How is proteinuria used as a marker for HIV kidney disease?
In addition to an impaired GFR as a sign of kidney disease in patients with HIV, often a patient with HIV will first present with only proteinuria and even microalbuminuria.
Proteinuria represents one of the pathognomonic hallmarks of HIV-induced glomerular disease, but also could represent early onset of cART-related kidney tubular injury.
All patients with HIV should have a dipstick urinalysis performed for detection of proteinuria.
The finding of proteinuria is an accurate and significant predictor of increased morbidity and mortality in patients with HIV. If the dipstick test result is positive, then a spot urine test for protein/creatinine ratio should be done to estimate the degree of proteinuria with a ratio >300 mg/g being a key cut-off level that requires further investigation.
Studies have shown that microalbuminuria may be an important indicator of the presence of kidney disease in patients with HIV, which is similar to the use of microalbuminuria in patients with diabetes.
However, current guidelines do require the measurement of microalbuminuria in this population.
