scholarly journals Burden and Risk Factors of Chronic Kidney Disease in Children with Sickle Cell Anaemia Aged 5 – 16 Years at the University Teaching Hospital, Lusaka - Zambia

2020 ◽  
Vol 4 (3) ◽  
pp. 40-48
Author(s):  
Nchimunya Machila ◽  
◽  
Chishala Chabala ◽  
Chisambo Mwaba ◽  
Catherine Chunda-Liyoka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Teaching Hospital ◽  
Sickle Cell Anaemia ◽  
Age At Diagnosis ◽  
University Teaching ◽  
Dipstick Urinalysis ◽  
The University

Background: Improved medical care has led to the improved life expectancy of sickle cell anaemia (SCA) patients hence complications associated with SCA such as chronic kidney disease (CKD) are being seen more frequently. Globally, nephropathy of varying severity occurs in 5 to 18 % of the SCA population across all age groups with a third of the adults proceeding to develop CKD while over 30 % of paediatric SCA patients have CKD in Africa. The mortality rate in SCA patients CKD is high. This study sought to determine the prevalence and risk factors of CKD in SCA, information that was not available in Zambia prior to this study. This information will guide in targeting and timing of screening for CKD in SCA in children in our population. Objectives: To determine the prevalence of haematuria, proteinuria, abnormal estimated glomerular filtration rate (eGFR), CKD, and risk factors of CKD among the steady-state SCA patients aged 5 to 16 years at the University Teaching Hospital (UTH), Lusaka. Methodology: This was a prospective cross-sectional study of 197 children aged 5 to 16 years with SCA at the UTH - Lusaka conducted from August 2014 to July 2015. Demographic and clinical data were collected using a structured questionnaire. Urine and blood samples were used to determine the urine albumin creatinine ratio (ACR) and full blood count /blood biochemistry respectively. CKD was defined and determined using the Kidney Disease Outcome Quality Initiative 2012 guidelines employing urine ACR, dipstick urinalysis and eGFR. In this study, spot urine ACR and dipstick urinalysis were done and repeated three months later if initial tests were abnormal. Data was analysed using SPSS version 21. Chi-square and t-test were used to compare proportions between groups. Relation between study variables and CKD were examined using logistic regression. Results: The mean age of the participants was 9.6 years (SD ±3.6). Male to female ratio was 1:1. The median age at diagnosis of SCA was 22 months (IQR = 44). The prevalence of haematuria, proteinuria and CKD among the study participants was 14.2%, 36% and 36 % respectively. Low haemoglobin and elevated mean corpuscular volume (MCV) were associated with CKD-AOR 0.62, 95% CI; 0.46-0.84 and 1.04, 95% CI; 1.01 – 1.08 respectively. Recurrent admissions (due to VOCs, severe anaemia and febrile illness) were also risk factors associated with CKD- AOR 0.52, 95% CI; 0.27-0.98. CKD was not associated with age at enrolment, sex, age at diagnosis of SCA, recurrent Vaso-occlusive crisis (VOCs) or abnormal liver function tests. Conclusion: The prevalence of CKD among the SCA patients at UTH- Lusaka is high (36%) with lower Haemoglobin, elevated MCV and recurrent admissions being risk factors for developing CKD. SCA patients should be screened for CKD routinely at least once a year. Interventions such as the early introduction of hydroxyurea, proactive blood transfusions and ACE inhibitors can reduce the risk of CKD and its progression to end-stage renal disease.

scholarly journals Assessment of serum Zinc, Copper and Selenium in non-symptomatic Sickle-Cell Anaemia patients at the University Teaching Hospital, Lusaka, Zambia

2021 ◽  
Vol 3 (2) ◽  
pp. 69-74
Author(s):  
Alfred Machiko ◽  
◽  
Trevor Kaile ◽  
Sumbukeni Kowa ◽  
Christopher Newton-Phiri ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Teaching Hospital ◽  
Sickle Cell Anaemia ◽  
Serum Zinc ◽  
Binary Logistic Regression ◽  
Absorption Spectrometry ◽  
Serum Levels ◽  
Vital Role ◽  
University Teaching ◽  
The University

Background: Zinc, copper and selenium are known important trace elements playing a vital role as cofactors of enzymes such as superoxide dismutase and glutathione peroxide. They form part of the first line antioxidants enzymes in red blood cells and plasma. The study aimed at determining the serum levels of zinc, copper and selenium in asymptomatic sickle-cell anaemia patients. Methods: This was a case control study conducted from the specialist Haematology and Oncology Clinic 4 at the University Teaching Hospital, Lusaka, Zambia. 5mls of whole blood was collected from 46 sickle-cell anaemia patients and 46 healthy controls from Out-Patient Department after consent. Using Atomic Absorption Spectrometry, serum levels of zinc, copper and selenium was determined. Independent t-test was used to compare the means and a binary logistic regression for the likelihood of developing a sickling crisis, using SPSS version 20.Results: The mean serum levels of zinc in patients were lower 86.92±20.46mg/L against 91.33±43.23mg/L; p<0.028 of controls. Copper mean levels were 149.85±54.82mg/L against 134.32±54.16mg/L; p<0.191 of controls. Selenium mean levels were 0.100±0.041mg/L against 0.081±0.032mg/L; p<0.380 in patients compared to controls. The odds of developing one sickling crises in the past year given the levels of zinc, copper and selenium was [B = -.340, zinc Exp(B) =1.011, copper Exp(B) = 1.008, selenium Exp(B) = .000, DF = 1].Conclusion: Zinc is reduced in sickle-cell anaemia patients. The probability of developing a sickling crisis is lower in patients with higher serum levels of zinc and copper by 1.1% and 0.8% respectively.

scholarly journals CHRONIC KIDNEY DISEASE AMONGST SICKLE CELL ANAEMIA PATIENT AT THE UNIVERSITY OF MAIDUGURI TEACHING HOSPITAL, NORTH EASTERN NIGERIA: A STUDY OF PREVALENCE AND RISK FACTORS

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Audu Abdullahi Bukar ◽  
Mohammad Maina Sulaiman ◽  
Adama Isa Ladu ◽  
Aisha Mohammed Abba ◽  
Mohammed Kabir Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Sickle Cell ◽  
Sickle Cell Anaemia ◽  
Laboratory Data ◽  
Transfusion Therapy ◽  
Haematological Profile ◽  
Stage Renal Disease

ABSTRACTIntroduction: Involvement of the kidneys in patient with sickle cell anaemia is a well recognized chronic complication of this disorder. The index study seeks to determine the prevalence of chronic kidney disease in patients with homozygous sickle cell disease (HbSS) and to identify risk factors associated with its development.Methodology: The subjects consisted of adolescents and adults with HbSS recruited sequentially from the adult haematology outpatient clinic and Day care ward of the unit. Clinical variables including age of diagnosis of SCA, frequency of vaso-occlusive crisis and transfusion therapy, as well as laboratory data including haematological profile, renal function test were obtained from routine blood result. The glomerular filtration rate was estimated (eGFR) using the ‘modification of diet in renal disease’ (MDRD) formula..Results: Two hundred and eighty-four HbSS patients were recruited. The prevalence of CKD amongst them was 38.9%.  Further stratification of the patients based on eGFR showed that sixty-nine (26.8%) had hyperfiltration; 35 (13.6%) stage 1 CKD; 53 (20.6%) stage 2 CKD; 61 (23.7%) stage 3 CKD; 30 (11.7%) stage 4 CKD and 9 (3.5%) had end stage renal disease. There was significant association between eGFR and clinical parameters such as age (r -0.353, p=0.000), SBP (r -0.148, p= 0.021), DBP (r -0.213, p=0.001) and total number of blood received (r -0.276, p=0.000); and laboratory parameters such as  PCV (r 0.371, p=0.000); urea ( r 0.527, p=000 ); creatinine (r 0.625, p=0.000) and uric acid  ( r -0.419, p=0.000).ConclusionThe present study has revealed a high prevalence of CKD amongst patients with SCA in this region. Various clinical and laboratory predictors of eGFR were also identified. Monitoring and detection of early stages of these groups of patients may allow for interventions which may delay progression into advance stages and ESRD.

scholarly journals Frequency and associations of chronic kidney disease among gout patients from a University Teaching Hospital in Nigeria

2018 ◽  
Vol 56 (1) ◽  
pp. 17-23
Author(s):  
Akpabio Akanimo Akpabio ◽  
Pam Stephen Dung-gwom ◽  
Babatunde Hakeem Olaosebikan ◽  
Olufemi Oladipo Adelowo
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Teaching Hospital ◽  
University Teaching

scholarly journals Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia

2017 ◽  
Vol 32 (9) ◽  
pp. 1565-1573 ◽  
Author(s):  
Jeffrey D. Lebensburger ◽  
Gary R. Cutter ◽  
Thomas H. Howard ◽  
Paul Muntner ◽  
Daniel I. Feig
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Pediatric Patients

Clinical Presentations of Chronic Kidney Disease Patients on Regular Haemodialysis Attending in Tribhuvan University Teaching Hospital Emergency Services

2019 ◽  
Vol 2 (2) ◽  
pp. 138-143
Author(s):  
Tirtha Man Shrestha ◽  
Pratap Narayan Prasad ◽  
Laxman Bhusal ◽  
Ram Prasad Neupane ◽  
Rajan Ghimire
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Teaching Hospital ◽  
Emergency Services ◽  
University Teaching ◽  
Receiver Operating Curve ◽  
Maintenance Hemodialysis ◽  
Institute Of Medicine ◽  
Emergency Visit

 Background: Chronic kidney disease is increasing day by day and so is condition of renal replacement therapy mainly hemodialysis. Emergency visit of the patients under maintenance hemodialysis is frequent. The objective of the study is to study clinical parameters of these patients so that in future these deranged parameters can be focused during patient management and decrease their emergency visit. Methods: A prospective cross sectional study was conducted in emergency services of Tribhuvan University Teaching Hospital from 1st May 2018 to 31st October 2018 among the adult chronic kidney disease patients under maintenance hemodialysis. Ethical approval was taken from Institutional review board, Institute of Medicine, Tribhuvan University. Non-probability sampling method was used. Total of 300 patients were enrolled in the study. Patients’ age, sex, causes, laboratory parameter during emergency visit, need of emergency hemodialysis, and need of blood transfusion were studied. Results: Out of total 300 patients, mean age was 45.64 years (S.D =17.15). 190 (63.3 %) were male and 110(36.70%) were female. 152(50.70%) of patients had hypertension.Diabetes and Glomerulonephritis both had equal prevalence of 63(21%). Mean hemoglobin was 6.52gm% (S.D = 1.93). Mean pH was 7.17 (S.D =0.154). Mean serum potassium and creatinine level were 5.77 mEq/L (S.D =0.76) and 1076.03 mmol/l (S.D =367.25) respectively. Area under the Receiver Operating Curve was 0.660 for potassium and 0.598 for serum creatinine. Conclusion: Causes of chronic kidney disease, decreased hemoglobin level, increased serum creatinine and potassium level and metabolic acidosis are reasons of frequent emergency room visit among CKD patients. So these conditions need to be addressed to decrease emergency visit of these patients

scholarly journals Assessment of Some Haemostatic Parameters in Sickle Cell Anaemia Subjects Resident in Rivers and Bayelsa States

2021 ◽  
pp. 53-64
Author(s):  
Barinaaziga S. Mbeera ◽  
Susanna O. Akwuebu ◽  
A. C. U. Ezimah ◽  
Nancy C. Ibeh ◽  
Evelyn M. Eze
Keyword(s):  
Steady State ◽  
Sample Size ◽  
Sickle Cell ◽  
Teaching Hospital ◽  
Sickle Cell Anaemia ◽  
Control Group ◽  
Port Harcourt ◽  
The Mean ◽  
The University ◽  
D Dimer

Aim: The aim of this study was to assess some haemostatic parameters in sickle cell anaemia subjects in Rivers and Bayelsa States. Study Design: This study is a cross-sectional observational study. Place and Duration of Study: This study was carried out at the University of Port Harcourt Teaching Hospital, Rivers State, and the Federal Medical Centre, Yenagoa, Bayelsa State, between the months of February and August, 2020.  Methodology: A total of four hundred and fifty (450) subjects with age range of 1-50 years were randomly selected. There were about 200 registered patients (adults and children alike) at the sickle cell clinics of the University of Port Harcourt Teaching Hospital, and the Federal Medical Centre, Yenagoa, with an average of 4 new patients per month. The sample size was obtained using a prevalence of sickle cell anaemia of 2% and the sample size was calculated using Cochran sample size formula. Five milliliters (5ml) of venous blood sample was withdrawn from the peripheral vein in the upper limb of subjects using a standard venipuncture technique. The sample was rocked gently to mix and kept at room temperature and the haemostatic parameters (vWF, FVIII, D-dimer, L-arginine, fibrinogen, ADAMTS13) were assayed quantitatively with Bioassay Technozym kit using Microplate Reader (Labtech microplate auto ELISA plate reader, an IS0 13485:2003 CE and WHO compliance Co., Ltd. Shanghai International Holding Corp. GmbH; Europe) calibrated to a wavelength of 450 nm with strict adherence to the manufacturer's instructions, while PT and APTT were analysed with Fortress reagent and Uniscope SM801A Laboratory using water bath.Data management and statistical analyses were conducted using Statistical Analyses System SAS 9.4 (SAS Institute, Cary, North Carolina, USA) and p values less than .05were considered statistically significant. Results: The results showed the mean comparison of haemostatic parameters in sickle cell anaemia and control subjects. The comparison of haemostatic parameters showed significant(p<.05) increasesand decreases inVaso-Occlusive Crisis (VOC) and steady state respectively compared with the control group. There was statistically significantreduction in the mean comparison of L-Arginine (p<.01) in VOC) condition than steady state in relation to the control group in our study population, while D-Dimer, ADAMTS13 were also significantly reduced statistically (p<.01) in VOC condition than steady state compared with the control group. However, the mean FVIII inhibitor, Fibrinogen, PT (INR) and APTT were significantly higher (p<.01) in VOC than steady state when compared to controls with normal haemoglobin (HbAA).Correlations of haemostaticparameters by sickle cell anaemia subjects’ condition showed more significant positive correlations in VOC than steady state. Conclusion: This study showed a heightened hypercoagulability in Sickle Cell Snaemia(SCA)subjects, and further pave way for better understanding particularly the diagnostic variables underlying SCA, specific to each subject condition (steady state and VOC). Subjects with SCA, particularly during VOC, undergo significant haemostatic alterations that increase their risk of developing coagulation activation-related complications. Thus, though selected markers of coagulation were significantly different between the subject conditions, they were often significantly higher in the SCA.

scholarly journals Progression of Chronic Kidney Disease in Sickle Cell Disease

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1323-1323
Author(s):  
Emily Ciccone ◽  
R. Rosina Kilgore ◽  
Qingning Zhou ◽  
Jianwen Cai ◽  
Vimal K. Derebail ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Sickle Cell ◽  
Acute Chest Syndrome ◽  
Factors Associated ◽  
History Of ◽  
Dipstick Urinalysis ◽  
Rate Of Decline

Abstract Introduction: Chronic kidney disease (CKD) is common in patients with sickle cell disease (SCD). Despite current practice and recent NHLBI guidelines, which recommend screening and treatment for albuminuria, the progression of CKD in SCD and factors associated with such progression remain poorly defined. The purpose of this study was to evaluate the prevalence of CKD and its rate of progression in adult SCD patients. We also evaluated the laboratory and clinical factors associated with CKD progression. Methods: We conducted a retrospective study of patients seen between July 2004 and December 2013 at an adult Sickle Cell Clinic. Patients had confirmed diagnoses of SCD, were at least 18 years old, and were in the non-crisis state at the time of evaluation. Patients were excluded for histories of HIV, hepatitis B and C, and systemic lupuserythematosus. Clinical and laboratory variables were obtained from medical records. Estimated glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation.Presence of CKD was assessed by using a modification of the Kidney Disease Improving Global Outcomes clinical practice guidelines that incorporateseGFR and levels of albuminuria. CKD was defined aseGFR<90 or presence of proteinuria (at least 1+ on dipstick urinalysis). A linear mixed effects model was used to analyze the rate ofeGFR decline with a random intercept and fixed time effect for each subject. Linear mixed effect models were also used to identify risk factors for decline ofeGFR - one utilizing laboratory values and the other utilizing demographic and clinical characteristics. Results: Four hundred and twenty six patients with SCD (SS = 268, SC = 98, Sb0 = 22, Sb+ = 29, SE = 3, SD = 2, SHPFH = 4), median age of 29.5 years (IQR: 20 - 41 years), were evaluated. CKD at baseline was observed in 92 patients (21.6 %). The rate of decline in eGFR over time was 2.1 mL/min per 1.73 m2 per year (SE: 0.11, p < 0.0001) (Figure 1). Baseline laboratory factors that were significantly associated with decline ineGFR inunivariate analyses were hemoglobin, lactate dehydrogenase, indirect bilirubin, ferritin, hematuria, urine specific gravity, and proteinuria (at least 1+ on dipstick urinalysis). Clinical variables significantly associated witheGFR decline inunivariate analyses were weight, history of acute chest syndrome,history of stroke, chronic transfusion, systolic blood pressure, diastolic blood pressure, and use of ACE inhibitors/angiotensin receptor blockers (ACE-I/ARB). Multivariable analyses showed that the rate ofeGFR decline was dependent on the status of having proteinuria (estimate: -3.96, p < 0.0001), age (estimate: -0.05, p<0.0001), weight (estimate: 0.025, p<0.0001), systolic blood pressure (estimate: -0.033, p<0.0001), stroke (estimate: -1.84, p<0.0001), acute chest syndrome (estimate: -0.93, p=0.006), and chronic transfusions (estimate: 3.60, p=0.0002) (Table 1). Conclusion: eGFR declined at a rate of 2.1 mL/min per 1.73 m2 per year in adult patients with SCD. Proteinuria, age, acute chest syndrome, stroke, and higher systolic blood pressure were associated with an increased rate of decline in eGFR. However, heavier weight and chronic red cell transfusions were associated with less severe eGFR decline. Better understanding of these relationships and their pathophysiology is needed so that we can modify identified risk factors and attenuate the loss of kidney function in SCD. Disclosures No relevant conflicts of interest to declare.

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