ACUTE KIDNEY INJURY STAGE 3 IN AIDS-ASSOCIATED DISSEMINATED HISTOPLASMOSIS: A PROSPECTIVE STUDY

 

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https://storage.unitedwebnetwork.com/files/1099/21e75aa628be12c62392d367b608f7a7.pdf
ACUTE KIDNEY INJURY STAGE 3 IN AIDS-ASSOCIATED DISSEMINATED HISTOPLASMOSIS: A PROSPECTIVE STUDY

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Elizabeth
De Francesco Daher
Matheus Alves de Lima Mota matheusmot@gmail.com Federal University of Ceara Medical Sciences Graduate Program Fortaleza Brazil - Sao Jose Infectious Diseases Hospital Division of Infectious Diseases Fortaleza Brazil
Geraldo Bezerra da Silva Junior geraldobsilvajr@yahoo.com University of Fortaleza Medical Sciences and Public Health Graduate Programs Fortaleza Brazil -
Marcos Maciel Sousa macielinfec@gmail.com Federal University of Ceara School of Medicine Fortaleza Brazil -
Letícia Machado de Araújo leticiamachado.ar@gmail.com Federal University of Ceara School of Medicine Fortaleza Brazil -
Jacó Ricarte Lima de Mesquita jacomesquita@hotmail.com Federal University of Ceara School of Medicine Fortaleza Brazil -
Claudia Maria Costa de Oliveira claudiadrl@gmail.com Unichristus University Center School of Medicine Fortaleza Brazil -
Silvana Daher Costa silvanadaher1@hotmail.com Federal University of Ceara Walter Cantidio University Hospital Fortaleza Brazil - General Hospital of Fortaleza Division of Nephrology and Kidney Transplantation Fortaleza Brazil
Alice Maria Costa Martins martinsalice@gmail.com Federal University of Ceara Pharmacy/Pharmacology Graduate Programs Fortaleza Brazil -
Lisandra Serra Damasceno lisandra.damasceno@ufc.br Sao Jose Infectious Diseases Hospital Division of Infectious Diseases Fortaleza Brazil -
Terezinha do Menino Jesus Silva Leitão tsilva@ufc.br Federal University of Ceara Department of Community Health Fortaleza Brazil - Sao Jose Infectious Diseases Hospital Division of Infectious Diseases Fortaleza Brazil
Gdayllon Cavalcante Meneses gdayllon@ufc.br Federal University of Ceara Division of Infectious Diseases Fortaleza Brazil -
Elizabeth De Francesco Daher ef.daher@uol.com.br Federal University of Ceara Medical Sciences Graduate Program Fortaleza Brazil *
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People living with HIV/AIDS (PLWHA) have an increased risk of acute kidney injury (AKI). Disseminated histoplasmosis (DH) often presents severe manifestations, including AKI. This study investigated the incidence and classification of AKI in PLWHA hospitalized with DH, and factors associated with AKI stage 3 (AKI-3), emphasizing novel kidney, endothelial, and inflammatory biomarkers. 

We conducted a prospective cohort (March 2023–December 2024) of PLWHA hospitalized with probable or proven DH at São José Hospital, Fortaleza, Brazil. Novel biomarkers—neutrophil gelatinase–associated lipocalin (NGAL), monocyte chemoattractant protein-1 (MCP-1), vascular cell adhesion molecule-1 (VCAM-1), syndecan-1, angiopoietin-1 (Ang-1), Ang-2, and interleukin-6 (IL-6)—were measured. Outcomes included AKI-3, renal replacement therapy (RRT), intensive care unit (ICU) admission, and mortality. Statistical significance was set at p < 0.05.  

Among 58 patients, 24 (41.4%) developed AKI-3. Living in Fortaleza (capital city) was associated with a lower risk (RR = 0.53; p = 0.033), while Histoplasma-like yeast visualization in peripheral blood and hepatomegaly (RR = 2.05; p = 0.029) were associated with a higher risk (RR = 2.72; p < 0.0001) of AKI-3. Patients who developed AKI-3 more often had lower body mass index (p = 0.022), and elevated C-reactive protein (p = 0.009), aspartate aminotransferase (AST) (p = 0.046), direct bilirubin (p = 0.007), alkaline phosphatase (p = 0.041), LDH (p = 0.028), and Ang-2 (p = 0.031). Longer amphotericin B exposure (p = 0.032) was observed in the AKI-3 group. AKI-3 was strongly associated with intensive care unit (ICU) admission (p = 0.006), mechanical ventilation (p < 0.001), vasoactive drug use (p < 0.001), and mortality (p < 0.001). 

In PLWHA with DH, advanced AKI was frequent and strongly associated with poor outcomes. Elevated Ang-2 emerged as a potential early biomarker. These findings underscore the importance of early diagnosis, personalized treatment, and strategies to mitigate nephrotoxic exposure, ultimately enhancing clinical outcomes.

Kewords