RESEARCH PAPER
Concentration of selected low molecular-weight proteins in urine – a retrospective analysis of chronic kidney disease among HIV patients receiving antiretroviral therapy
 
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Submission date: 2019-01-05
 
 
Final revision date: 2019-02-08
 
 
Acceptance date: 2019-02-11
 
 
Publication date: 2019-03-28
 
 
HIV & AIDS Review 2019;18(1):7-13
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Human immunodeficiency virus (HIV) infection remains an important health problem despite the fact that combined antiretroviral therapy (cART) prolongs life and protects against acquired immunodeficiency syndrome (AIDS). Chronic kidney disease is an important cause of mortality among HIV patients, co-monitoring of renal function and modifying factors such as cART require constant analysis. The aim of this study was a retrospective analysis of renal function among HIV- infected and cART-treated patients by measuring urine concentrations of chosen low molecular weight proteins (LMWP) as biomarkers of kidney dysfunction: retinol-binding protein (RBP), β2-microglobulin (β2M), and neutrophil gelatinase-associated lipocalin (NGAL). The results were compared with those obtained seven years earlier (in 2011) in the same patients.

Material and methods:
Urine samples from 34 patients of Wroclaw outpatient HIV Clinic and from 30 HIV-negative individuals with no renal or any other disease were examined. Concentrations of LMWP were measured by immunoenzymatic ELISA tests.

Results:
Compared to 2011, reduction in the concentration of excreted LMWP was observed. No deleterious renal effect of tenofovir could be shown; however, most patients were receiving the new prodrug (TAF) of reduced nephrotoxicity. Positive correlation between serum creatinine and urine β2M was shown and negative correlation between eGFR and urine RBP. Coexistence of HCV infection and the number of T CD4(+) cells also correlated with the concentration of the biomarkers.

Conclusions:
This retrospective analysis shows a need for long-term renal function monitoring as well as other factors that may influence renal function among HIV patients. RBP, NGAL, and β2M have been confirmed to be useful biomarkers for early detection of renal dysfunction.

 
REFERENCES (34)
1.
Gładysz A, Knysz B. Zakażenia HIV i AIDS – poradnik dla lekarzy. Wydawnictwo Continuo, Wrocław 2014; 109-125.
 
2.
Marchewka Z, Szymańska B, Szymanek-Pasternak A, et al. Przydatność oznaczania aktywności wybranych enzymów w moczu w ocenie uszkodzenia funkcji nerek u pacjentów zakażonych HIV poddanych terapii antyretrowirusowej. Diagn Lab 2014; 50: 227-234.
 
3.
Horban A, Podlasin R, Cholewińska G, et al. Zasady opieki nad osobami zakażonymi HIV. Pol Tow Nauk AIDS, Warszawa-Szczecin 2018; 397-407, 408-415.
 
4.
Qadir MI. Hepatitis in AIDS patients. Rev Med Virol 2017; 28: 1956-1963.
 
5.
Sikavi C, Chen PH, Lee AD, et al. Hepatitis C and Human Immunodeficiency Virus Co-Infection in the Era of Direct-Acting Antiviral Agents: No Longer A Difficult to Treat Population. Hepatology 2017; 67: 847-857.
 
6.
Bertoldi A, De Crignis E, Re MC, et al. HIV and kidney: a dangerous liaison. New Microbiol 2017; 40: 1-10.
 
7.
Röling J, Schmid H, Fischereder M, et al. HIV-Associated Renal Diseases and Highly Active Antiretroviral Therapy Induced Nephro- pathy. Clin Infect Dis 2006; 42: 1488-1495.
 
8.
Horban A, Podlasin R, Cholewińska G, et al. Zasady opieki nad osobami zakażonymi HIV. Zalecenia PTN AIDS. PTN AIDS, Warszawa-Wrocław 2016; 376-384.
 
9.
Jin A, Boroujerdi-Rad L, Shah G, Chen JL. Thrombotic microangio­pathy and human immunodeficiency virus in the era of eculizumab. Clin Kidney J 2016; 9: 576-579.
 
10.
Weiner NJ, Goodman JW, Kimmel PL. The HIV-associated renal diseases: current insight into pathogenesis and treatment. Kidney Int 2003; 63: 1618-1631.
 
11.
Ross MJ. Advances in the pathogenesis of HIV-associated kidney diseases. Kidney Int 2014; 86: 266-274.
 
12.
Butt AA, McGinnis K, Rodriguez-Barradas MC, et al. HIV Infection and the Risk of Diabetes Mellitus. AIDS 2009; 23: 1227-1234.
 
13.
Campos P, Ortiz A, Soto K. HIV and kidney diseases: 35 years of history and consequences. Clin Kidney J 2016; 9: 772-781.
 
14.
Marchewka Z, Szymczak A, Knysz B. Choroby współistniejące jako czynniki ryzyka przewlekłej choroby nerek u osób zakażonych HIV. Postepy Hig Med Dosw 2015; 69: 1364-1370.
 
15.
Adebamiro A, Perazella MA. Recurrent acute kidney injury following bath salts intoxication. Am J Kidney Dis 2012; 59: 273-275.
 
16.
Gładysz A, Knysz B. Diagnostyka, profilaktyka, klinika i terapia zakażeń HIV/AIDS – współczesne możliwości i problemy. Wydaw­nictwo Continuo, Wrocław 2009; 157-165.
 
17.
Marchewka Z. Niskocząsteczkowe wskaźniki biochemiczne w diagnostyce nefrotoksyczności. Adv Clin Exp Med 2006; 15: 1129-1138.
 
18.
Shyam R, Patel ML, Sachan R, et al. Role of Urinary Neutrophil Gelatinase-associated Lipocalin as a Biomarker of Acute Kidney Injury in Patients with Circulatory Shock. Indian J Crit Care Med 2017; 21: 740-745.
 
19.
Mårtensson J, Bellomo R. The rise and fall of NGAL in acute kidney injury. Blood Purif 2014; 37: 304-310.
 
20.
Varnell CD, Goldstein SL, Devarajan P, Basu RK. Impact of Near Real-Time Urine Neutrophil Gelatinase–Associated Lipocalin Asses­sment on Clinical Practice. Kidney Int Rep 2017; 2: 1243-1249.
 
21.
Lisowska-Myjak B, Skarżyńska E, Wilczyńska P, Jakimiuk A. Correlation between the concentrations of lactoferrin and neutrophil gelatinase-associated lipocalin in meconium. Biometals 2018; 31: 123-129.
 
22.
Haase-Fielitz A, Haase M, Devarajan P. Neutrophil gelatinase- associated lipocalin as a biomarker of acute kidney injury: a critical evaluation of current status. Ann Clin Biochem 2014; 51: 335-351.
 
23.
Sola-Del Valle DA, Mohan S, Cheng JT, et al. Urinary NGAL is a useful clinical biomarker of HIV-associated nephropathy. Nephrol Dial Transplant 2011; 26: 2387-2390.
 
24.
Argyropoulos CP, Chen SS, Ng YH, et al. Rediscovering Beta-2 Micro­globulin As a Biomarker across the Spectrum of Kidney Diseases. Front Med (Lausanne) 2017; 4: 73-98.
 
25.
Tian F, Wang ZB, Meng DM, et al. Preliminary study on the role of virtual touch tissue quantification combined with a urinary β2-microglobulin test on the early diagnosis of gouty kidney damage. Ultrasound Med Biol 2014; 40: 1394-1399.
 
26.
Norden AG, Lapsley M, Unwin RJ. Urine Retinol Binding Protein 4: A Functional Biomarker of the Proximal renal Tubule. Adv Clin Chem 2014; 63: 85-122.
 
27.
Kirsztajn GM, Nishida SK, Silva MS, et al. Urinary retinol-binding protein as a prognostic marker in glomerulopathies. Nephron 2002; 90: 424-431.
 
28.
Lee JE, Lee S, Song SH, et al. Incidence and risk factors for tenofovir-associated nephrotoxicity among human immunodeficiency virus-infected patients in Korea. Korean J Intern Med 2017; http://kjim.org/journal/view.p... (accessed: 13 December 2017).
 
29.
Cattaneo D, Minisci D, Baldelli S, et al. Effect of Cobicistat on Tenofovir Disoproxil Fumarate (TDF): What Is True for TAF May Also Be True for TDF. J Acquir Immune Defic Syndr 2018; 77: 86-92.
 
30.
DeJesus E, Haas B, Segal-Maurer S, et al. Superior Efficacy and Improved Renal and Bone Safety After Switching from a TenofovirDisoproxil Fumarate- to a Tenofovir Alafenamide-Based Regimen Through 96 Weeks of Treatment. AIDS Res Hum Retroviruses 2018; 34: 337-342.
 
31.
Spiegel LR, Schrier PB, Shah HH. Severe recurrent rhabdomyolysis- induced acute kidney injury in a HIV-infected patient on antiretroviral therapy. Ren. Fail 2013; 35: 1186-1190.
 
32.
Campbell LJ, Dew T, Salota R, et al. Total protein, albumin and low-molecular-weight protein excretion in HIV-positive patients. BMC Nephrol 2012; 13: 85.
 
33.
Oboho I, Abraham A, Benning L, et al. Tenofovir use and urinary biomarkers among HIV-infected women in the Women’s Interagency HIV Study (WIHS). J Acquir Immune Defic Syndr 2013; 62: 388-395.
 
34.
Rossi C, Raboud J, Walmsley S, et al. Hepatitis C co-infection is associated with an increased risk of incident chronic kidney disease in HIV-infected patients initiating combination antiretroviral therapy. BMC Infect Dis 2017; 17: 246-247.
 
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