JURNALUL PEDIATRULUI – Year XII, Vol. XII, Nr. 45-46, january-june 2009 27 RENAL CONSEQUENCES IN HIV INFECTED CHILDREN K.R. Nilima 1 , Mihai Gafencu 1 , Gabriela Doros 1 , C.N. Thanki 2 , M. Lesovici 3 , Margit Serban 1 1 IIIrd Pediatric Clinic, Children Emergency Hospital, Timisoara 2 University of Medicine and Pharmacy ‘Victor Babes’Timisoara, 3 Laboratory, Children Emergency Hospital, Timisoara, Romania Abstract Background and Aim: Renal dysfunction is seen after years of HIV infection in adults but the true prevalence of childhood HIV nephropathy is unknown. HAART has been beneficial not only for long term patient survival but also to slow down the process of renal involvement and rapid progression to end stage renal disease. HIV infection can have a renal impact conditioned by the induced immunodeficiency (autoimmunity, infection) or by its highly aggressive therapeutical approach. The aim was to study the renal involvement of long term HIV infection in 91 children and adolescents. Materials and Methods: The study lot comprised 91 HIV patients (6 weeks-19 years old) admitted in the period of September 2008 - February 2009. All were previously diagnosed cases in different HIV stages. 70.32% of patients have been on HAART (2 NRTI + 1 PI) and rest on double or single anti retroviral drugs. Results: 32.96% of patients were hypertensive (16.66% borderline, 66.66% stage1, 10.12% stage 2, and 6.66% stage 3). Hematuria in Addis cell count was present in 8.79% and proteinuria was found in 5.49% patients all in stage C2 and C3. On 24 hr urine samples we found 25.57% having high chloride levels, 6.59 with natriuria. Urinary levels of potassium and calcium were within normal range. Metabolic acidosis was found in 31.86%. 8.79% had hyperkalemia and 5.49% had hypernatremia in stage C2 and C3. 2.19% had low creatinine clearance (in stage C2). Urinary tract infection (UTI) was diagnosed in 13.18% (91.66% with E.Coli & 8.33% with Proteus); associated mild hydronephrosis in 5.49% and renal calculi in 3.29% of patients have been identified. 27.47% had a high viral load at the time of study. Conclusion: Renal involvement in HIV positive children is a frequent finding. Hence, measuring early urinary biomarkers can help in early detection of kidney disease and to prevent ESRD in HIV-infected children. Metabolic acidosis and hyperkalemia were positive findings without any evidence of kidney damage seen in our patients. The presence of proteinuria in only 5.49% patients was suggestive of none having severe glomerular lesions. There is evidence that HAART treatment has a beneficial effect on kidney disease progression as the same can be seen in our patients. We can conclude that the impact of long term HIV infection in our study lot affects the renal function, but on a slow velocity. Key words: HIV, nephropathy, children. Introduction HIV infection/AIDS is a global pandemic, with cases reported virtually from every country. In Romania we were confronted HIV/AIDS being is one of the world’s most devastating diseases; nearly 25 million people have died worldwide, since 5 th June 1981, since the first case was diagnosed by Dr. M. Gottlieb (from UCLA). The current estimates of the number of persons living with HIV infection worldwide are over 42 million. Though children represent only 6% out of it, they accounted for 18% of the 3 million AIDS deaths approximately every year. Only 4% out of the one million people now on antiretroviral treatment are children. Unlike adults where more than 90% of the time HIV infection occurs through sexual route, in children 95% of cases occur due to Vertical Transmission from their infected parents. Among the various organs which are involved with the progression of HIV infection, kidney is also a part of it. Hence, HIV-associated nephropathy (HIVAN) is a type of kidney disease that occurs in patients who are infected with the human immunodeficiency virus (HIV). In 1984, clinicians in New York and Miami reported HIV-infected patients with heavy proteinuria (often > 10 gm/day) and rapid progression to end-stage renal disease (ESRD) occurring within 1-2 years. Nephropathy associated with human immunodeficiency virus type 1 (HIV-1), is generally seen after years of HIV-1 infection, although in few cases early onset have been described (1). Associated AIDS is found in majority of patients with early-onset HIV associated nephropathy (2). Nearly 5 to 15 % of patients having well-controlled HIV-1 infection and an undetectable viral load in blood may have histologic stigmata of HIV- associated nephropathy (5). However, in these patients, actual AIDS had occurred in the course of the disease, which was not the same in our study group. A paper from NEJM 2005 suggested that HIV-associated nephropathy (HIVAN) can occur at any stage of HIV-1 infection (4). Attempts to estimate the number of HIV-infected or AIDS patients who have developed the HIV nephropathy are hindered by the fact that diagnosis of nephropathy in an HIV-infected patient does not lead to the diagnosis of AIDS; this diagnosis is made only when the HIV antibodies plus certain unusual infections occur. Appropriate accurate diagnosis based on HIV antibody detection until the age of 15 months is generally difficult and hence needs special additional parameters. (6) Striking similarities are encountered between patients having HIV associated or