*4.1.2 Concentrated urine associated with serum LDL and HDL in HIV patients*

This study demonstrated a significant association between high urine creatinine and serum low-density lipoprotein cholesterol as well as serum highdensity lipoprotein cholesterol. Literature was sparse on the impact of high urine creatinine excretion on serum low-density lipoprotein cholesterol or serum high-density lipoprotein cholesterol. Nonetheless, in chronic kidney disease, low serum low-density lipoprotein cholesterol and low serum high-density lipoprotein cholesterol are characteristic components of dyslipidemia. Lipid synthesis by the liver is thought to be induced by proteinuria in kidney disease. Triglyceride-rich apolipoprotein B (apoB) containing complex lipoproteins, mark these syntheses. They have profound atherogenic potential which inadvertently will impact negatively on the kidney and subsequently affect urine creatinine excretion [18–20].

## *4.1.3 Concentrated urine associated with 24-hour urine osmolality in HIV patients*

This study showed that there was very strong correlation between high urine creatinine and 24-hour urine osmolality (r = 0.95). A similar observation was reported in a study that assessed the utility of urine creatinine and urine osmolality in determining dilute or concentrated urine and therefore the factors that influenced these. That study observed that the quantum of associations depicted as a fraction in change was profoundly stronger with urine creatinine than urine osmolality. The report noted that urine osmolality, compared to urine creatinine, was influenced by daily total protein intake but failed to vary by diabetes status. Although this association seemed relevant, the study inferred that the plausibility of accepting the utilization of urine osmolality adjustment and water intake

prescription to enhance on the accuracy of spot urine samples provision for the monitoring of bioenvironmental pollution would in itself espouse the merit for further evaluations [12].
