application) This proposal for career development award for Lynda Szczech, MD will provide the didactic training and research experience necessary to make her a competitive and productive clinical investigator in the field of HIV-associated nephropathy (HIVAN). This proposal focuses on the epidemiology of HIV associated nephropathy (HIVAN). HIVAN is a complication of HIV infection that is associated with a 50% annual mortality. As demonstrated by the United States Renal Data Service, HIVAN is now the fourth leading cause of end-stage renal disease in African-Americans aged 20 to 64. This study will provide vital information on the risk factors and clinical course of this kidney disease that may be used subsequently to design strategies for prevention and treatment. This study will utilize a cross-sectional survey to study a large, population-based sample of HIV-infected patients to determine the prevalence of microalbuminuria and proteinuria and the risk factors for the development of HIVAN. The cohort of patients with microalbuminuria will be followed prospectively along with a sample of patients without evidence of renal disease to determine if the presence of microalbuminuria is predictive for the development of nephropathy or other outcomes such as mortality. Determination of the natural history of microalbuminuria may subsequently provide a noninvasive means to detect early disease or predict mortality. Prevention and treatment strategies focused on patients with microalbuminuria may definitively impact the burden of disease. This proposal will also study the effect of different anti-retroviral treatment regimens and clinical markers for the progression of HIV-infection such as plasma HIV RNA level or CD4 count on the progression of nephropathy. These effects will be explored using a retrospective cohort design among the patients with evidence of nephropathy identified in the cross-sectional survey and among patients enrolled in the Women's Interagency HIV Study. This information combined with our knowledge of renal pathophysiology and the progression of kidney diseases can then be used to design effective prevention and treatment strategies aimed at decreasing the morbidity and mortality associated with this devastating nephropathy.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rankin, Tracy L
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Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
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Szczech, L A; Menezes, P; Byrd Quinlivan, E et al. (2010) Microalbuminuria predicts overt proteinuria among patients with HIV infection. HIV Med 11:419-26
Odden, Michelle C; Scherzer, Rebecca; Bacchetti, Peter et al. (2007) Cystatin C level as a marker of kidney function in human immunodeficiency virus infection: the FRAM study. Arch Intern Med 167:2213-9
Szczech, Lynda Anne; Grunfeld, Carl; Scherzer, Rebecca et al. (2007) Microalbuminuria in HIV infection. AIDS 21:1003-9
Perry, Stephanie L; O'Shea, Susan I; Byrne, Stephen et al. (2006) A multi-dose pharmacokinetic study of dalteparin in haemodialysis patients. Thromb Haemost 96:750-5
Szczech, L A; Klassen, P S; Chua, B et al. (2006) Associations between CMS's Clinical Performance Measures project benchmarks, profit structure, and mortality in dialysis units. Kidney Int 69:2094-100
Szczech, Lynda Anne; Anderson, Albert; Ramers, Christian et al. (2006) The uncertain significance of anti-glomerular basement membrane antibody among HIV-infected persons with kidney disease. Am J Kidney Dis 48:e55-9
Hedayati, S S; Bosworth, H B; Kuchibhatla, M et al. (2006) The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients. Kidney Int 69:1662-8
Gupta, Samir K; Eustace, Joseph A; Winston, Jonathan A et al. (2005) Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 40:1559-85
Schwartz, Elissa J; Szczech, Lynda A; Ross, Michael J et al. (2005) Highly active antiretroviral therapy and the epidemic of HIV+ end-stage renal disease. J Am Soc Nephrol 16:2412-20
Hedayati, S Susan; Grambow, Steven C; Szczech, Lynda A et al. (2005) Physician-diagnosed depression as a correlate of hospitalizations in patients receiving long-term hemodialysis. Am J Kidney Dis 46:642-9

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