title: Strong correlation between protein reagent strip and protein-to-creatinine ratio for detection of renal dysfunction in HIV-infected patients: a cross-sectional study.
abstract: BACKGROUND
  Tubular dysfunction is common in HIV-infected people and detection of proteinuria is essential to identify this problem. In low-income countries, resources for detection of proteinuria using the Kidney Disease Improve Global Outcomes (KDIGO) gold standard urinary protein/creatinine ratio (uPCR) is rarely possible, and use of the protein reagent strip (PRS) could be an option in these places. The aims of this study were to establish the concordance between PRS and uPCR to detect tubular proteinuria in HIV-infected people, and to assess the sensitivity and specificity of PRS as a diagnostic method in this group.
  
  
  METHODS
  A cross-sectional study was conducted to evaluate the correlation between the two techniques to detect protein in urine. Participants were enrolled for a period of 6 months. The measurements were performed in participants who were on highly active antiretroviral therapy (HAART) or prior to the start of treatment. Proteinuria was defined as uPCR ≥ 150 mg/g, and/or ≥ trace on PRS. A phi coefficient was calculated to establish the degree of correlation. We assessed the sensitivity and specificity of PRS compared with uPCR using standard methods.
  
  
  RESULTS
  A total of 799 subjects were included. Of these, 737 (92%) were men. The mean age was 32.9 years (±10.1 years). Most (561, 70%) were on antiretroviral treatment. The mean estimated glomerular filtration rate (eGFR) calculated according to Modification of Diet in Renal Disease (MDRD)-4 was 113.0 mL/min (±22.6). Comorbidities included diabetes mellitus (10, 1.3%) and hypertension (17, 2.1%). The prevalence of proteinuria detected by PRS was 8.3% (n = 66) and by uPCR 10.6% (n = 85). The concordance assessed by phi correlation coefficient was 0.70, p < 0.001, with a sensitivity of 51.7% (95% confidence interval [CI] 41%-62%) and specificity 97% (95% CI 39%-97%).
  
  
  CONCLUSIONS
  There is a high concordance between detection of proteinuria by PRS and uPCR. Therefore, in low-income countries PRS can be helpful for detecting tubular damage in people infected with HIV.
authors: Nephrology Department, National Medical Center "La Raza", IMSS, Mexico City, Mexico.
authors: José Ignacio
authors: JI
authors: López De León
authors: Infectious diseases department, National Medical Center "La Raza", IMSS, Mexico City, Mexico.
authors: Jose Antonio
authors: JA
authors: Mata-Marín
authors: Nephrology Department, HGR 25, IMSS, Mexico City, Mexico.
authors: Karen
authors: K
authors: Andrade-Fuentes
authors: Pediatric Hospital, National Medical Center "Siglo XXI", IMSS, Mexico City, Mexico.
authors: Gloria
authors: G
authors: Huerta-Garcia
authors: Infectious diseases department, National Medical Center "La Raza", IMSS, Mexico City, Mexico.
authors: Juan C
authors: JC
authors: Domínguez-Hemosillo
authors: Infectious diseases department, National Medical Center "La Raza", IMSS, Mexico City, Mexico.
authors: Jesus
authors: J
authors: Gaytán-Martínez
keywords: Human immunodeficiency virus; Protein reagent strip; Protein-to-creatinine ratio