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Kidney function of HIV-infected children in Lagos, Nigeria: using Filler's serum cystatin C-based formula
Christopher I Esezobor1, Edna Iroha, Olajumoke Oladipo
1Department of Paediatrics, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Nigeria. esezobor@gmail.com
Insights
HIV-infected children in Nigeria show impaired kidney function, with higher serum cystatin C levels and lower estimated glomerular filtration rate (eGFR) compared to healthy children. This highlights the need for monitoring renal health in pediatric HIV cases.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Public Health in Sub-Saharan Africa
Background:
- Limited data exists on kidney function in HIV-infected children in sub-Saharan Africa.
- Malnutrition in these children complicates standard kidney function diagnostics like creatinine-based eGFR.
- This study investigated kidney function markers in HIV-affected pediatric populations.
Purpose of the Study:
- To determine serum cystatin C levels and estimated glomerular filtration rate (eGFR) in HIV-infected children.
- To compare kidney function markers between antiretroviral-naïve HIV-infected children and healthy controls.
- To assess the impact of HIV on renal health in Nigerian children.
Main Methods:
- Serum cystatin C was measured using ELISA.
- Glomerular filtration rate (eGFR) was estimated using Filler's serum cystatin C formula.
- Statistical analyses included t-tests, Mann Whitney U, chi-square, and Fisher's exact tests to compare groups.
Main Results:
- HIV-infected children had significantly higher serum cystatin C levels (p=0.025) and a greater proportion with levels >1 mg/l (p=0.004) compared to controls.
- Mean eGFR was significantly lower in HIV-infected children (96.8 ml/min/1.73 m2) versus controls (110.5 ml/min/1.73 m2) (p=0.021).
- A higher proportion of HIV-infected children had eGFR <60 ml/min/1.73 m2 (13.3%) compared to controls (0%) (p=0.006).
Conclusions:
- HIV-infected children in Nigeria exhibit elevated serum cystatin C levels.
- These children also present with a reduced estimated glomerular filtration rate (eGFR) compared to their healthy peers.
- The findings underscore the significant impact of HIV on kidney function in this vulnerable pediatric population.
Background:
Limited data is available on kidney function in HIV-infected children in sub-Saharan Africa. In addition, malnutrition in these children further reduces the utility of diagnostic methods such as creatinine-based estimates of glomerular filtration rate. We determined the serum cystatin C level and estimated glomerular filtration rate of 60 antiretroviral-naïve, HIV-infected children and 60 apparently healthy age and sex matched children.
Methods:
Serum cystatin C level was measured using enzyme-linked immunosorbent assay technique, while glomerular filtration rate was estimated using Filler's serum cystatin C formula. Student t test, Mann Whitney U test, Pearson chi square and Fisher's exact test were used, where appropriate, to test difference between groups.
Results:
Compared to the controls, the HIV-infected group had significantly higher median (interquartile range) serum cystatin C levels {0.77 (0.29) mg/l versus 0.66 (0.20) mg/l; p = 0.025} and a higher proportion of children with serum cystatin C level >1 mg/l {10 (16.7%) versus one (1.7%); p = 0.004}. The HIV-infected children had a mean (+/- SD) eGFR of 96.8 (+/- 36.1) ml/min/1.73 m2 compared with 110.5 (+/- 27.8) ml/min/1.73 m2 in the controls (p = 0.021). After controlling for age, sex and body mass index, only the study group (HIV infected versus control) remained a significant predictor of serum cystatin C level (beta = -0.216, p = 0.021). The proportion of HIV-infected children with eGFR <60 ml/min/1.73 m2 was eight (13.3%) versus none (0%) in the control group (p = 0.006). However, the serum cystatin C level, eGFR and proportions of children with serum cystatin C level >1 mg/l and eGFR <60 ml/min/1.73 m2 were not significantly different between the HIV-infected children with advanced disease and those with milder disease.
Conclusions:
HIV-infected children in Nigeria have higher serum cystatin C level and lower eGFR compared to age and sex matched controls.
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