Background. Human immunodeficiency virus associated nephropathy (HIVAN) is a rapidly progressive chronic renal parenchymal disease that occurs in HIV-infected individuals and manifests commonly as proteinuria, which is preceded by microalbuminuria (MA). This clinical entity is defined as a spot urine albumin of 20–200？mg/L. Objectives. To determine the prevalence of microalbuminuria in HIV positive children in UNTH, Enugu and compare it with that of HIV-negative children. Methods. A total of 154？HIV positive children aged 18 months to 14 years and 154？HIV-negative children of corresponding attributes were screened for microalbuminuria, using Micral test II strip which has a sensitivity of 90–99%. Results. No child among the groups (HIV positive and negative) had microalbuminuria. Majority (96.0%) of HIV-positive children had nonadvanced HIV disease at the time of the study ( ). About 77.3% were using HAART ( ), the mean CD4 cell count of the subjects was cells/mm3; while 78.0% had nonsevere immunosuppression ( ). Furthermore, HIV-positive children with severe immunosuppression were younger and had shorter duration of treatment. Conclusion. Microalbuminuria may not be very common in Nigerian children irrespective of their HIV status. 1. Introduction Nigeria contributes 9% to global HIV burden, and has a seroprevalence of 4.6% with 220,000 children already living with HIV infection as of 2008 [1, 2]. Human immunodeficiency virus (HIV) affects many organs including the kidney [3]. HIV renal parenchymal disease is varied and may result from direct effect of the virus on renal epithelial cells, immune-complex mediated vasculitis, hyperviscosity of blood secondary to hyperglobulinaemia, various opportunistic infections, and also drugs [4]. The commonest chronic renal parenchymal disease in HIV-positive patients is HIV-associated nephropathy (HIVAN) [5, 6], which occurs in childhood [6–9] and has been documented in Nigerian children too [9, 10]. HIVAN progresses to ESRD but if detected early, this progression can be slowed or even halted with the use of HAART [6]. The commonest manifestation of HIVAN is proteinuria, [5, 11] which has been described in HIV-positive children [6, 9] and Esezobor and colleague [9] in Nigeria documented a prevalence of 20.5% in HIV-positive Nigerian children. Microalbuminuria is a predictor of subclinical renal involvement in systemic diseases including HIVAN [3]. It precedes proteinuria [3] and has been shown to be an early manifestation of HIVAN [3]. Therefore, the detection of microalbuminuria as well as the prompt institution
References
[1]
United Nations General Assembly Special Session (UNGASS) Country Progress Report, Nigeria. Reporting period: January 2008-December 2009.
[2]
UNICEF, UNAIDS, WHO, and AIDS, Country Fact Sheets 2009.
[3]
T. M. Han, S. Naicker, P. K. Ramdial, and A. G. Assounga, “A cross-sectional study of HIV-seropositive patients with varying degrees of proteinuria in South Africa,” Kidney International, vol. 69, no. 12, pp. 2243–2250, 2006.
[4]
P. E. Ray, L. Xu, T. Rakusan, and X. Liu, “A 20-year history of childhood HIV-associated nephropathy,” Pediatric Nephrology, vol. 19, no. 10, pp. 1075–1092, 2004.
[5]
B. Leroy, M. Pressac, A. Bensman, P. Sinnassamy, and C. Courpotin, “Renal status in human immunodeficiency virus infected children: a prospective study,” in Proceedings of the International AIDS Conference, 1992.
[6]
A. I. Chaparro, C. D. Mitchell, C. L. Abitbol et al., “Proteinuria in children infected with the human immunodeficiency virus,” Journal of Pediatrics, vol. 152, no. 6, pp. 844–849, 2008.
[7]
“Interim WHO clinical staging of HIV/AIDS and HIV/AIDS case definitions for surveillance: African Region Reference number: WHO/HIV/2005.02,” http://www.who.int/hiv/pub/guidelines/casedefinitions/en/index.html.
[8]
P. Zambrano, A. Chávez, X. Chaparro et al., “Renal compromise in HIV/AIDS in patients attended at a chilean children hospital,” Revista Chilena de Infectologia, vol. 26, no. 1, pp. 21–25, 2009.
[9]
C. Esezobor, E. Iroha, E. Onifade, A. Akinsulie, E. Temiye, and C. Ezeaka, “Prevalence of proteinuria among HIV-infected children attending a tertiary hospital in Lagos, Nigeria,” Journal of Tropical Pediatrics, vol. 56, no. 3, pp. 187–190, 2010.
[10]
F. U. Eke, I. C. Anochie, A. N. Okpere, A. U. Eneh, R. N. Ugwu, and A. A. Ejilemele, “Microalbuminuria in children with human immunodeficiency virus (HIV) infection in Port Harcourt, Nigeria,” Nigerian Journal of Medicine, vol. 19, no. 3, pp. 298–300, 2010.
[11]
Information leaflet on Micral-test; an ACCU-CHEK product. Roche diagnostics. Batch number 23024338.
[12]
B. A. Vogt and E. D. Avner, “Conditions particularly associated with proteinuria,” in Nelson Textbook of Paediatrics, R. E. Behrman, R. M. Kliegman, and H. B. Jenson, Eds., pp. 1751–1757, Saunders, Philadelphia, Pa, USA, 17th edition, 2004.
[13]
S. M. Marshall, P. A. Shearing, and K. G. M. M. Alberti, “Micral-test strips evaluated for screening for albuminuria,” Clinical Chemistry, vol. 38, no. 4, pp. 588–591, 1992.
[14]
J. L. Carter, C. R. V. Tomson, P. E. Stevens, and E. J. Lamb, “Does urinary tract infection cause proteinuria or microalbuminuria? A systematic review,” Nephrology Dialysis Transplantation, vol. 21, no. 11, pp. 3031–3037, 2006.
[15]
B. J. Brown, A. O. Asinobi, O. J. Fatunde, K. Osinusi, and N. A. Fasina, “Evaluation of the nitrite test in screening for urinary tract infection in febrile children with sickle cell anaemia,” Nigerian Journal of Paediatrics, vol. 31, pp. 10–13, 2004.
[16]
P. Whiting, M. Westwood, I. Watt, J. Cooper, and J. Kleijnen, “Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review,” Pediatrics, vol. 5, article 4, 2005.
[17]
C. R. Parikh, M. J. Fischer, R. Estacio, and R. W. Schrier, “Rapid microalbuminuria screening in type 2 diabetes mellitus: simplified approach with micral test strips and specific gravity,” Nephrology Dialysis Transplantation, vol. 19, no. 9, pp. 1881–1885, 2004.
[18]
“Estimation,” in Determination of Sample Size for Estimating Proportion, W. W. Daniel, Ed., Biostatistics. A Foundation for Analysis in the Health Sciences, pp. 183–184, Wiley Dreamtech, India, 2005.
[19]
D. Tindyebwa, J. Kayita, P. Musoke, et al., Eds., Handbook on Paediatric AIDS in Africa, African Network for The Care of Children Affected by AIDS, 2006.
[20]
G. Lepore, M. L. Maglio, I. Nosari, A. R. Dodesini, and R. Trevisan, “Cost-effectiveness of two screening programs for microalbuminuria in type 2 diabetes,” Diabetes Care, vol. 25, no. 11, pp. 2103–2104, 2002.
[21]
D. Tindyebwa, J. Kayita, P. Musoke, et al., Eds., Handbook on Paediatric AIDS in Africa, vol. 240 of African Network for The Care of Children Affected by AIDS, Family Health International, Uganda, 2nd edition, 2006.
[22]
M. Baekken, I. Os, L. Sandvik, and O. Oektedalen, “Microalbuminuria associated with indicators of inflammatory activity in an HIV-positive population,” Nephrology Dialysis Transplantation, vol. 23, no. 10, pp. 3130–3137, 2008.
[23]
J. A. Winston, L. A. Bruggeman, M. D. Ross et al., “Nephropathy and establishment of a renal reservoir of HIV type I during primary infection,” The New England Journal of Medicine, vol. 344, no. 26, pp. 1979–1984, 2001.
[24]
L. A. Szczech, C. Grunfeld, R. Scherzer et al., “Microalbuminuria in HIV infection,” AIDS, vol. 21, no. 8, pp. 1003–1009, 2007.
[25]
S. K. Gupta, R. A. Parker, G. K. Robbins, and M. P. Dubé, “The effects of highly active antiretroviral therapy on albuminuria in HIV-infected persons: results from a randomized trial,” Nephrology Dialysis Transplantation, vol. 20, no. 10, pp. 2237–2242, 2005.
