uAPRs were available in 144 patients: 46 patients (32%) had TP and 21 (15%) GP; the remainder had uPCR < 30 mg/mmol. The TP Protease Inhibitor Library cell line group had a higher fractional excretion of phosphate compared with the GP group (mean 27% vs. 16%, respectively; P < 0.01). Patients with TP were more likely to be on tenofovir and/or a boosted
protease inhibitor compared with those with GP. In 18 patients with heavy proteinuria (uPCR > 100 mg/mmol), a renal assessment was made; eight had a kidney biopsy. In all cases, the uAPR results correlated with the nephrological diagnosis. In HIV-infected patients, measuring uAPR may help to identify patients in whom a renal biopsy is indicated, and those in whom tubular dysfunction might be an important cause of proteinuria and which may be related to antiretroviral toxicity. We suggest that this would be useful as a routine screening procedure in patients with proteinuria. A spectrum of renal disease occurs in HIV-infected patients [1]. Chronic kidney disease (CKD) can be caused by the virus itself, sometimes manifesting as HIV-associated nephropathy (HIVAN) or HIV-associated immune complex kidney disease (HIVICK) [2-4]. Alternatively and increasingly, it Selleck PARP inhibitor is attributable to other unrelated pathologies,
for example, hypertension, diabetes, opportunistic infections or other viral coinfections [5, 6], and it is becoming more important to identify this group. Renal disease can also be caused by combination antiretroviral therapy (cART) [1]. As survival in HIV-infected patients improves, interest in cART-related renal toxicity continues to grow. Tenofovir (TDF) is a nucleotide reverse
transcriptase inhibitor that is an effective antiretroviral drug widely used as first-line treatment [7]. Although some data suggest that it is not reliably associated with increased renal toxicity [8-11], there are increasing numbers of reports and studies of renal tubular dysfunction, with rare reports of Fanconi syndrome [12-15]. Data from other studies confirm that TDF co-prescribed with a boosted protease inhibitor (PI) is associated with the highest risk of such toxicity [16-18]. Screening for proteinuria in HIV-infected patients is therefore important, as it is often an early indicator of underlying kidney dysfunction. check details There are different methods for routinely assessing proteinuria. How, and when, to screen for proteinuria continues to be debated. Urine dipstick analysis is frequently performed, but in the context of urine protein, it mainly detects albumin and may fail to identify those patients in whom protein in the urine is predominantly caused by other proteins. It is generally accepted that measurement of the urine protein/creatinine ratio (uPCR) and the urine albumin/creatinine ratio (uACR) is a relatively cheap (approximately £0.20 and £0.50, respectively) and effective way to screen for renal disease [19]. The specific test used often depends upon the laboratory practice.