Strong correlation between protein reagent strip and protein-to-creatinine ratio for detection of renal dysfunction in H
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RESEARCH
Open Access
Strong correlation between protein reagent strip and protein-to-creatinine ratio for detection of renal dysfunction in HIV-infected patients: a cross-sectional study José Ignacio López De León1*, Jose Antonio Mata-Marín2, Karen Andrade-Fuentes3, Gloria Huerta-Garcia4, Juan C Domínguez-Hemosillo2 and Jesus Gaytán-Martínez2
Abstract Background: Tubular dysfunction is common in HIV-infected people and detection of proteinuria is essential to identify this problem. In low-income countries, resources for detection of proteinuria using the Kidney Disease Improve Global Outcomes (KDIGO) gold standard urinary protein/creatinine ratio (uPCR) is rarely possible, and use of the protein reagent strip (PRS) could be an option in these places. The aims of this study were to establish the concordance between PRS and uPCR to detect tubular proteinuria in HIV-infected people, and to assess the sensitivity and specificity of PRS as a diagnostic method in this group. Methods: A cross-sectional study was conducted to evaluate the correlation between the two techniques to detect protein in urine. Participants were enrolled for a period of 6 months. The measurements were performed in participants who were on highly active antiretroviral therapy (HAART) or prior to the start of treatment. Proteinuria was defined as uPCR ≥ 150 mg/g, and/or ≥ trace on PRS. A phi coefficient was calculated to establish the degree of correlation. We assessed the sensitivity and specificity of PRS compared with uPCR using standard methods. Results: A total of 799 subjects were included. Of these, 737 (92%) were men. The mean age was 32.9 years (±10.1 years). Most (561, 70%) were on antiretroviral treatment. The mean estimated glomerular filtration rate (eGFR) calculated according to Modification of Diet in Renal Disease (MDRD)-4 was 113.0 mL/min (±22.6). Comorbidities included diabetes mellitus (10, 1.3%) and hypertension (17, 2.1%). The prevalence of proteinuria detected by PRS was 8.3% (n = 66) and by uPCR 10.6% (n = 85). The concordance assessed by phi correlation coefficient was 0.70, p < 0.001, with a sensitivity of 51.7% (95% confidence interval [CI] 41%–62%) and specificity 97% (95% CI 39%–97%). Conclusions: There is a high concordance between detection of proteinuria by PRS and uPCR. Therefore, in low-income countries PRS can be helpful for detecting tubular damage in people infected with HIV. Keywords: Protein reagent strip, Protein-to-creatinine ratio, Human immunodeficiency virus
Background Kidney disease is a complication that is observed in 10%–30% of patients infected with human immunodeficiency virus (HIV), and is a common cause of morbidity and mortality [1,2]. In Mexico, an estimated 175,093 HIV-infected individuals are included in national registries * Correspondence: [email protected] 1 Nephrology Department, National Medical Center “La Raza”, IMSS, Mexico City, Mexico Full list of author information is available at the end of the article
[3]. The increased survival of HIV-infected patients has changed the course
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