Strategies for early detection of renal injury in HIV-infected patients : the new troponin
Year: 2011
Type: dissertation
Abstract: Background: HIV-infected patients have a known increased risk of kidney disease. For that reason, a biomarker that enables reliable detection of early and mild kidney dysfunction would be advantageous. Cystatin C is considered to be a better marker of kidney function than creatinine. Objectives: This study aimed to evaluate if serum cystatin C was a better marker than creatinine in a HIV-infected population. Material and Methods: This was an observational study of HIV-infected patients that attend the Infectious Diseases Department, at the Hospital Santa Maria, Lisbon. Patients with known kidney disease or HIV-2 infection were excluded. Clinical and demographic data was recorded and serum creatinine and cystatin C levels were determined. Results: A total of 242 patients were included. Cystatin C is an independent factor of age, gender, ethnicity and body mass index. Of the 17 patients with elevated levels of cystatin C but with an estimated creatinine clearance within normal range, 11 were on antiretroviral therapy with tenofovir and/or atazanavir. Fourteen patients were smokers and 10 patients had hepatitis C virus co-infection, which are known causes of inflammation. In a matched control group of 27 patients, with cystatin C within normal range, the majority of patients also were on an antiretroviral regimen with tenofovir and/or atazanavir. However, none of them had hepatitis C virus co-infection. Moreover, a statistical association was found between high levels of cystatin C and alanine transaminase. Differences between biomarkers’ levels and patients on combinations with tenofovir, ritonavir boosted atazanavir or both were also studied. Although it was not found any statistically significant difference in creatinine and estimated creatinine clearance, with cystatin C, patients that were on atazanavir or tenofovir and had a higher level of cystatin C, compared with patients that never were on these drugs. Conclusion: Cystatin C levels may be increased in inflammatory conditions. Therefore, in HIV-infected patients, where chronic systemic inflammation is present, often associated to other inflammation sources, such as chronic hepatitis C virus co-infection, the use of cystatin C to monitor kidney function may overestimate kidney impairment. In what concerns to nephrotoxicity, it was found that patients on atazanavir had higher levels of cystatin C. It is important to develop prospective studies, in order to assess the real long-time impact of the more recent antiretroviral drugs on kidney function.
Author: Sara Sofia dos Santos Brilha
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2264097613