Total protein, albumin and low-molecular-weight protein excretion in HIV-positive patients

BMC Nephrology

Research Article

Lucy J Campbell¹  Fowzia Ibrahim¹  Pantelis A Sarafidis¹  Bruce M Hendry¹  Frank A Post²  Lisa Hamzah²  Rashim Salota³  Caje F Moniz³  Tracy Dew³  Roy A Sherwood³  Emily Cheserem⁴  Mary Poulton⁴ 

[1] Academic Department of Renal Sciences, King's College London, London, United Kingdom;Academic Department of Renal Sciences, King's College London, London, United Kingdom;Sexual Health, King's College Hospital, London, United Kingdom;Departments of Clinical Biochemistry, King's College Hospital, London, United Kingdom;Sexual Health, King's College Hospital, London, United Kingdom;

关键词: Proteinuria;    Albuminuria;    Retinol-binding protein;    RBP;    Cystatin C;    Neutrophil gelatinase-associated lipocalin;    NGAL;    Tenofovir;    HIV;   

DOI  :  10.1186/1471-2369-13-85

 received in 2012-01-13, accepted in 2012-08-07,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundChronic kidney disease is common in HIV positive patients and renal tubular dysfunction has been reported in those receiving combination antiretroviral therapy (cART). Tenofovir (TFV) in particular has been linked to severe renal tubular disease as well as proximal tubular dysfunction. Markedly elevated urinary concentrations of retinal-binding protein (RBP) have been reported in patients with severe renal tubular disease, and low-molecular-weight proteins (LMWP) such as RBP may be useful in clinical practice to assess renal tubular function in patients receiving TFV. We analysed 3 LMWP as well as protein and albumin in the urine of a sample of HIV positive patients.MethodsIn a cross-sectional fashion, total protein, albumin, RBP, cystatin C, and neutrophil gelatinase-associated lipocalin (NGAL) were quantified in random urine samples of 317 HIV positive outpatients and expressed as the ratio-to-creatinine (RBPCR, CCR and NGALCR). Exposure to cART was categorised as none, cART without TFV, and cART containing TFV and a non-nucleoside reverse-transcriptase-inhibitor (TFV/NNRTI) or TFV and a protease-inhibitor (TFV/PI).ResultsProteinuria was present in 10.4 % and microalbuminuria in 16.7 % of patients. Albumin accounted for approximately 10 % of total urinary protein. RBPCR was within the reference range in 95 % of patients while NGALCR was elevated in 67 % of patients. No overall differences in urine protein, albumin, and LMWP levels were observed among patients stratified by cART exposure, although a greater proportion of patients exposed to TFV/PI had RBPCR >38.8 μg/mmol (343 μg/g) (p = 0.003). In multivariate analyses, black ethnicity (OR 0.43, 95 % CI 0.24, 0.77) and eGFR <75 mL/min/1.73 m2 (OR 3.54, 95 % CI 1.61, 7.80) were independently associated with upper quartile (UQ) RBPCR. RBPCR correlated well to CCR (r2 = 0.71), but not to NGALCR, PCR or ACR.ConclusionsIn HIV positive patients, proteinuria was predominantly of tubular origin and microalbuminuria was common. RBPCR in patients without overt renal tubular disease was generally within the reference range, including those receiving TFV. RBP therefore appears a promising biomarker for monitoring renal tubular function in patients receiving TFV and for distinguishing patients with normal tubular function or mild tubular dysfunction from those with severe renal tubular disease or Fanconi syndrome.

【 授权许可】

Unknown   
© Campbell et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.