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Microalbuminuria predicts overt proteinuria among patients with HIV infection
Author(s) -
Szczech LA,
Menezes P,
Byrd Quinlivan E,
Van Der Horst C,
Bartlett JA,
Svetkey LP
Publication year - 2010
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2009.00805.x
Subject(s) - microalbuminuria , proteinuria , medicine , creatinine , urine , endocrinology , albuminuria , urology , renal function , kidney
Background This study examines the association between microalbuminuria and the development of proteinuria among HIV‐infected persons. Methods A total of 948 subjects provided urine samples for albumin, protein and creatinine measurements semiannually. Microalbuminuria was defined as an albumin‐to‐creatinine ratio of >30 mg/g. Proteinuria was defined as a protein‐to‐creatinine ratio of ≥0.350 mg/mg. The progression from microalbuminuria to proteinuria was described. Results At baseline, 69.4% of the subjects had no detectable proteinuria, 20.2% had microalbuminuria, and 10.4% had proteinuria. Subjects with microalbuminuria and proteinuria were more likely to be black ( P =0.02), have lower CD4 cell counts ( P =0.02 comparing subjects without abnormal urine protein excretion to subjects with microalbuminuria; P =0.0001 comparing subjects with microalbuminuria to subjects with proteinuria), and have a higher HIV RNA level ( P =0.08 and 0.04, respectively). Among 658 subjects with normal urine protein, 82.7% continued to have no abnormality, 14.3% developed microalbuminuria, and 3.0% developed proteinuria. Subjects without baseline proteinuria (i.e. either normal protein excretion or microalbuminuria) who developed proteinuria were more likely to have microalbuminuria ( P =0.001), a lower CD4 cell count ( P =0.06), and a higher plasma HIV RNA ( P =0.03) than those who did not progress to proteinuria. In multivariate analysis, only microalbuminuria remained associated with the development of proteinuria (odds ratio 2.9; 95% confidence interval 1.5, 5.5; P =0.001). Conclusion Microalbuminuria predicts the development of proteinuria among HIV‐infected persons. Because proteinuria has been linked to poorer outcomes, strategies to affect microalbuminuria should be tested.