Document 0622
 DOCN  M95A0622
 TI    HIV nephropathy (HIVN) in children: early identification essential.
       American Pediatric Society 104th annual meeting and Society for
       Pediatric Research 63rd annual meeting; 1994 May 2-5; Seattle.
 DT    9510
 AU    Strauss J; Zilleruelo G; Abitbol C; Montane B; Scott G; Roias E;
       Canal-Cano T; Department of Pediatrics, University of Miami, FL, USA.
 SO    Pediatr AIDS HIV Infect. 1994 Oct;5(5):318 (unnumbered abstract). Unique
       Identifier : AIDSLINE AIDS/95330422
 AB    As we reported (N. Eng. J. Med. 1989; 321:625-630), HIV+ infants and
       children develop HIVN as often as adults, have a broader spectrum of
       histologic changes, and longer periods of time between onset of
       proteinuria and chronic renal failure. The purpose of this study was to
       further ascertain the natural history, clinical presentation, and
       outcome of HIVN in infants and children. Of 568 HIV+ pediatric patients
       seen at our Medical Center between 1 January 1981 and 1 September 1993,
       84 (14.8%) were diagnosed as having HIVN. Of 298 patients followed
       prospectively during a 53-month period (1 February 1989 to 1 September
       1993) because their mothers were HIV+, 44 (14.8%) had HIVN. HIVN was
       diagnosed when persistent abnormal proteinuria (Albulstix > or = 1+ in >
       or = 2 urines > or = 2 weeks apart) was documented in the absence of
       fever or positive urine culture. Most urines also were evaluated for
       protein/creatinine (UPr/Cr) ratios. In the 84 patients, mean age at
       onset of HIVN was 29.5 months (range 0-128, median 21.3 months; 20.8
       months in patients followed prospectively, and 39.4 months in those
       referred to us because of renal disease). 16 (19%) patients diagnosed as
       having HIVN developed renal insufficiency (4 HIV+, 12 with AIDS). 47
       (56%) patients with HIVN developed a nephrotic syndrome (10 HIV+, 37
       with AIDS). 50% of patients with HIVN expired, all from non-renal
       causes. 5 (6%) patients with HIVN have been dialyzed. We conclude that
       HIV+ infants and children have a high risk of developing HIVN (higher
       than that estimated for adults), and that HIVN can be identified
       prospectively long before the patient has clear evidence of renal
       disease. Thus, screening for proteinuria in HIV+ children is essential
       for early diagnosis of HIVN and eventual treatment.
 DE    AIDS-Associated Nephropathy/*DIAGNOSIS  Child  Child, Preschool  Human
       HIV Seropositivity/URINE  Kidney Failure,
       Chronic/COMPLICATIONS/DIAGNOSIS  Nephrotic
       Syndrome/COMPLICATIONS/DIAGNOSIS  Prospective Studies  Proteinuria
       MEETING ABSTRACT  JOURNAL ARTICLE

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