Home Ahead of print Instructions
About us Current issue Subscribe
Editorial board Archives Contact us
Search Submit article Login 
Print this page Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 1  |  Page : 26-32

Sonographic evaluation of renal changes among drug-dependent and drug-naive adult patients with human immunodeficiency virus/acquired immunodeficiency syndrome in Kano, Nigeria


1 Department of Medical Radiography, Bayero University Kano, Kano, Nigeria
2 Department of Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Awka, Nigeria
3 Department of Radiology, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
4 Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Submission26-Nov-2019
Date of Acceptance20-Feb-2020
Date of Web Publication30-May-2020

Correspondence Address:
Dr. Abdu Hamisu Dambatta
Department of Radiology, Aminu Kano Teaching Hospital, Bayero University Kano, Kano
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_34_19

Rights and Permissions
  Abstract 


Context: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains a major challenge globally. HIVassociated nephropathy is the third most common cause of endstage renal failure and more prevalent among AfricanAmericans with HIV compared with other races. Aims: This study evaluated sonographic renal changes in drugdependent and drugnaive patients with HIV/AIDS in Kano, Nigeria.Materials and Methods: A prospective and comparative study involving 190 each of drugdependent and drugnaïve patients were conducted. Renal sonography was performed using digital ultrasonic diagnostic imaging system, equipped with a 3.5 MHz curvilinear transducer. Statistical analysis used: An independent ttest and Mann–Whitney Utest were used to compare the renal volume and mean rank of the renal parenchymal echogenicity between drugdependent and drugnaïve patients. Statistical significance was considered at P < 0.05. Results: The mean values of the CD4 counts were 573.20 ± 222.441 cells/mm3 for drugdependent and 252.43 ± 215.22 cells/mm3 for drugnaïve patients. The drugdependent and drugnaïve patients had mean right renal volumes of 118.12 ± 27.75 cm3 and 128.48 ± 37.73 cm3, whereas the left renal volumes were 114.84 ± 24.14 cm3 and 123.35 ± 28.22 cm3, respectively. The drugdependent patients had 6.3% and 4.7% increased renal parenchymal echogenicity on the right and left, whereas the drugsnaïve patients had 45.3% and 43.7%, respectively. There was a statistically significant difference in the right and left renal volume between drugdependent and drugnaïve patients (P = 0.003 and P = 0.002). There was a significant statistical difference in the right and left renal parenchymal echogenicity between drugdependent and drugnaïve patients (P = 0.00). Conclusions: There was a significant statistical difference in the renal volume and parenchymal echogenicity between drugdependent and drugnaïve patients.

Keywords: Drug-dependent, drug-naïve, human immunodeficiency virus/acquired immunodeficiency syndrome, Kano


How to cite this article:
Sidi M, Ugwu AC, Dambatta AH, Saleh MK, Jibo U, Jega MA, Aminu AA, Ya'u A, Mansur U. Sonographic evaluation of renal changes among drug-dependent and drug-naive adult patients with human immunodeficiency virus/acquired immunodeficiency syndrome in Kano, Nigeria. Niger J Basic Clin Sci 2020;17:26-32

How to cite this URL:
Sidi M, Ugwu AC, Dambatta AH, Saleh MK, Jibo U, Jega MA, Aminu AA, Ya'u A, Mansur U. Sonographic evaluation of renal changes among drug-dependent and drug-naive adult patients with human immunodeficiency virus/acquired immunodeficiency syndrome in Kano, Nigeria. Niger J Basic Clin Sci [serial online] 2020 [cited 2020 Aug 15];17:26-32. Available from: http://www.njbcs.net/text.asp?2020/17/1/26/285468




  Introduction Top


Human immunodeficiency virus (HIV) is a lentivirus that causes HIV infections, and over time, if not treated, it leads to acquired immunodeficiency syndrome (AIDS).[1] AIDS is a condition in humans, in which progressive failure of the immune system allows life-threatening infections and cancers to thrive. The average survival time of an individual infected with HIV without antiretroviral therapy (ART) is estimated to be 9–11 years, depending on the HIV subtype.[2] Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, free-ejaculate, or breast milk. In these body fluids, HIV is present as both free virus particle and virus within the infected immune cells. HIV infects vital cells in the human immune system such as helper T cells, macrophages, and dendritic cells.[3] Since the beginning of the epidemic in 1981, more than 70 million people have been infected with the virus and about 35 million people died of the disease.[4]

Ultrasonography allows clear visualization of the kidney in various planes, including the sagittal and transverse planes, both at rest and during dynamic maneuvers.[5] It allows assessment of the total kidney size and the renal parenchymal thickness. It also gives the details of appearance of the kidneys and detects tumors, swelling, and blockage of urine flow and it is helpful in identifying the cysts including polycystic kidney disease. Renal diseases are diagnosed at sonography using combination of changes in renal size and parenchymal echogenicity. The majority of patients with HIV-associated nephropathy (HIVAN) have a normal-sized kidney; however, enlarged kidneys have been described in up to 20% of patients with HIVAN, but is not thought to be specific for any parenchymal disease.[6] A study conducted by Garko et al.[7] showed normal-sized kidney at 72%, but enlarged kidneys in 28% among the selected patients. A study conducted by Napegwa [8] showed that 85% of the selected patients had normal kidney size, 7% with small kidneys, and 8% with enlarged kidneys. Furthermore, Okeke et al.[9] revealed a 23% enlarged kidneys among the selected patients. Increased renal parenchymal echogenicity has been described as a sonographic feature of HIVAN; Eze et al.[10] had shown an increased renal parenchymal echogenicity among 56.9% of the selected patients; and Ibinaiye et al.[11] and Napegwa [8] reported 94% and 41.7% increased renal parenchymal echogenicity, respectively.

HIV/AIDS remains a major challenge globally, and approximately 180,000 people died from AIDS-related illnesses in Nigeria in 2015.[12] HIVAN is the third most common cause of end-stage renal failure and more prevalent among African-Americans with HIV compared with other races. Early identification of patients with renal disease allows early intervention targeting at the reversing process of the renal injury or slowing down its progression, aimed at reducing the morbidity and mortality.[8] In the standard practice, all HIV-infected patients shall be screened for kidney disease at the time of HIV diagnosis or entry into care and ultrasonography is one of the screening tools.[13] The previous study in the subject area did not compare changes in renal parameters between drug-naïve and drug-dependent HIV/AIDS patients, which would have been very important in determining the necessity or otherwise of early intervention in preventing or halting the progress of HIVAN. This study was aimed at evaluating changes in renal parameters among drug-dependent and drug-naïve adult patients with HIV/AIDS in Kano.


  Materials and Methods Top


This prospective and comparative study was conducted in the Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria, from July 2017 to December 2017. An ethical clearance was obtained from the Research and Ethics Committee of the Aminu Kano Teaching Hospital, and informed consent was obtained from all the selected patients. A purposive sampling method was employed; 190 drug-dependent and 190 drug-naïve patients with HIV/AIDS were studied. Exclusion criteria included patients with acute or chronic hepatitis B and/or C, patients with fatty liver, hypertensive patients, diabetes mellitus patients, pregnant patients, and patients being placed on nephrotoxic antiretroviral drugs.[8] All the ultrasound scans were performed using digital ultrasonic diagnostic imaging system, model DP-8800 Plus (Mindray Bio-medical Electronics Co., Ltd., 2013 Shenzhen, China) and a 3.5 MHz curvilinear ultrasound transducer. The right kidney was examined in the supine position through the liver by angling the transducer obliquely.[14] With the patients in the right decubitus, the arm extended over the head, and using a coronal approach, the left kidney was visualized through the spleen. The kidneys were best measured in a prone position; the images of both kidneys were acquired with the patient in a prone position for assessing corticomedullary differentiation and measurements. The machine automatically displayed the value of the renal volume, whenever the length, width, and thickness were measured. The right and left renal volumes, the parenchymal echogenicities, and corticomedullary differentiation were recorded on the data capture sheet. After the ultrasound scans, patients were accompanied to the laboratory where the samples of their blood were collected for CD4 count determination.

Test for normality was carried out on the data using Shapiro–Wilk test. Both descriptive and inferential statistics were applied for data analysis. Means, standard deviations, and range were obtained using descriptive statistics. The independent two-sample t-test was used to compare the mean renal volume between drug-dependent and drug-naïve patients. A Mann–Whitney U-test was used for comparing the renal parenchymal echogenicity between drug-dependent and drug-naïve patients. Pearson's correlation was used to correlate the values of the CD4 count with renal volume in both drug-dependent and drug-naïve patients. The Spearman's rank correlation was used to correlate the values of the CD4 count with the renal parenchymal echogenicity in both drug-dependent and drug-naïve patients. The data were analyzed using Statistical Package for the Social Sciences (IBM SPSS) Version 22.0 (New York, United States, 2018). Statistical level of significance was set at P < 0.05.


  Results Top


The mean, standard deviation and the range of the drugs dependent subjects was 42.87±10.1 (2065) while that of drugs naïve was found to be 35.87±9.9 (1865).

The BMI of the drugs dependent was found to be 25.27±3.9 (1642) while that of drugs naïve was found to be 23.11±5.90 (1247).

The BSA of the dependent was found to be 1.72±0.20 (1.222.20) while that of drugs naïve was found to 1.60±0.22 (1.172.71) as shown in [Table 1].
Table 1: Demographic characteristics of the patients

Click here to view



  Discussion Top


In this study, the mean value of the CD4 was generally higher in the drug-dependent patients when compared to that of the drug-naive patients and was higher in females when compared to their male counterparts in both drug-dependent and drug-naïve patients as shown in [Table 2]. The number of patients in Group 1 and 2 of the CD4 count was higher in drug-dependent patients when compared to the number in Group 1 and 2 of the drug-naïve patients. Whereas, the number in Group 3 of the drug-dependent patients was lower when compared to the number in Group 3 of the drug-naïve patients as shown in [Table 2]. The male patients in both drug-dependent and drug-naïve patients stand a higher risk of developing HIVAN when compared with their female counterparts. The result of this study agrees with that of Atsukei et al.,[15] who reported a mean CD+ 4 count of 520.55 ± 282.67/μl. The mean CD+ 4 counts in males and females were 451.05/μl and 537.93/μl, respectively, which were close to the values reported for the drug-dependent patients in this study, but much higher than the value of the drugs-naïve patients. Similarly, the findings agree with the findings reported by Aggarwal et al.,[16] which reported the mean CD4 count of 464.91 ± 89.39 cells/μl, which was between the mean values of drug-dependent patients and drug-naïve patients of this study. On the contrary, low values of CD4 count were reported by Prakash et al.,[17] with a mean CD4 count of 201.38 ± 151.22 cell/μl, and 180 (61.43%) patients had a CD4 count of <200 cell/μl. Furthermore, a study conducted by Eze et al.[10] reported a CD4 count of 153.1 ± 103.2 cells/mm [3] for males and 121.9 ± 91.0 cells/mm [3] for females. Another study conducted by Adeyekun et al.[18] showed that 63.8% of the selected patients had a CD4 count of <200 cells/mm [3] and 31% had a CD4 count of 200–499 cells/mm [3], which were by far lower than the percentage recorded in this study. The findings of the study show that among drugs dependent only 1.6% had CD4 count of <200 cells/mm3while among the drugs naïve 49.5% had CD4 count of <200 cells/mm [3]. The difference might be as a results of the positive influence of antiretroviral drugs on the CD4 count. The findings of this study also showed the effectiveness of nonnephrotoxic antiretroviral drugs because only 3 (1.6%) of the male patients among drug-dependent patients had CD4 count of <200 cells/mm [3], and all the female drug-dependent patients had CD4 count of >200 cells/mm [3].
Table 2: CD4+ count for drug-dependent and drug-naive patients with human immunodeficiency virus/acquired immunodeficiency syndrome (n=190)

Click here to view


In this study, the mean values of the right and left renal volume among drug-dependent patients were 118.12 ± 27.75 cm [3] and 114.84 ± 24.14 cm [3], whereas the drug-naïve patients measured 128.48 ± 37.73 cm [3] and 123.35 ± 28.22 cm [3], respectively, as shown in [Table 3]. The findings of this study were similar to the findings of the study conducted by Adeyekun et al.,[18] who reported the mean right and left renal volume as 127.28 ± 85.01 cm [3] and 120.76 ± 37.39 cm [3], respectively. The mean values of the right and left renal volume of both drug-dependent and drug-naïve patients were within the normal range.[19] The findings of this study were also similar to the findings of the study conducted by Igbinedion et al.,[20] which showed that the overall renal sizes for HIV positive and control were within the normal range. The normal range for adult male kidney volume is 110–190 cm [3], whereas that of the adult female kidney is 90–150 cm [3].[19] The findings of this study also showed a higher incidence of abnormal kidney size among drugnaïve when compared with drugdependent patients. In both male and females abnormal kidney size was more in the right kidney then the left.as shown in [Table 4] and [Table 5]. The majority of the previously published research articles did not compute the renal volume, but rather reported the renal length. However, renal volume is the most precise measurement of the renal size.[21] The result of this study agrees with that of Okeke et al.,[9] who reported 23 (10.5%) enlarged kidneys among the selected patients, which was slightly higher than what was reported among drugs-naïve patients and much higher among drug-dependent patients in this study. Similarly, a study conducted by Adeyekun et al.[18] reported 7% of the selected patients with Small kidney size, 85% with normal kidney, and 8% with enlarged kidney, which was almost similar to the findings reported in this study. On the contrary, studies conducted by Garko et al.[7] and Fiori et al.[22] reported 28% and 20% of enlarged kidneys, which were much higher than what was found in this study. The possible reasons of variation of renal volume obtained in this study with previously published study might be the current study used renal volume in determining renal size, whereas the previous studies used renal length and categorization into drug-dependent and drug-naïve patients. The prominent hypertrophy and hyperplasia of the overlying podocytes, interstitial fibrosis, edema, inflammation, and widespread tubular degenerative and regenerative changes are the possible causes of enlarged kidneys in patients with HIV/AIDS.[23] The higher incidence of enlarged kidneys among drug-naïve patients when compared to drug-dependent patients might be as a result of less common endothelial tubuloreticular inclusions in renal biopsies from patients with HIVAN who are receiving ART.[23] The right kidney volume was higher than the left among both drug-dependent and drug-naïve patients probably as a result of higher incidences of increased renal parenchymal echogenicity on the right kidney than on the left as reported in this study. The higher incidence of enlarged kidney among males in both drug-dependent and drug-naïve patients might be as results of higher incidence of renal parenchymal echogenicity in males more than females, which might also be linked to lower CD4 count among males when compared to their female counterparts. The implication of the findings of this study was that drug-naïve patients were likely to develop HIVAN than drug-dependent group, and the right kidney was likely affected than the left possibly because of the perfusion difference between the right and left kidneys, which is higher in the left than the right kidney.
Table 3: The mean renal volume in drug-dependent and drug-naive patients (n=190)

Click here to view
Table 4: The normal and abnormal renal volume for males in both drug dependent and drug naïve patients (n=95)

Click here to view
Table 5: The normal and abnormal renal volume for females in drug-dependent and drug-naïve patients (n=95)

Click here to view


The finding of this study showed that drug-dependent patients had 6.3% and 4.7% right and left increased renal parenchymal echogenicity, whereas the drug-naïve patients had 45.3% and 43.7% as right and left renal parenchymal echogenicity, respectively, as shown in [Table 6] and [Table 7]. The result of this study agrees with that of Okeke et al.,[9] who reported 11% renal parenchymal echogenicity among HIV-positive patients and 5.5% among control patients, which were close to the percentage reported among drug-dependent patients and by far lower than the percentage reported among drug-naïve patients. The findings reported by Adeyekun et al.[18] showed that 41.7% of the selected patients had increased renal parenchymal echogenicity, which is almost similar to the findings reported among drug naïve of the current study. However, a study conducted by Ibinaiye et al.[11] reported that 96% of the selected patients had renal parenchymal disease, which was much higher than the percentage reported among the drug-naïve patients of the current study. Similarly, a study conducted by Ulu et al.[24] showed that 77% of the selected patients had an increased renal parenchymal echogenicity, which was also by far higher than the percentage reported in the current study. The possible reason of the variation might be the time interval between the current study and the previously published studies, because there is increasing awareness and availability of antiretroviral drugs. In this study, the renal parenchymal echogenicity was generally lower in the drug-dependent patients when compared to that of the drug-naive patients and in females when compared to males in both groups. This variation might be as a result of higher CD4 count among drug-dependent patients when compared with CD4 count of drug-naïve patients and in females more than the male' counterparts. The right kidney is more affected than the left kidney in both drug-dependent and drug-naïve patients and in both males and females, probably as a result of more blood supply to the left kidney per unit time when compared with the right kidney. The possible reason of variation in renal parenchymal echogenicity reported in this study and the previously published research might be as a result of categorization of the selected patients into drug-dependent and drug-naïve patients. The renal parenchymal echogenicity is an indicator of HIVAN. The high renal parenchymal echogenicity among drugs naïve patients and in the right kidney more than the left showed that the drugs naïve group had a high tendency of developing HIVAN when compared to drugs dependent patients. Furthermore, the right kidney was more prone when compared with the left kidney.
Table 6: The grades of renal parenchymal echogenicity in drug-dependent patients

Click here to view
Table 7: The frequency distribution of the grades of renal parenchymal echogenicity in drug-naïve patients

Click here to view


The mean value of the right renal volume of the drug-dependent patients was lower when compared with that of the right renal volume of the drug-naïve patients, deemed statistically significant (P = 0.003). Furthermore, the mean value of the left renal volume among drug-dependent patients was also lower when compared with the mean left renal volume of the drug-naïve patients and deemed also statistically significant (P = 0.002) as shown in [Table 8]. The right and left renal parenchymal echogenicity in drugs dependent when compared with that of drugs naïve deemed statistically significant (P = 0.000) in both cases as shown in [Table 8]. The statistically significant difference in the mean rank of renal parenchymal echogenicity between the drug-dependent and drug-naïve patients might be as a result of pronounced glomerular, tubular, and interstitial renal changes among the drug-naïve when compared to that of the drug-dependent patients.[25] This might be linked to the higher CD4 count in drug-dependent patients when compared with that of drug-naïve patients.
Table 8: Comparison of renal volume and parenchymal echogenicity between drug-dependent and drug-naïve patients

Click here to view


The result of this study shows a weak positive relationship between the CD4 count and right renal volume; however, there was a weak negative relationship between the CD4 counts and left renal volume among drug-dependent patients. Whereas, in drug-naïve patients, there was a weak positive correlation between the CD4 counts and right and left renal volumes. The result of this study has shown that CD4 count has a weak relationship with the renal volume among both drug-dependent patients and drug-naïve patients as shown in [Table 9]. The result of the present study agrees with that of Ulu et al.,[24] who reported a negative correlation between CD4 count and renal volume, which is similar to the correlation of CD4 count with left renal volume among drug-dependent patients of this study. The findings of the current study are contrary to the findings reported by Adeyekun et al.,[18] who reported that there was no correlation between CD4 count and renal volume. The result of this study shows a weak negative relationship between the CD4 count and right and left renal parenchymal echogenicity among drug-dependent patients. However, there was a strong negative correlation in CD4 count and renal parenchymal echogenicity in both right and left kidneys in drug-naïve patients. The result of this study has shown that CD4 count has a weak relationship with the renal parenchymal echogenicity among drug-dependent patients, but a strong relationship among drug-naïve patients as shown in [Table 9]. In general, as the CD4 count increases, the mean rank of renal parenchymal echogenicity decreases. Furthermore, the result of the present study agrees with that of Ibinaiye et al.,[11] who showed a negative correlation between CD4 count and renal parenchymal echogenicity. On the contrary, Adeyekun et al.[18] and Ulu et al.[24] reported that the CD4 did not correlate with renal parenchymal echogenicity. The possible reason of stronger correlation in drug-naïve when compared with drug-dependent patients reported in this study might be as a result of lower CD4 counts among drugs naïve patients.
Table 9: Correlation of CD4 count with renal volume and renal parenchymal echogenicity in drug-dependent and drug-naïve patients

Click here to view



  Conclusion Top


The findings of this study showed significant differences in renal parameters of drug-dependent and drug-naïve HIV/AIDS patients. These differences suggest that early intervention in HIV/AIDS infection may be beneficial to patients by preventing the decline in kidney status.

Acknowledgements

We are thankful to Mohammed Kabir Saleh, Radiology, Head of Department, who provided a conducive environment during the data collection. We are also grateful to Musa Muhammad Dorayi, Dayyabu Mukhtar, and Usman Abdullahi Gumel for their assistance with blood sample collection and CD4+ determination. We have to express our appreciation to the C. C Ohagwu for sharing their pearls of wisdom with us during the course of this research. We are also immensely grateful to J. Eze and Ali Alhaji Modu for their comments on an earlier version of the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Douek DC, Roederer M, Koup RA. Emerging concepts in the immunopathogenesis of AIDS. Annu Rev Med 2009;60:471-84.  Back to cited text no. 1
    
2.
Joint United Nations Programme on HIV/AIDS. Global AIDS Monitoring. Joint United Nations Programme on HIV/AIDS; 2019. Available from: https://www.unaids.org/sites/default/files/media_asset/global-aids-monitoring_en.pdf. [Last accessed on 2018 Nov 15].  Back to cited text no. 2
    
3.
Cunningham AL, Donaghy H, Harman AN, Kim M, Turville SG. Manipulation of dendritic cell function by viruses. Curr Opin Microbiol 2010;13:524-9.  Back to cited text no. 3
    
4.
Klem TH, Jacobsen M, Malchow-Mller A. “Kaposi sarcoma among homosexual men”. Lancet 1981;318:688.  Back to cited text no. 4
    
5.
Cubberley DA, Gosink BB, Forsythe J. Coronal sonography: A review of abdominal applications. J Ultrasound Med 1985;4:35-46.  Back to cited text no. 5
    
6.
Symeonidou C, Standish R, Sahdev A, Katz RD, Morlese J, Malhotra A. Imaging and histopathologic features of HIV-related renal disease. Radiographics 2008;28:1339-54.  Back to cited text no. 6
    
7.
Garko SS, Ibinaiye PO, Abba SM, Ahmed A, Tanimu SS, Kere PC. The utilization of diagnostic ultrasound in the evaluation of the kidneys in HIV-associated nephropathy. West Afr J Radiol 2015;22:20-6.  Back to cited text no. 7
  [Full text]  
8.
Napegwa KS. The Renal Sonographic Findings in HIV/AIDS Adults Patients with Proteuria and CD4+ Count Correlation at Mwanyamala Care and Treatment Clinic; 2013. Available from: http://ir.muhas.ac.tz:8080/jspui/bitstream/123456789/1807/1/Silas%20Napegwa%20Kishaluli.pdf. [Last accessed on 2017 Oct 29].  Back to cited text no. 8
    
9.
Okeke C, Mgbor S, Obikili E. Is there a significant renal sonographic difference between hiv/aids positives and negatives? A developing country perspective. Br J Med Med Res 2016;13:1-9.  Back to cited text no. 9
    
10.
Eze CU, Eze CU, Adeyomoye A. Sonographic evaluation of kidney echogenicity and morphology among HIV sero-positive adults at Lagos University Teaching Hospital. J Ultrasound 2018;21:25-34.  Back to cited text no. 10
    
11.
Ibinaiye PO, Garko SS, Ahmed A, Tanimu SS, Tahir NM. Relationship of ultrasound renal echogenicity, serum creatinine level and CD4 cell counts in patients with human immunodeficiency virus-associated nephropathy. Sub-Saharan Afr J Med 2014;1:191-7.  Back to cited text no. 11
  [Full text]  
12.
HIV and AIDS in Nigeria. Global Information and Education on HIV and AIDS; 2015. Available from: http://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/nigeria#footnote1_aqgblu6. [Last accessed on 2018 Mar 16].  Back to cited text no. 12
    
13.
HIV/AIDS, Renal Disease, Primary Care of Veterans with HIV, Organ System and Metabolic. U.S. Department of Veterans; 2011. Available from: https://www.hiv.va.gov/provider/manual-primary-care/. [Last accessed on 2018 May 27].  Back to cited text no. 13
    
14.
Roger CS. Clinical Sonography – A Practical Guide. 3rd ed. Lippincott: Williams and Wilkins; 1998.  Back to cited text no. 14
    
15.
Atsukwei D, Eze ED, Chom ND. Correlation between abdominal ultraso-nographic findings and CD4 cell count in adult patients with HIV/AIDS in Jos, Nigeria. Adv Mol Imaging 2017;7:49-66.  Back to cited text no. 15
    
16.
Aggarwal HK, Jain D, Dahiya S, Jain P, Pawar S. Evaluation of renal profile in asymptomatic HIV patients with special reference to proteinuria. Medyczne 2014;4:228-33.  Back to cited text no. 16
    
17.
Prakash J, Ganiger V, Prakash S, Sivasankar M, Sunder S, Singh U. Kidney disease in human immunodeficiency virus-seropositive patients: Absence of human immunodeficiency virus-associated nephropathy was a characteristic feature. Indian J Nephrol 2017;27:271-6.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Adeyekun AA, Unuigbe EI, Onunu AN, Azubike CO. Renal sonographic parameters in human immunodeficiency virus – Infected subjects and relationship to CD4 cell count. Saudi J Kidney Dis Transpl 2011;22:1164-8.  Back to cited text no. 18
[PUBMED]  [Full text]  
19.
Cheong B, Muthupillai R, Rubin MF, Flamm SD. Normal values for renal length and volume as measured by magnetic resonance imaging. Clin J Am Soc Nephrol 2007;2:38-45.  Back to cited text no. 19
    
20.
Igbinedion BO, Marchie TT, Ogbeide E. Trans-abdominal ultrasonic findings correlated with CD4+ count in adult HIV-infected patients in Benin, Nigeria. S Afr J Radiol 2009;13:34-40.  Back to cited text no. 20
    
21.
Egberongbe AA, Adetiloye VA, Adeyinka AO, Afolabi OT, Akintomide AO, Ayoola OO. Evaluation of renal volume by ultrasonography in patients with essential hypertension in IleIfe, south western Nigeria. Libyan J Med 2010;5:4848.  Back to cited text no. 21
    
22.
Di Fiori JL, Rodrigue D, Kaptein EM, Ralls PW. Diagnostic sonography of HIV-associated nephropathy: New observations and clinical correlation. AJR Am J Roentgenol 1998;171:713-6.  Back to cited text no. 22
    
23.
Wyatt CM, Malvestutto C, Coca SG, Klotman PE, Parikh CR. The impact of hepatitis C virus coinfection on HIV-related kidney disease: A systematic review and meta-analysis. AIDS 2008;22:1799-807.  Back to cited text no. 23
    
24.
Ulu UO, Agbaji O, Agwu KK. Sonographic characterization of renal pathologies in HIV/AIDS in Plateau State, Nigeria. Niger J Med 2012;21:160-4.  Back to cited text no. 24
    
25.
D'Agati V, Appel GB. Renal pathology of human immunodeficiency virus infection. Semin Nephrol 1998;18:406-21.  Back to cited text no. 25
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed239    
    Printed13    
    Emailed0    
    PDF Downloaded40    
    Comments [Add]    

Recommend this journal