1 - Pediatrics Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.;
2 - Nephrology Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.;
3 - Infectious Diseases Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.
- Excellence in Paediatrics 2012, Madrid, Espanha, 28/11-01/12/2012 (Poster).
Introduction: Nephropathy in HIV infected patients may result from viral infection, immune mechanisms or toxicity of highly effective antiretroviral therapy (HAART), mainly tenofovir. Before the era of HAART, about 40% of HIV-infected children developed renal complications. The actual incidence of these pathologies in pediatric patients is unknown and clinical guidelines were only established for adults.
Purpose: Elaboration and application of a protocol of nephrological survey to a population of HIV-infected children and adolescents followed in a immunodeficiency appointment and determination of incidence of nephropathy.
Material and Methods: Determination of demographical, clinical and laboratorial parameters.
Results: Ninety seven patients were included, 51.5% were male and 49.5% of African origin. The median age was 14 years (3-19 years). Most patients were infected with HIV type 1 virus (94.9%) and vertical transmission was the most frequent pathway of infection (91.8%). In 86.6% of cases patients were receiving HAART, and in 23.8% of these, treatment included tenofovir. None of the children had CD4+<200 and 73.6% had CD4+>500. Viral load was indetectable or <1000 in 78.4%. Two patients had chronic kidney disease (1 in peritoneal dialysis) and 1 had proteinuria and high blood pressure. In the remaining patients, microalbuminuria was found in 1.7%. Urinary excretion of calcium was elevated in 8.5% and of phosphate in 3.4% (71.4% receiving tenofovir); none of the patients had alteration of the urinary excretion of uric acid.
Conclusions: In this population, some renal alterations were found. A longer follow-up is needed to confirm these findings and establish timing for onset and periodicity of screening.
Palavras-chave: HIV nephropathy, antiretroviral therapy, nephrotoxicity, survey protocol.