Profiling Biomarkers in HIV Glomerular Disease - Potential for the Non-Invasive Diagnosis of HIVAN?

Saraladevi Naicker; Therese Dix-Peek; Roland Manfred Klar; Glendah Kalunga; Pulane Mosiane; Caroline Dickens; Raquel Duarte

doi:10.2147/IJNRD.S331484

Profiling Biomarkers in HIV Glomerular Disease - Potential for the Non-Invasive Diagnosis of HIVAN?

Int J Nephrol Renovasc Dis. 2021 Dec 8:14:427-440. doi: 10.2147/IJNRD.S331484. eCollection 2021.

Authors

Saraladevi Naicker^#¹, Therese Dix-Peek^#², Roland Manfred Klar², Glendah Kalunga¹, Pulane Mosiane³, Caroline Dickens², Raquel Duarte²

Affiliations

¹ Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
² Department of Internal Medicine Laboratory, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³ Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

^# Contributed equally.

Abstract

Background: There is a wide spectrum of kidney pathology in human immunodeficiency virus (HIV) infection, affecting all structures of the kidney. The histology of HIV chronic kidney disease (CKD) is diverse, ranging from HIV-associated nephropathy (HIVAN) to focal glomerulosclerosis (FSGS), HIV-immune complex disease (HIV-ICD), other glomerulopathies and tubulo-interstitial nephritis. Definitive diagnosis is by kidney biopsy, an invasive procedure. However, serum and urinary biomarkers may be useful in predicting the histological diagnosis of HIVAN.

Purpose: We wished to determine the utility of serum and urinary biomarkers in predicting the histological diagnosis of HIVAN.

Patients and methods: We measured neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, transforming growth factor (TGF)-β isoforms and bone morphogenetic protein (BMP)-7 in the serum and urine in patients with different histological forms of HIV glomerular disease.

Results: In HIVAN, we demonstrated increased levels of serum cystatin C and increased levels of serum and urinary NGAL. Urinary TGF-β1 and TGF-β2 levels were elevated in HIV-positive patients with CKD but were not significantly different in the different HIV histologies, while urinary BMP-7 levels were elevated in minimal change disease.

Conclusion: This study confirmed the presence of increased serum and urinary biomarkers of tubular injury in patients with HIVAN, and increased urinary biomarkers of fibrosis in HIV CKD, and may indicate their value as a non-invasive diagnostic tool for the diagnosis of HIVAN.

Keywords: HIV chronic kidney disease; NGAL; bone morphogenetic protein (BMP)-7; cystatin C; neutrophil gelatinase-associated lipocalin; transforming growth factor (TGF)-β isoforms.