Microalbuminuria, proteinuria and associated factors among HIV infected children attending hiv care and treatment clinic at Muhimbili national hospital, Dar es salaam, Tanzania

Abstract

Background: Human immunodeficiency virus (HIV) infection is still a global challenge, and Sub-Sahara African countries including Tanzania contribute a great proportion in this epidemic disease. Children are among the most vulnerable group to HIV infection and acquire HIV infections mainly through mother to child transmission, which may occur in utero, intra-partum or through breastfeeding. HIV complications are attributed to either opportunistic infections or direct effects of virus to tissues. In the era of Highly Active Anti-retroviral Therapy (HAART), there has been a reduction in the incidence of opportunistic infections with reduction of both morbidity and mortality, which has paved way for manifestation of non-infectious complications including renal complications. The most common renal complication of HIV infection is HIV associated nephropathy whose earliest manifestation is microalbuminuria and proteinuria, and children of African descent are at risk of this complication. There is limited information on HIV associated nephropathy in children in Tanzania, although some studies have documented its occurrence in adults. Objective: This study determined the prevalence of proteinuria and microalbuminuria and associated factors among HIV infected children attending HIV care and treatment clinic at Muhimbili National Hospital. Methodology: This is a cross-sectional hospital based study which was conducted among HIV infected children aged between one year and 14 years. The children were consecutively recruited from paediatric HIV care and treatment clinic between February, 2011 and March, 2011. Standardized questionnaires were used to collect socio-demographic characteristics and clinical presentation of study participants. Spot urine was used to determine microalbuminuria and proteinuria using Microalbumin 2-1 combo test strips and dipsticks respectively. Serum creatinine, blood urea nitrogen, white blood cell count, CD4 count, haemoglobin level and renal ultrasound were performed. Results: A total of 240 HIV infected children were recruited into this study. One hundred and seven (44.6%) were female. Mean age of participants was 7.6 ± 3.7 years. Two hundred and nineteen (91.2%) were using anti-retroviral drugs. Forty nine children (20.4%) had microalbuminuria and 17 (7.1%) had proteinuria. Prevalence of proteinuria was noted to be vi significantly higher among children aged 10 years and above (p<0.05). Children with CD4+ percent < 25% were noted to have higher prevalence of microalbuminuria (p<0.01) and proteinuria (p<0.01) as compared to those with CD4+ above 25%. Children with microalbuminuria had significantly lower mean CD4+ count (937.4 ± 595.3 cell/μL) than those without microalbuminuria (1164.7 ± 664.3 cell/μL), p<0.05, similarly children with proteinuria had significantly lower mean CD4+ count (675.5 ± 352.3 cell/μL) as compared to those without proteinuria (1152 ± 662 cells/μL), p<0.001. Of the 153 children who had renal ultrasound performed 28 (11.7%) had increased cortical echogenicity, however no difference were noted on renal ultrasound findings between children with microalbuminuria/proteinuria and those without. Conclusion: Microalbuminuria and proteinuria were prevalent in HIV infected children, and children with low CD4 counts and percent were more likely to have both microalbuminuria and proteinuria. Recommendation: HIV infected children should be screened for proteinuria at initial visit and annually thereafter.