Microalbuminuria predicts overt proteinuria among patients with HIV infection.
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 > or =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).


CONCLUSIONS
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.
Szczech
L A
LA
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. szcze001@mc.duke.edu
Menezes
P
P
Byrd Quinlivan
E
E
van der Horst
C
C
Bartlett
J A
JA
Svetkey
L P
LP
D000328:Adult; D000367:Age Factors; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications / Q000378:metabolism / Q000652:urine*; D015497:HIV-1; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D012367:RNA, Viral / Q000097:blood*
D015415:Biomarkers; D012367:RNA, Viral; D003404:Creatinine