Research Article: The Influence of HIV and Schistosomiasis on Renal Function: A Cross-sectional Study among Children at a Hospital in Tanzania

Date Published: January 22, 2015

Publisher: Public Library of Science

Author(s): Neema M. Kayange, Luke R. Smart, Jennifer A. Downs, Mwanaisha Maskini, Daniel W. Fitzgerald, Robert N. Peck, Zvi Bentwich. http://doi.org/10.1371/journal.pntd.0003472

Abstract: BackgroundSchistosomiasis and HIV are both associated with kidney disease. Prevalence and factors associated with abnormal renal function among HIV-infected children in Africa compared to uninfected controls have not been well described in a schistosomiasis endemic area.Methodology/Principal FindingsThis cross-sectional study was conducted at the Sekou Toure Regional Hospital HIV clinic in Mwanza, Tanzania. A total of 122 HIV-infected children and 122 HIV-uninfected siblings were consecutively enrolled. Fresh urine was obtained for measurement of albuminuria and Schistosoma circulating cathodic antigen. Blood was collected for measurement of serum creatinine. Estimated glomerular filtration rate (eGFR) was calculated using the modified Schwartz equation. Renal dysfunction was defined operationally as eGFR<60mL/min/1.73m2 and/or albuminuria>20mg/L in a single sample. Among 122 HIV-infected children, 61/122 (50.0%) met our criteria for renal dysfunction: 54/122 (44.3%) had albuminuria>20mg/L and 9/122 (7.4%) had eGFR<60. Among 122 HIV-uninfected children, 51/122 (41.8%) met our criteria for renal dysfunction: 48/122 (39.3%) had albuminuria>20mg/L and 6/122 (4.9%) had eGFR<60. Schistosomiasis was the only factor significantly associated with renal dysfunction by multivariable logistic regression (OR = 2.51, 95% CI 1.46–4.31, p = 0.001).Conclusions/SignificanceA high prevalence of renal dysfunction exists among both HIV-infected Tanzanian children and their HIV-uninfected siblings. Schistosomiasis was strongly associated with renal dysfunction.

Partial Text: HIV remains common in sub-Saharan Africa (SSA) where 91% of HIV-infected children reside and 1 in every 20 adults is infected [1, 2]. Kidney disease is an important complication in HIV-infected individuals and is associated with an increased risk of morbidity and mortality [3, 4]. The prevalence of kidney disease among HIV-infected adults in high-income countries ranges from 5%–50%, and is most common in patients of African descent [4]. Among more than 300 HIV-infected adults starting ART at our own hospital in Tanzania, 70% had evidence of kidney disease [5, 6].

In our study, half of the HIV-infected children attending an HIV clinic in the Lake Zone of northwestern Tanzania had evidence of renal dysfunction (defined operationally as eGFR <60mL/min/1.73m2 and/or albuminuria >20mg/L in a single urine test): 44.3% had albuminuria >20mg/L and 7.4% had an eGFR <60 ml/min/1.73 m2. These rates are higher than those found in other studies from SSA. Four other countries in SSA (Burkina Faso, Democratic Republic of Congo, Nigeria, and Zimbabwe) have reported the prevalence of markers of kidney disease among HIV-infected children as ranging from 0–31.6% using methodologies similar to ours [8–18]. The reasons for the higher prevalence of renal dysfunction among HIV-infected children in the Lake Zone compared to prior studies in SSA is not known, but our findings are consistent with the findings among HIV-infected adults in our region [5, 6]. Source: http://doi.org/10.1371/journal.pntd.0003472

 

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