albumin - publications

Predict more albumin - ligand interactions now!

1. HIV Med. 2012 Mar 14. doi: 10.1111/j.1468-1293.2012.01003.x. [Epub ahead of

Simultaneous measurement of urinary albumin and total protein may facilitate
decision-making in HIV-infected patients with proteinuria.

Samarawickrama A, Cai M, Smith E, Nambiar K, Sabin C, Fisher M, Gilleece Y, Holt

Brighton and Sussex Medical School, Brighton, UK; Brighton and Sussex University
Hospitals, Brighton, UK.

OBJECTIVE: We recently showed that a urine albumin/total protein ratio
(uAPR) < 0.4 identifies tubular pathology in proteinuric patients. In tubular
disorders, proteinuria is usually of low molecular weight and contains relatively
little albumin. We tested the hypothesis that uAPR is useful in identifying
tubular pathology related to antiretroviral use in HIV-infected patients.
METHODS: We retrospectively identified urine protein/creatinine ratios (uPCRs) in
HIV-infected patients. A subset of samples had uPCR and urine albumin/creatinie
ratio (uACR) measured simultaneously. We classified proteinuric patients
(uPCR > 30 mg/mmol) into two groups: those with predominantly 'tubular'
proteinuria (TP) (uAPR < 0.4) and those with predominantly 'glomerular'
proteinuria (GP) (uAPR ≥ 0.4). RESULTS: A total of 618 of 5244 samples from 1378
patients had uPCR ≥ 30 mg/mmol. uAPRs were available in 144 patients: 46 patients
(32%) had TP and 21 (15%) GP; the remainder had uPCR < 30 mg/mmol. The TP group
had a higher fractional excretion of phosphate compared with the GP group (mean
27% vs. 16%, respectively; P < 0.01). Patients with TP were more likely to be on
tenofovir and/or a boosted protease inhibitor compared with those with GP. In 18
patients with heavy proteinuria (uPCR > 100 mg/mmol), a renal assessment was
made; eight had a kidney biopsy. In all cases, the uAPR results correlated with
the nephrological diagnosis. CONCLUSIONS: In HIV-infected patients, measuring
uAPR may help to identify patients in whom a renal biopsy is indicated, and those
in whom tubular dysfunction might be an important cause of proteinuria and which
may be related to antiretroviral toxicity. We suggest that this would be useful
as a routine screening procedure in patients with proteinuria.

© 2012 British HIV Association.

PMID: 22413854 [PubMed - as supplied by publisher]