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Low-grade proteinuria is highly prevalent in HIV-positive patients on antiretroviral treatment

Gravemann, Sophiab,d,*; Brinkkoetter, Paul T.a,e,*; Vehreschild, Jörg J.b,d; Franke, Berndb; Ehren, Kathrinb; Bünemann, Elisabethb; Orbach, Henningb; Wei, Verena; Hellmich, Martinc; Benzing, Thomasa,e,f,g; Fätkenheuer, Gerdb,d

doi: 10.1097/QAD.0000000000000324
Clinical Science: Concise Communications

Objectives: HIV-positive patients are at an increased risk for chronic kidney disease. However, these data mainly derive from cohorts with a high percentage of African-American patients, representing a specific ethnical risk group for chronic kidney disease. The aim of this study was to estimate the prevalence and risk factors specifically for early signs of kidney dysfunction in a large, predominantly white cohort of HIV patients.

Design: Cross-sectional study.

Methods: Prevalence of low-grade proteinuria was measured by quantitative analysis of urinary protein-to-creatinine ratio (cutoff >70 mg/g) and further differentiated by assessing α1-microglobulin (tubular proteinuria) and albumin-to-creatinine ratio (glomerular proteinuria) of HIV patients attending the University Hospital in Cologne, Germany. Together with standard and HIV-related laboratory findings and medical history, risk factors for each form of proteinuria were identified using multivariate forward selection.

Results: Of 945 enrolled patients, 55% were identified with low-grade proteinuria, 41% with tubular proteinuria, and 20% with glomerular proteinuria. Older age was a risk factor for all forms of proteinuria in multivariate analysis. Low-grade proteinuria was also associated with concomitant diabetes and exposure to nucleoside reverse transcriptase inhibitor [anytime during HIV infection, not tenofovir (TDF)-specific], whereas tubular proteinuria was linked to current and any exposure to nucleoside reverse transcriptase inhibitor (TDF-specific). Further risk factors for glomerular proteinuria were hypertension and diabetes in this cohort.

Conclusion: Low-grade, glomerular and tubular proteinuria are highly prevalent in this large white HIV cohort. Older age represents a nonmodifiable risk factor for all forms of proteinuria. Glomerular proteinuria is associated with modifiable cardiovascular, but not HIV-related risk factors, whereas tubular proteinuria is linked to TDF exposure.

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aDepartment II of Internal Medicine

bDepartment I of Internal Medicine, University Hospital of Cologne

cInstitute of Medical Statistics, Informatics and Epidemiology, University of Cologne

dGerman Centre for Infection Research (DZIF), Partner Site Bonn-Cologne

eCenter for Molecular Medicine Cologne

fCologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD)

gSystems Biology of Ageing Cologne, University of Cologne, Cologne, Germany.

*Dr Sophia Gravemann and Dr Paul T. Brinkkoetter contributed equally to the writing of the article.

Correspondence to Sophia Gravemann, MD, Department I of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. Tel: +49 221 478 3324; fax: +49 221 478 88646; e-mail:

Received 20 January, 2014

Revised 28 April, 2014

Accepted 29 April, 2014

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© 2014 Lippincott Williams & Wilkins, Inc.