Brief Report: Subclinical Kidney Dysfunction in HIV-Infected Children: A Cross-Sectional Study.

OBJECTIVE: Most of the kidney dysfunction in HIV-positive children receiving antiretroviral therapy (ART) is attributed to tenofovir. There is a paucity of data on kidney dysfunction in tenofovir-naive children. The primary objective was to know the point prevalence of albuminuria and β2-microglobulinuria in HIV-infected children aged 3-18 years receiving ART. Albuminuria and β2-microglobulinuria were used as surrogates for glomerular and tubular dysfunction, respectively. The secondary objective was to determine their predictors.

DESIGN: Cross-sectional study-design.

METHODS: One hundred consecutive HIV-positive children (3-18 years) on ART were included. Spot urine sample was analyzed for urinary creatinine, total protein, microalbumin, and β2-microglobulin. Albuminuria was defined as albumin to creatinine ratio of >30 mg/g; proteinuria as urine dipstick ≥trace or spot urine protein to creatinine ratio (uPCR) of ≥0.2. β2-microglobulinuria was defined as β2-microglobulin levels of >350 µg/L.

RESULTS: There were 71 boys and 29 girls. Most of the children had WHO clinical stage I and were getting zidovudine-based regimen. Only 7 children were getting tenofovir. estimated Glomerular Filtration Rate and serum creatinine were normal in all children. Approximately half (48%) had renal dysfunction in the form of glomerular dysfunction (26%), tubular dysfunction (27%), or both (5%). Age at diagnosis was significantly associated with β2-microglobulinuria (P = 0.044). None of the selected variables were associated with albuminuria.

CONCLUSIONS: HIV-associated glomerular and tubular dysfunction is common in children receiving ART other than tenofovir. The standard guidelines should consider including routine urinary biomarker monitoring in children on ART.