Immunotherapy: Open Access
Open Access

Abstract

Early Diagnosis of Renal Tubular Dysfunction in HIV-Infected Patients; a Case of Interleukin (IL)-18 and other Common Indicators of Renal Toxicity

Deebii N, Tamuno I, Orluwene CG, Okerengwo AA, Obunge OK, Odum EP and Oko-jaja RI

Background: At present renal dysfunction in clinical practice is measured using serum creatinine values to calculate eGFR (estimated glomerular filtration rate) but creatinine is a late marker of renal dysfunction and is only raised when up to 30-50% of renal function is lost.

Methods: Serial urine samples were analyzed by enzyme-linked immunosorbent assay for IL-18. Urinary IL-18 together with other common indicators of renal damage was assessed in 325 HIV patients; of which 66 developed renal dysfunction after 12 weeks of follow-up.

Result: Marked increase in IL-18 (p=0.000) was observed at an earlier stage in the renal disease group compared to a delayed elevation of eGFR, serum creatinine, fractional excretion of phosphate and fractional excretion of uric acid which was evident only after 4 weeks.

Conclusion: This finding seems to suggest that IL-18 can be used as an early marker of subclinical renal tubular dysfunction in HIV-infected patients, owing to the fact that IL-18 increases in urine only under conditions of marked tubular damage, apoptotic tubular cell shedding, and cell necrosis, associated with deterioration of renal function.