Renal Function Abnormalities in HIV-infected Children and Adolescents on Antiretroviral Therapy at the University of Abuja Teaching Hospital, Gwagwalada, Nigeria: A Cross-sectional Study

Aims: To determine the degree of renal function abnormalities in HIV positive children and adolescents on highly active antiretroviral therapy in our health institution for baseline information and intervention.
Study Design: A cross sectional hospital based study.
Place and Duration of Study: Department of Paediatrics (Paediatric Outpatient Special Treatment Clinic), University of Abuja Teaching Hospital, Gwagwalada, and Zankli Hospital, Abuja.
Methodology: 161 HIV positive children and adolescents (103 males and 58 females, aged 6months to 18 years who were on highly active antiretroviral therapy overtime in our hospital were studied from February to May 2016. Clinical evaluation was carried out which included: blood and urine for urea, electrolytes, creatinine, CD4 cell count, viral load, microalbumin, protein, and heamaturia. Glomerular filtration rate estimate was also calculated with modified Schwartz equation, and kidney sizes assessed with a high-resolution real-time sonographic scanner.
Results: Of 161 patients studied, 137(85.1%) were on 1st line medications, 118 (73.3%) had normal eGFR of > 90 ml/min/1.73 m2, 22(13.7%) had urine albumin creatinine ratio of >30 mg/gm, 18 (11.2%) had haematuria, and 11(6.8%) had proteinuria. High viral load, and low CD4 cell count were the two most important variables in this study with risk factor for microalbuminuria [OR 4.64 (CI 2.671–8.237), p value = 0.0001] for viral load, and [OR 3.69 (CI 1.938–7.774), p values=0.0001 for CD4 cell count. Other variables with risk factors for microalbuminuria are presence of haematuria [OR 2.22 (1.172–10.240), p value= 0.03]; systolic hypertension [OR 2.73 (1.832–6.244), p value= 0.007]; duration on HAART [OR 2.74 (0.630–7.283), p value =0.041], and types of 1st and 2nd line HAART [OR 2.30 (0.542-6.431), p value= 0.037].
Conclusion: Renal function abnormalities are common among HIV positive children and adolescents on highly active antiretroviral therapy without adequate viral suppression. Regular renal function monitoring is to be institutionalized and supported in resource limited settings for earlier diagnosis to forestall development of chronic kidney disease.