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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 5  |  Page : 1025-1026
Author's Reply


Department of Child Health, University of Benin/University of Benin Teaching Hospital, Benin City, Nigeria

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Date of Web Publication12-Sep-2013
 

How to cite this article:
Iduoriyekemwen NJ, Sadoh WE, Sadoh AE. Author's Reply. Saudi J Kidney Dis Transpl 2013;24:1025-6

How to cite this URL:
Iduoriyekemwen NJ, Sadoh WE, Sadoh AE. Author's Reply. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Nov 21];24:1025-6. Available from: http://www.sjkdt.org/text.asp?2013/24/5/1025/118086
To the Editor,

I wish to thank Prof. Mahmood Dhahir Al-Mendalawi for his comments on our article entitled, "Prevalence of Renal Disease in Nigerian Children Infected with the Human Immuno-deficiency Virus (HIV) and on Highly Active Anti-retroviral Therapy (HAART)". We respond to his comments as follows:

He has raised several issues: (a) Microalbuminuria (MA) is not very common in Nigerian children irrespective of HIV status, (b) highly active anti-retroviral therapy (HAART) does not seem to alter the prevalence of MA and (c) the need for caution in interpreting our results as TB co-infection was not addressed in the exclusion criteria.

We disagree with the conclusion that MA is uncommon in HIV-infected Nigerian children as several other studies [1],[2],[3] have shown the presence of MA in HIV-infected Nigerian children. The single study by Ezeonwu et al, [4] which found no MA, cannot be used to conclude that MA is uncommon in Nigerian HIV-infected children. It should be noted that in both our study and in the study of Eke et al, [1] MA was associated with advanced HIV disease, whereas in the study of Ezeonwu et al, [4] children with advanced disease were under-represented. In addition, the duration of exposure to HAART in our study was longer than that of the children in the study by Ezeonwu et al. [4] Thus, allowing more time to elapse for possible renal damage might have resulted in the MA that was observed in the children we studied.

We agree that evidence in the literature abounds that the initiation of HAART reduces proteinuria and thus slows down or even halts the progression of HIVAN. [5],[6],[7],[8] However, what is not known is the long-term effect of HAART on the kidney, especially as more children are surviving the infection. Based on this premise, the objective of our study was to determine whether evidence of renal disease can also be seen in children who have been on HAART. In order to detect early renal disease, MA, a predictor of sub-clinical renal involvement in systemic disease that precedes proteinuria, was used as one of the parameters. We found MA in 11.1% of the children in our study when we expected to find none, which shows that MA is not uncommon in Nigerian children on HAART.

Unfortunately, very few studies have been carried out on the presence of renal disease in children on HAART. Further studies, especially long-term longitudinal and biopsy-based studies, are needed. Until results of such studies are available, inclusion of MA in the diagnostic algorithm of renal involvement of HIV-infected patients is reasonable.

Co-infection of tuberculosis (TB) with HIV is indeed common in Nigerian children, and TB does significantly contribute to proteinuric renal disease in HIV-infected children. Although we did not include TB co-infection as an exclusion criterion, we have reviewed the data and noted that of the 11 children with MA, seven had a past history of pulmonary TB and had completed treatment for TB, while four had no TB co-infection. Thus, it is unlikely that TB was contributory to the observed MA in the children we studied.

 
   References Top

1.Eke FU, Anochie IC, Okpere AN, et al. Microalbuminuria in children with human immunodeficiency virus (HIV) infection in Port Harcourt, Nigeria. Niger J Med 2010;19:298-301.  Back to cited text no. 1
[PUBMED]    
2.Ikpeme EE, Ekrikpo UE, Akpan MU, Ekaidem SI. Determining the prevalence of Human Immunodeficiency Virus Associated nephropathy (HIVAN) using proteinuria and ultrasound finding in a Nigerian paediatric HIV population. Pan African Med J 2012;11:13. Available from: http://www.panafrican-med-journal.com/content/article/11/13/full/ [Last assessed on 2013 Mar 14].  Back to cited text no. 2
    
3.Iduoriyekemwen NJ, Sadoh WE, Sadoh AE. Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy. Saudi J Kidney Dis Transpl 2013;24:172-7.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Bertilla Uzoma E, Henrietta Uchenna O, Anthony Nnaemeka I, Tagbo O. Screening for Microalbuminuria in HIV-Positive Children in Enugu. Int J Nephrol 2012;2012:805834.  Back to cited text no. 4
[PUBMED]    
5.Lucas GM, Eustace JA, Sozio S, Mentari EK, Appiah KA, Moore RD. Highly active anti-retroviral therapy and the incidence of HIV-1-associated nephropathy: A 12-year cohort study. AIDS 2004;18:541-6.  Back to cited text no. 5
[PUBMED]    
6.Atta MG, Gallant JE, Rahman MH, et al. Anti-retroviral therapy in the treatment of HIV-associated nephropathy. Nephrol Dial Transpl 2006;21:2809-13.  Back to cited text no. 6
    
7.Shah I. Response of HIV- Associated Proteinuria to Antiretroviral therapy in HIV-1 infected children. Braz J Infect Dis 2006;10:408-10.  Back to cited text no. 7
[PUBMED]    
8.Ramsuran D, Bhimma R, Ramadial PK, et al. The spectrum of HIV-related nephropathy in children. Pediatr Nephrol 2012;27:821-7.  Back to cited text no. 8
    

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Correspondence Address:
Nosakhare J Iduoriyekemwen
Department of Child Health, University of Benin/University of Benin Teaching Hospital, Benin City
Nigeria
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DOI: 10.4103/1319-2442.118086

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