Chronic kidney disease in children with sickle cell disease attending Bugando Medical Centre
Kimaro, Donald. Pransisca CUHAS/6000129/T/13
Chronic kidney disease in children with sickle cell disease attending Bugando Medical Centre - Mwanza, Tanzania: Catholic University of Health and Allied Sciences CUHAS - Bugando 2016 - xiii; 65 Pages Includes References and Appendices
Abstract:
Background: The prevalence of Sickle cell disease (SCD) is high around the Lake Zone in Tanzania. The kidney is one of the affected organs in SCD. Renal damage is preceded by asymptomatic presentations like microalbuminuria (MA) which can be detected early to allow interventions that may slow the disease progression and prevent end stage renal disease (ESRD). Despite high prevalence of SCD in the Lake Zone, there is a scarcity of data on the prevalence and factors associated with chronic kidney disease (CKD) among children with SCD in Mwanza.
Objectives: To determine the prevalence and factors associated with CKD among children with SCD at Bugando Medical Centre.
Material and Methods: This was a hospital based cross-sectional study with a prospective follow up component. A total of 187 children aged 6 months to 12 years with SCD attending the pediatric sickle cell disease clinic at BMC during the study period were enrolled into the study and screened for features suggestive of renal dysfunction. Subjects with renal dysfunction were followed up after 3 months to confirm the presence of CKD. Few confounders of chronic kidney disease like schistosomiasis, HIV infection, and diabetes mellitus were assessed in all participants and Hepatitis B and C infection for those with renal dysfunction. Data analysis was done using STATA version 13.0.
Results: A total of 187 children were enrolled. Fifty seven (30.5%) met the criteria of renal dysfunction a baseline, of which 53 (28.4%) had positive albuminuria and 5 (2.7%) had eGFR <60mls/ ml/min/1.73 m². Out of those with renal of dysfunction, 53 were available for follow up at the end of three months. Thirty five (18.7%) had CKD, of which 34 (18.2%) had albuminuria and 3 (1.6%) had an eGFR< 60ml/min/1.73m² at 3 months follow up. Factors associated with chronic kidney disease positive history of acute chest syndrome (p=0.003), lower hemoglobin level (p=0.009), positive urine schistosoma Circulating Cathodic Antigen (CCA) test (p<0.001), moderate to severe malnutrition (p=0.001) and hematuria (p=0.002). There were five children with history of kidney disease and all of them had CKD.
Conclusion and Recommendation: High prevalence of CKD was observed among children with SCD attending clinic in Mwanza, Screening for renal disease should be performed on all children with SCD on a regular basis, particularly in those with a positive history of acute chest syndrome, lower hemoglobin level, moderate to severe malnutrition, history of neurological deficit and family history of kidney disease. Screening and treatment of urine schistosomiasis is of utmost value as schistosomiasis contributes to a burden of renal disease in children with SCD in Mwanza. Screening for micro albuminuria is a reasonable measure even when serum creatinine is not feasible.
--Pediatrics and Child Health
Chronic kidney disease in children with sickle cell disease attending Bugando Medical Centre - Mwanza, Tanzania: Catholic University of Health and Allied Sciences CUHAS - Bugando 2016 - xiii; 65 Pages Includes References and Appendices
Abstract:
Background: The prevalence of Sickle cell disease (SCD) is high around the Lake Zone in Tanzania. The kidney is one of the affected organs in SCD. Renal damage is preceded by asymptomatic presentations like microalbuminuria (MA) which can be detected early to allow interventions that may slow the disease progression and prevent end stage renal disease (ESRD). Despite high prevalence of SCD in the Lake Zone, there is a scarcity of data on the prevalence and factors associated with chronic kidney disease (CKD) among children with SCD in Mwanza.
Objectives: To determine the prevalence and factors associated with CKD among children with SCD at Bugando Medical Centre.
Material and Methods: This was a hospital based cross-sectional study with a prospective follow up component. A total of 187 children aged 6 months to 12 years with SCD attending the pediatric sickle cell disease clinic at BMC during the study period were enrolled into the study and screened for features suggestive of renal dysfunction. Subjects with renal dysfunction were followed up after 3 months to confirm the presence of CKD. Few confounders of chronic kidney disease like schistosomiasis, HIV infection, and diabetes mellitus were assessed in all participants and Hepatitis B and C infection for those with renal dysfunction. Data analysis was done using STATA version 13.0.
Results: A total of 187 children were enrolled. Fifty seven (30.5%) met the criteria of renal dysfunction a baseline, of which 53 (28.4%) had positive albuminuria and 5 (2.7%) had eGFR <60mls/ ml/min/1.73 m². Out of those with renal of dysfunction, 53 were available for follow up at the end of three months. Thirty five (18.7%) had CKD, of which 34 (18.2%) had albuminuria and 3 (1.6%) had an eGFR< 60ml/min/1.73m² at 3 months follow up. Factors associated with chronic kidney disease positive history of acute chest syndrome (p=0.003), lower hemoglobin level (p=0.009), positive urine schistosoma Circulating Cathodic Antigen (CCA) test (p<0.001), moderate to severe malnutrition (p=0.001) and hematuria (p=0.002). There were five children with history of kidney disease and all of them had CKD.
Conclusion and Recommendation: High prevalence of CKD was observed among children with SCD attending clinic in Mwanza, Screening for renal disease should be performed on all children with SCD on a regular basis, particularly in those with a positive history of acute chest syndrome, lower hemoglobin level, moderate to severe malnutrition, history of neurological deficit and family history of kidney disease. Screening and treatment of urine schistosomiasis is of utmost value as schistosomiasis contributes to a burden of renal disease in children with SCD in Mwanza. Screening for micro albuminuria is a reasonable measure even when serum creatinine is not feasible.
--Pediatrics and Child Health