Urine osmolality in treatment-naïve HIV-positive subjects in Southeast Nigeria

Abstract

Background and Objectives: Urine osmolality varies over a wide range of values in a healthy state. Dilute urine or concentrated urine may be observed in many environmental, physiologic, and disease conditions. Urine osmolality is not commonly evaluated in routine clinical practice and in human immunodeficiency virus (HIV) subjects. The factors that influence urine osmolality have not been completely identified. The aim of this study was to evaluate urine osmolality in treatment‑naïve HIV subjects and to identify the factors that may influence dilute and concentrated urine in this group of patients.

Methodology: This was a cross‑sectional study of treatment‑naive HIV subjects conducted in Federal Medical Centre (FMC), Owerri, Nigeria. Demographic and anthropometric data were obtained. Urine osmolality and other relevant investigations were conducted. Normal urine osmolality was defined as 24‑h urine osmolality (24 HUOsm) 300–750 mOsm/kgH₂O, dilute urine as 24 HUOsm <300 mOsm/kgH₂O and concentrated urine as 24 HUOsm >750 mOsm/kgH₂O. The association between the variables and urine osmolality and the strength of variables to predict dilute urine and concentrated urine were determined.

Results: The mean 24HUOsm was 564 ± 501 mOsm/kgH₂O and the mean spot urine osmolality (SUOsm) 464 ± 271 mOsm/kgH₂O. Normal urine osmolality was observed in 29.6%, dilute urine in 64.5%, and concentrated urine in 5.9% of the HIV subjects. There was a significant association between urine osmolality and body mass index (BMI), creatinine clearance, as well as serum cholesterol level. Only high‑density lipoprotein cholesterol (HDL) predicted dilute urine, whereas BMI, spot urine protein, 24‑h urine protein, spot urine creatinine, serum HDL, and CD4 cell count predicted concentrated urine.

Conclusion: The prevalence of dilute urine was high among the treatment‑naïve HIV subjects. Abnormalities of serum lipids, renal function, and weight were common in treatment‑naïve HIV subjects who had dilute urine. There is a need for clinicians to routinely assess urine osmolality and further diagnose for dyslipidemia, renal function impairment, and abnormal weight in HIV subjects at the early stage of the infection.

Keywords: Dilute and concentrated urine, dyslipidemia, HIV, low CD4 cells count, Nigeria, underweight and obesity, urine osmolality