HIV Nephropathy among children in the Ashanti Region of Ghana

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JUNE, 2016
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Background: HIV nephropathy (HIVAN being the commonest) remains one of the important non-infectious complications of HIV infections, affecting especially children of Sub Saharan Africa and African-Americans origin and is the third leading cause of end-stage renal disease (ESRD) among blacks. Currently the definitive diagnostic method for diagnosing HIV nephropathy is kidney biopsy, an invasive technique which requires special skills and which could pose potential risks for clients’ aside the fact that the technique is not available in majority of the health – care facilities attending to and administering antiretroviral therapies (ARTs) in Ghana. The study determined the prevalence of dipstick microalbuminuria and proteinuria among the study participants and also established the prevalence of HIV nephropathy using eGFR < 60 ml min-11.73 m-2 in addition to microalbuminuria and or proteinuria among the HIV positive participants. Materials and methods: A total of 530 participants, including 380 HIV infected children (cases) and 150 HIV negative children (controls) attending three different ART centers namely Suntreso Government Hospital, Agogo Presbyterian Hospital and Komfo- Anokye Teaching Hospital all in the Ashanti Region were involved in the study. Five (5) mls of blood specimen was collected from each participant through a venesection into a serum gel separator tube (3mls) and an ethylenediamine tetra acetic acid (EDTA) tube (2mls). The serum samples were analysed for creatinine and cystatin-C while the EDTA samples were analysed for full blood count (FBC) and CD4 count. Additionally, urine samples were collected and urinalysis as well as microalbumin determination was done for each subject. Urine deposits were examined microscopically for urinary sediments. Results: There was no significant difference in age between the case group (HIV infected participants) and control group (HIV negative participants) (7.4 ± 2.6 and 7.5± 2.5years, p=0.7729 respectively). The control group were significantly heavier (20.2 ± 6.6 kg) when compared with the case group (18.7 ± 6.7, p=0.0232). BMI was significantly higher in the control group (15.6 ± 2.0 kg m-2) compared with the case group (14.7 ± 1.8 kg m-2, p<0.0001). The proportion of participants within the case group who were on drugs was 77.1%; mean duration of infection of 3.7 ± 2.4 years with a mean duration on drugs of 3.1 ± 2.2 years. A Chi-square for trend analysis showed a significant difference in the number of the participants within the sub-categories of growth with 11.3% of the case group falling within the category of grade 3 thinness compared to 2.0% for the control group. 8.6% of the participants within the case group versus 4.0% of the participants within the control group had grade 2 thinness. 12.7% of the participants within the case group and 9.4% of those within the control group were within the grade 1 thinness category. The case group had significantly higher proteinuria 47(13.0%) compared to the control group 0(0.0%); p < 0.0001. Similarly microalbuminuria was significantly higher in the case group 95(26.2%) compared to the controls 9(6.0%); p < 0.0001. Again urinary cast and crystals were significantly higher in the case group compared to the controls 35(9.7%) and 2(1.3%); p = 0.001 and 30(8.3%) and 0(0.0%); p= 0.0003 respectively. Other urinary deposit elements such as yeast like cells were also significantly higher in the case group 16(4.4%) compared to the control group 0(0.0%); p=0.0091.The prevalence of HIV nephropathy (eGFR <60 ml min-1 1.73 m-2 with microalbuminuria and or proteinuria) using creatinine-based (Schwartz, Counahan-Baratt and Leger equations) and Cystatin C-based (Larsson, Rule and Zapittelli equations)eGFR equations were 27.6%, 29.1% and 29.6% for Leger, Counahan-Barat and Schwartz equations and 21.1%, 28.2% and 30.6% for Rule, Larson and Zapittelli respectively. Conclusion: Microalbumin and proteinuria are prevalent among children living with HIV/AIDS in Ghana. These in association with eGFR< 60 ml min-11.73 m-2 estimated using either a creatinine or cystatin-C based equation could be the easiest, cheapest, readily available and fastest way of diagnosing HIV nephropathy among such children. 
Thesis submitted to the department of molecular medicine in fulfilment of requirement for the award of Master of Philosophy (Chemical Pathology). By Felix Sorvor June, 2016