Prevalence, risk factors, and histological pattern of kidney disease in patients with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome at Aminu Kano Teaching Hospital: A clinicopathologic study

Abstract

Background: Renal disease in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) contributes significantly to morbidity and mortality associated with HIV infection worldwide. Aim: To determine the prevalence, risk factors, and histological pattern of kidney disease in HIV-positive patients in Kano, Nigeria. Materials and Methods: Four hundred consecutive treatment naοve HIV-positive patients with no other condition known to cause kidney disease were screened for proteinuria and reduced glomerular filtration rate (GFR). Kidney disease was defined as the presence of persistent microalbuminuria/proteinuria or decreased GFR (<60 ml/min/1.73 m 2 ). Kidney biopsy was performed on 20 patients. Data were analyzed using SPSS version 17. Results: The mean ± standard deviation age of the study population was 34.03 ± 10.23 years with 240 (60%) being females. Kidney disease was found in 227 patients (56.8%), with a higher prevalence seen in males (odds ratio = 1.9305, 95% confidence interval = 1.2760-2.9207, P = 0.0018). Proteinuria including persistent microalbuminuria was found in 211 (52.8%) and reduced GFR was found in 64 (16.0%). The risk factors for developing kidney disease were age >40 years, male gender, low CD4 cell count, cigarette smoking, low body mass index, and low serum cholesterol. Logistic regression identified low CD4 cell count as an independent risk factor for kidney disease. Collapsing focal segmental glomerulosclerosis (FSGS) was the predominant histological pattern seen. Conclusion: The prevalence of renal disease in HIV-positive patients was high in Kano, Nigeria; and microalbuminuria was a manifestation of collapsing FSGS.