Prevalence of renal disease in HIV-1 infected children at Kenyatta National Hospital

Abstract

Introduction: HIV/AIDS is a multi-system infection and approximately 60% ofpatients develop some form of renal pathology. These patients are at increased risk of developing renal failure as a primary manifestation or secondary to complications such as intercurrent illnesses and drug therapy. In children, as in adults, proteinuria may be the earliest clinical presentation of HIV nephropathy. Although urinalysis and serum biochemistry are relatively accessible methods of identifying HIV infected children with nephropathy, there are limited studies doneto determine the prevalence of persistent proteinuria and that of nephropathy among patients with HIV infection. We carried out a cross-sectional survey among HIV infected children to determine the prevalence of renal disease. Methods: ARV naive children between ages 18months to 12years were enrolled at the KNH HIV clinic and paediatric wards between December 2005 and April 2006. Sociodemographic and clinical information was collected. At baseline urine protein, serum creatinine, serum bicarbonate, serum albumin and CD4% were determined. Among children with proteinuria, a repeat urine assay for protein was performed two weeks later. Renal disease was defined aspersistent proteinuria and/or decreased GFR. Results: A total of87 subjects were recruited. Forty six (52.8%) were females and 41 (47.1%)males. Their age ranged from 18months to 13years with a median age of 60 months. Overall, 35.6% (95% CI 26.8%-44.4%) of the patients had evidence of nephropathy based on presence ofpersistent proteinuria and/or abnormal glomerular filtration rate