was the only independent factor associated with reduction in GFR (OR 4.43 CI (1.32; 4.89) p = 0.016). CONCLUSION Tubular dysfunction was uncommon in Zimbabwean children on a TDF-based ART regimen. Hypophosphatemia, proteinuria and reduction in eGFR were common. Reassessing renal function using more sensitive biomarkers is needed to examine the long-term tolerance of TDF.
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Affiliation(s)
| | | | - Charles C. Maponga
- School of Pharmacy, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
- Center for Integrated Global Biomedical Sciences, University at Buffalo, New York, United States of America
- International Pharmacotherapy Education and Research Initiative, Harare, Zimbabwe
| | - Gene D. Morse
- Center for Integrated Global Biomedical Sciences, University at Buffalo, New York, United States of America
| | | | - Takudzwa J. Mtisi
- Department of Clinical Pharmacology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Tinashe Mudzviti
- School of Pharmacy, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
- International Pharmacotherapy Education and Research Initiative, Harare, Zimbabwe
- Newlands Clinic, Highlands, Harare, Zimbabwe
| | - Hilda A. Mujuru
- Department of Paediatrics, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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Lavinya AA, Lee CS, Hashim OH, Azwa I, Rajasuriar R, Lim SK, Wong YF. Proteomics analysis of blood plasma in HIV-infected patients with chronic kidney disease. Clin Biochem 2019; 73:90-97. [PMID: 31401122 DOI: 10.1016/j.clinbiochem.2019.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/30/2019] [Accepted: 08/07/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients treated for human immunodeficiency virus (HIV) infection are prone to developing chronic kidney disease (CKD). Current methods used in assessing kidney function suffer inaccuracy in HIV-infected patients. This study aims to identify biomarkers that could complement existing methods of kidney assessment among HIV-infected subjects. METHODS Plasma protein profiling was performed for HIV patients with CKD presented with negative/trace proteinuria (non-proteinuric) (n = 8) and their matched non-CKD controls, using two-dimensional gel electrophoresis (2DE); selected protein candidates were identified using mass spectrometry. Subsequently, altered plasma abundance of protein candidates were verified using Western blotting in HIV-infected subjects with non-proteinuric CKD (n = 8), proteinuric CKD (n = 5), and their matched non-CKD controls, as well as in HIV-uninfected subjects with impaired kidney function (n = 3) and their matched controls. RESULTS Analysis of 2DE found significantly altered abundance of five protein candidates between HIV-infected patients with non-proteinuric CKD and without CKD: alpha-1-microglobulin (A1M), serum albumin (ALB), zinc-alpha-2-glycoprotein (AZGP1), haptoglobin (HP), and retinol binding protein (RBP4). Western blotting showed an increased abundance of A1M and HP in HIV-infected patients with non-proteinuric CKD compared to their non-CKD controls, whereas A1M, AZGP1, and RBP4 were significantly increased in HIV-infected patients with proteinuric CKD compared to their non-CKD controls. Such pattern was not found in HIV-uninfected subjects with impaired kidney function. CONCLUSION The data suggests four proteins that may be used as biomarkers of CKD in HIV-infected patients. Further validation in a larger cohort of HIV-infected patients is necessary for assessing the clinical use of these proposed biomarkers for CKD.
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Affiliation(s)
- Amanda Anne Lavinya
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Cheng Siang Lee
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Onn Haji Hashim
- University of Malaya Centre for Proteomics Research, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Soo Kun Lim
- Nephrology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yuen Fei Wong
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Hassan KS, Balkhair A. Prevalence of Nephrotoxicity in HIV Patients Treated with Tenofovir Disoproxil Fumarate: A Single-center Observational Study. Oman Med J 2019; 34:231-237. [PMID: 31110631 PMCID: PMC6505346 DOI: 10.5001/omj.2019.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives Tenofovir disoproxil fumarate (TDF) has been reported to cause nephrotoxicity necessitating cessation in some patients. No information is available on the nephrotoxic effect of TDF in Omani or regional patients with HIV infection. We sought to determine the prevalence of the nephrotoxic effects of TDF in our cohort of Omani patients with HIV and investigate the nephrotoxic effects of other cofactors. Methods We conducted an observational cohort study on 83 Omani patients currently on TDF-containing antiretroviral therapy. Renal dysfunction was monitored by measuring the serum creatinine estimated glomerular function rate (eGFR), urinary protein creatinine ratio (uPCR), and fractional excretion of phosphate (FEPi). Fisher's exact test was used to determine any additional nephrotoxic effects of cofactors. Results The median values for the duration of TDF use, patient age, and body mass index (BMI) at the time of the study were 178 weeks (range = 3-554), 42 years (range = 21-80), and 27 (range = 17.4-42.7), respectively. The median initial CD4 count and viral load were 205 × 106/L (range = 3-1745) and 37 250 copies/mL (range = undetectable-9 523 428), respectively. FEPi was high in two (2.4%) patients, moderate in 26 (31.3%), and low in 55 (66.3%) patients. uPCR was high in 10 (12.0%) patients, moderate in 28 (33.7%), and low in 45 (54.2%) patients. No cofactors added to the nephrotoxicity except hypertension (p = 0.045). Conclusions Better definitions for TDF-associated toxicity are needed. uPCR is not a very good indicator of TDF-associated tubular dysfunction. Omani patients with HIV on TDF have a 4% prevalence of renal toxicity, but a study with a larger number of patients is required to explore this observation further. Cofactors like duration of TDF use, age, BMI, gender, diabetes mellitus, and use of protease inhibitors did not have an impact on the severity of FEPi and uPCR.
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Affiliation(s)
- Kowthar Salman Hassan
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Muscat, Oman
| | - Abdullah Balkhair
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Muscat, Oman
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Abstract
Different biochemical markers exist in both blood and urine for assessing renal function. Most of these biomarkers have advantages and limitations associated with their use, which is important to consider when ordering and utilising them in the clinical setting. The ideal marker should be able to detect acute kidney injury (AKI) at the onset and be used for the diagnosis and ongoing monitoring and management of kidney disease. The search for such a marker is ongoing, as all potential candidates thus far are associated with certain limitations. This article will attempt to compare and contrast established and emerging kidney disease markers.
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Affiliation(s)
- Oliver Treacy
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital Ipswich Road, Woolloongabba, Queensland, Australia
| | - Nigel N Brown
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital Ipswich Road, Woolloongabba, Queensland, Australia
| | - Goce Dimeski
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital Ipswich Road, Woolloongabba, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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11
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Tenofovir disoproxil fumarate initiation and changes in urinary biomarker concentrations among HIV-infected men and women. AIDS 2019; 33:723-733. [PMID: 30830887 DOI: 10.1097/qad.0000000000002114] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Urinary biomarkers of kidney injury may have potential to identify subclinical injury attributable to tenofovir disoproxil fumarate (TDF) toxicity. DESIGN This observational study included 198 HIV-infected participants from the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study, who initiated TDF between 2009 and 2015 and had urine samples collected at baseline before and after TDF initiation. METHODS We used linear mixed-effects models controlling for urine creatinine and time on TDF to evaluate the effects of TDF initiation on changes in 14 urinary biomarkers. RESULTS Within 1 year after TDF initiation, concentrations of trefoil factor 3 [+78%; 95% confidence interval (CI) +38%, +129%), alpha-1 microglobulin (α1m) (+32%; 95% CI +13%, +55%), clusterin (+21%; 95% CI +6%, +38%), uromodulin (+19%; 95% CI +4%, +36%), and kidney injury molecule-1 (KIM-1) (+13%; 95% CI +1%, +26%) significantly increased, whereas interleukin-18 (IL-18) significantly decreased (-13%, 95% CI -7%, -25%). Subsequent to the first year of TDF use, biomarker concentrations stabilized, and these changes were not statistically significant. When stratifying by baseline viremia (HIV-1 RNA < vs. ≥80 copies/ml), concentration changes for most biomarkers during the first year of TDF use were greater among aviremic vs. viremic participants, with significant differences in α1m (+80 vs. +22%), KIM-1 (+43 vs. +10%), beta-2 microglobulin (+83 vs. -10%), YKL-40 (+33 vs. -5%), and IL-18 (+20 vs. -27%). CONCLUSIONS TDF initiation was associated with substantial changes in urinary biomarkers of kidney injury within the first year of use, particularly among aviremic participants. A urinary biomarker panel may be a clinically useful tool to detect and monitor the heterogeneous effects of TDF on the kidney.
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Sueud T, Hadi NR, Abdulameer R, Jamil DA, Al-Aubaidy HA. Assessing urinary levels of IL-18, NGAL and albumin creatinine ratio in patients with diabetic nephropathy. Diabetes Metab Syndr 2019; 13:564-568. [PMID: 30641767 DOI: 10.1016/j.dsx.2018.11.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/02/2018] [Indexed: 01/05/2023]
Abstract
AIMS Diabetic nephropathy (DN) is a serious microvascular complication of a longstanding hyperglycemia. This study aims to evaluate whether urinary neutrophil gelatinase-associated lipocalin (NGAL) and urinary Interleukin-18 possess a better diagnostic value than albumin creatinine ratio in assessing the severity of nephropathy in patients with type 2 diabetes mellitus (T2DM). MATERIAL & METHODS Ninety participants diagnosed with T2DM were recruited and they were divided into three study groups according to their albumin/creatinine ratio (ACR): (Normoalbuminuria group, Microalbuminuria group, and Macroalbuminuria group). A matching of Ninety healthy subjects were included as controls. Blood and urine samples were collected to measure various markers of glycemic control and kidney function. RESULTS IL-18 levels were not changed significantly between all study groups (P > 0.05), despite a significant positive correlation between IL-18 and urinary albumin levels. NGAL levels were significantly increased in Microalbuminuria group and Macroalbuminuria group as compared to the control and Normoalbuminuria groups. NGAL was also positively correlated with urinary albumin and ACR, but negatively correlated with the age and body mass index. Receiver Operating Characteristic curves revealed that for early detection of DN, the best cutoff values to discriminate DN and diabetic without nephropathy groups were ˃ 21.4 ng/ml for NGAL (94.67 sensitivity, 26.67% specificity), ≤0.34 pg/mL for IL-18 (72% sensitivity, 53.33% specificity), and ˃29.8 mg/g for ACR (80% sensitivity, 100% specificity). CONCLUSION We conclude that the urinary ACR is a more accurate individual biomarker of DN when compared to both NGAL and IL-18.
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Affiliation(s)
- Taqwaa Sueud
- Faculty of Medicine, University of Kufa, Al-Najaf, Iraq
| | - Najah R Hadi
- Faculty of Medicine, University of Kufa, Al-Najaf, Iraq
| | | | - Dina A Jamil
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Hayder A Al-Aubaidy
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia; School of Life Sciences, La Trobe University, Bundoora, VIC, 3086, Australia.
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Verma SK, Albrecht AK, Siebecke V, Klöck G, Kolesnikova TA, Springer S. Comparative validation of a microcapsule-based immunoassay for the detection of proteins and nucleic acids. PLoS One 2018; 13:e0201009. [PMID: 30028867 PMCID: PMC6054379 DOI: 10.1371/journal.pone.0201009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/06/2018] [Indexed: 01/12/2023] Open
Abstract
To detect and study diseases, research and clinical laboratories must quantify specific biomarkers in the plasma and urine of patients with precision, sensitivity, and cost-effectiveness. Newly developed techniques, such as particle-based immunoassays, must be validated in these terms against standard methods such as enzyme-linked immunosorbent assays (ELISAs). Here, we compare the performance of assays that use hollow polyelectrolyte microcapsules with assays based on solid plastic beads, and with standard microplate immunoassays. The polyelectrolyte microcapsules detect the disease biomarker beta-2 microglobulin with a fifty-fold increase in sensitivity than polystyrene (PS) beads. For sequence-specific nucleic acid detection, the oligonucleotide-coated microcapsules exhibit a two-fold lower increase in sensitivity over PS beads. The microcapsules also detect the presence of a monoclonal antibody in hybridoma supernatant at a fifty-six-fold increase in sensitivity compared to a microplate assay. Overall, polyelectrolyte microcapsule-based assays are more sensitive for the detection of protein and nucleic acid analytes than PS beads and microplate assays, and they are viable alternatives as a platform for the rapid quantitative detection of analytes at very low concentrations.
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Affiliation(s)
- Sujit Kumar Verma
- Department of Life Sciences and Chemistry, Jacobs University, Bremen, Germany
| | | | | | - Gerd Klöck
- City University of Applied Sciences, Bremen, Germany
| | | | - Sebastian Springer
- Department of Life Sciences and Chemistry, Jacobs University, Bremen, Germany
- * E-mail:
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Abstract
PURPOSE OF REVIEW HIV-infected individuals have improved access to antiretroviral therapy. This has resulted in a shift in causes of mortality from infectious diseases to noncommunicable diseases including cardiovascular disease, chronic kidney disease (CKD) and malignancies. This review will look at the epidemiological shift, risk factors for the development of these diseases and examine some of the supporting laboratory diagnostic testing, which may be required. RECENT FINDINGS Risk factors for the development of these diseases in HIV-infected patients include underlying genetic predisposition, lifestyle risk factors, chronic inflammation as a consequence of HIV infection, the presence and persistence of opportunistic infections and in some cases, highly active antiretroviral therapy, itself. Morbidity and mortality from HIV-associated conditions are increasing in low-income and middle-income countries (LMICs) with increased prevalence of HIV-associated cancers, cardiovascular disease and CKD. SUMMARY Management of these conditions in LMICs requires an integrated pathology solution that will enable early screening, diagnosis and monitoring.
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