title: Long-Term Follow-Up of Proteinuria and Estimated Glomerular Filtration Rate in HIV-Infected Patients with Tubular Proteinuria.
abstract: OBJECTIVE
  The objective of this prospective observational study was to describe the evolution of tubular proteinuria detected in HIV-infected patients, and to evaluate the impact of tenofovir disoproxil fumarate (TDF) discontinuation.
  
  
  METHODS
  Proteinuria and estimated glomerular filtration rate (eGFR) were followed during a median duration of 32 months, in 81 HIV-infected patients with tubular proteinuria and eGFR ≥ 60 ml/min/1.73 m2 (determined using the Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration equation). Tubular proteinuria was defined by urine protein to creatinine ratio (uPCR) ≥200 mg/g and albumin to protein ratio (uAPR) <0.4.
  
  
  RESULTS
  Twenty per cent of patients had persistence of tubular proteinuria: TDF continuation was the main factor associated with this persistence [OR 9.0; 95%CI: 1.9-41.4; p = 0.01]. Among the 23 patients who discontinued TDF, uPCR returned below the threshold of 200 mg/g in 11 patients. Overall, eGFR decreased with a mean rate of decline of 3.8 ml/min/1.73m2/year. The decline in eGFR was lesser after discontinuation of TDF (5.8 ml/min/1.73m2/year during TDF exposure versus 3 ml/min/1.73m2/year after TDF discontinuation; p = 0.01).
  
  
  CONCLUSIONS
  The continuation of TDF was the main factor associated with the persistence of proteinuria. Moreover, proteinuria was normalized in only half of the patients who discontinued TDF. The clinical significance of TDF-related low level of proteinuria as a factor associated with renal disease progression and bone loss remains poorly understood.
authors.affiliation: UMI 233/INSERM U1175, Institut de Recherche pour le Développement, Université Montpellier, Montpellier, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Peyriere
authors.affiliation: UMI 233/INSERM U1175, Institut de Recherche pour le Développement, Université Montpellier, Montpellier, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Cournil
authors.affiliation: Centre Hospitalier Universitaire, Département des Maladies Infectieuses et Tropicales, Montpellier, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Casanova
authors.affiliation: Centre Hospitalier Universitaire, Département de Biochimie, Montpellier, France.|UMR 204 NUTRIPASS, Université Montpellier, Montpellier, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Badiou
authors.affiliation: Centre Hospitalier Universitaire, Département de Biochimie, Montpellier, France.|UMR 204 NUTRIPASS, Université Montpellier, Montpellier, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cristol
authors.affiliation: UMI 233/INSERM U1175, Institut de Recherche pour le Développement, Université Montpellier, Montpellier, France.|Centre Hospitalier Universitaire, Département des Maladies Infectieuses et Tropicales, Montpellier, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Reynes
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000494:pharmacology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D007684:Kidney Tubules / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D011507:Proteinuria / Q000150:complications* / Q000503:physiopathology; D000068698:Tenofovir / Q000494:pharmacology; D013997:Time Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir