dc.contributor.author | Schutz, Charlotte | |
dc.contributor.author | Boulwa, David R. | |
dc.contributor.author | Huppler-Hullsie, Katherine | |
dc.contributor.author | Hohenbe, Maximilian von | |
dc.contributor.author | Rhei, Joshua | |
dc.contributor.author | Taseera, Kabanda | |
dc.contributor.author | Thienemann, Friedrich | |
dc.contributor.author | Muzoora, Conrad | |
dc.contributor.author | Meya, David B | |
dc.contributor.author | Meintjes, Graeme | |
dc.date.accessioned | 2022-01-21T09:49:39Z | |
dc.date.available | 2022-01-21T09:49:39Z | |
dc.date.issued | 2017 | |
dc.identifier.citation | Schutz, C., Boulware, D. R., Huppler-Hullsiek, K., von Hohenberg, M., Rhein, J., Taseera, K., ... & Meintjes, G. (2017, July). Acute Kidney Injury and Urinary Biomarkers in Human Immunodeficiency Virus–Associated Cryptococcal Meningitis. In Open forum infectious diseases (Vol. 4, No. 3). Oxford University Press. | en_US |
dc.identifier.uri | http://ir.must.ac.ug/xmlui/handle/123456789/1264 | |
dc.description.abstract | Background. Cryptococcus is the most common etiology of adult meningitis in Africa. Amphotericin B deoxycholate remains paramount to treatment, despite toxicities, including acute kidney injury (AKI). We assessed the ability of the following urine mark- ers to predict AKI in patients who received amphotericin B: urine neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC), tissue inhibitor of metalloproteinases-2 (TIMP-2), and protein.
Methods. One hundred and thirty human immunodeficiency virus (HIV)–infected participants with cryptococcal meningitis were enrolled and received amphotericin and fluconazole for 2 weeks. We defined AKI as glomerular filtration rate (GFR) < 60 mL/ min/1.73 m2; measured urine NGAL, CysC, TIMP-2, and protein; and explored AKI incidence, risk factors, and associations with mortality using Cox proportional hazards models.
Results. Participants were 48% female with a median age of 35 years, a median CD4 count of 21 cells/μL, and 44% died within 12 months. Incident AKI occurred in 42% and was associated with mortality (adjusted hazard ratio [aHR] = 2.8; P < .001). Development of AKI was associated with female sex (P = .04) and with higher CD4 count (49 vs 14 cells/μL; P < .01). Urine protein level in the highest quartile independently predicted AKI and mortality (aHR = 1.64, P = .04; aHR = 2.13, P = .02, respectively). Urine NGAL levels in the highest quartile independently predicted AKI (aHR = 1.65; P = .04).
Conclusions. Acute kidney injury occurred in 42% of patients, and AKI was associated with mortality. Urine biomarkers, specif- ically urine protein, may be useful for antecedent prediction of amphotericin-associated AKI but need further evaluation | en_US |
dc.description.sponsorship | This work was supported by provided by the
National Institute of Allergy and Infectious Diseases (U01AI089244 and
T32AI055433), Wellcome Trust (081667 and 098316 to G. M.), a Fogarty
International Center South Africa TB/AIDS Training Award (NIH/
FIC 1U2RTW007373- 01A1 and U2RTW007373 ICORTA to G. M. and
C. S.). The South African Research Chairs Initiative of the Department of
Science and Technology and National Research Foundation (NRF) of South
Africa (64787 to G. M.), NRF incentive funding (UID: 85858 to G. M.)
and the South African Medical Research Council through its TB and HIV
Collaborating Centres Programme with funds received from the National
Department of Health (RFA no. SAMRC-RFA-CC: TB/HIV/AIDS-01-2014
to G. M.). The funders had no role in the study design, data collection,
data analysis, data interpretation, or writing of this report. The opinions,
findings and conclusions expressed in this manuscript reflect those of the
authors alone | en_US |
dc.language.iso | en | en_US |
dc.publisher | Oxford University Press on behalf of Infectious Diseases Society of America. | en_US |
dc.subject | acute kidney injury | en_US |
dc.subject | amphotericin B | en_US |
dc.subject | biological marker | en_US |
dc.subject | cystatin C | en_US |
dc.subject | neutrophil gelatinase-associated lipocalin | en_US |
dc.subject | pro- tein | en_US |
dc.subject | tissue inhibitor of metalloproteinase | en_US |
dc.title | Acute kidney injury and urinary biomarkers in human immunodeficiency virus–associated cryptococcal meningitis | en_US |
dc.type | Article | en_US |