Evaluation of Glomerular functions in Patients with SCA in Maiduguri North-eastern Nigeria: A recommendation for early assessment and detection of dysfunction in a resource-poor setting

Abstract

Background: Sickle cell anaemia (SCA) is a disorder of Mendelian autosomal recessive inheritance, characterised by abnormal haemoglobin synthesis resulting in multi-systemic manifestations. The kidneys are largely affected by this disorder, but overt features of kidney disease mostly manifest after the second decade, even though insult and sub-clinical features may occur during childhood. Unfortunately, investigating these sub-clinical features is not routinely done in resource-scarce settings, partly due to the low socioeconomic status of most of our patients and the overwhelmed health care workers.

Objectives: To investigate glomerular dysfunction in children with SCA in the context of the resource-poor setting.

Methodology: This cross-sectional study was conducted at the University of Maiduguri Teaching Hospital (UMTH), over 6 months. One hundred and ten SCA (Hb SS) children aged 3 – 14 years in steady-state constituted the cases, while 110 non-SCA (Hb AA) age and sex-matched, apparently healthy children formed the control. Anthropometry, blood pressure, urinalysis and serum creatinine of the subjects was done. Glomerular filtration rate (GFR) was estimated using the Schwartz formula.

Results: The mean systolic blood pressure (SBP) ± SD of the cases and controls were 96.8±9.34mmHg and 99.14±13.44mmHg respectively, (p = 0.13). The mean diastolic BP ± SD of the cases and controls were 60.18±6.85mmHg and 64.35±8.23mmHg respectively, (p = 0.0001). Glomerular 2 filtration rate was significantly higher among the cases than the controls, 126±32ml/min/1.73m and 293±16ml/min/1.73m respectively (p <0.001). Proteinuria was higher among the cases (8.2%), with one (0.9%) having nephrotic range proteinuria.

Conclusions: The proteinuria and hyperfiltration found in some of the children with SCA in this study suggest that renal function abnormalities can be detected early in this group of children when appropriately and timely investigated.