16th Annual Conference of the British HIV Association

21-23 April 2010, Manchester, UK

THE VALUE OF URINE PROTEIN/CREATININE (uPCR) AND ALBUMIN/CREATININE RATIOS (uACR) IN ASSESSING RENAL DISEASE IN HIV INFECTION

HIV Med 2010 Apr 21-23; 11(Suppl. 1):10 (abstract no. O27) A Samarawickrama, S Holt, K Nambiar, M Fisher and Y Gilleece Brighton and Sussex University Hospitals, Brighton, UK

BACKGROUND: Renal disease in HIV can be due to the virus, combination antiretroviral therapy (cART) or other pathology. Low level proteinuria in patients on cART is common but there is continued uncertainty as to its significance, and its value for screening and monitoring. We analysed the utility of measuring urine protein/creatinine ratio (uPCR) and albumin/creatinine ratio (uACR) concurrently in assessing renal disease.

METHODS: Simultaneous uPCR and uACR (mg/mmol) values were assessed in patients attending an HIV clinic over 2.5 years. Markers of renal function and cART use were analysed. Statistical significance was assessed by one-way analysis of variance (ANOVA) or a 2 test as appropriate.

RESULTS: Of 6132 uPCR results (1437 patients), 368 (6%) had uPCR >50. There were 206 simultaneous uPCR and uACR results from 123 patients, of whom 120 were cART-experienced. Samples were categorised into 3 groups: uPCR 50 and uACR 50 and uACR >30 (probable glomerular proteinuria) (see table). Of 18 (15%) patients with heavy proteinuria (uPCR >100), 16 had non-HIV/cART-related renal injury. Of these, 7 had a renal biopsy: 6 showed glomerular or other pathology (mean uPCR 190, mean uACR 150, ACR/PCR=80%), and 1 showed no glomerular injury, but minor tubular cART-related abnormalities (mean uPCR 151, mean uACR 20, ACR/PCR=15%).

Trivial proteinuria (n=145)

Probable tubular

proteinuria (n=33)

Probable glomerular proteinuria

(n=28) p value

Mean eGFR, ml / min / 1.73 m2 (SD)

57.8 (5.21) 58.6 (3.03) 57.5 (5.74) 0.637

Mean plasma phosphate, mmol / l (SD)

0.86 (0.22) 0.74 (0.24) 0.94 (0.20) 0.002

Any tenofovir (TDF) use up to sampling, n (%)

132 (92) 33 (100) 21 (78) 0.004

TDF at time of sampling n (%)

64 (44) 17 (52) 13 (46) 0.742

CONCLUSIONS: High uPCR with low uACR may identify patients with tubular proteinuria suggested by lower plasma phosphate levels. Use of uPCR alone risks misdiagnosing glomerular disease as tubular and may lead to unnecessary alteration of cART regimens. In patients with significant proteinuria (uPCR >50) measuring both uPCR and uACR may assist in the diagnosis of renal disease.

2010-04-23 O27

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Local Disk[O27] The value of urine protein/creatinine (uPCR) and albumin/creatinine ratios (uACR) in assessing renal disease in HIV infection