Date Published: June 18, 2019
Publisher: Public Library of Science
Author(s): Fransisca D. Kimaro, Shakilu Jumanne, Emmanuel M. Sindato, Neema Kayange, Neema Chami, Jeffrey Lebensburger.
Little is known on how the interaction between Sickle Cell Disease (SCD) and renal insults caused by other coexisting conditions in Sub Saharan Africa such as urinary schistosomiasis, malnutrition and HIV affect the prevalence of renal dysfunction in children with SCD.
To determine the prevalence and factors associated with renal dysfunction among children with SCD aged 6 months to 12 years attended at a tertiary hospital in Northwestern Tanzania.
A cross sectional hospital-based study with a short follow up component of 3 months for 153 children with SCD was done to document demographics, clinical characteristics and features of renal dysfunction including urine dipstick albuminuria (>20mg/l) and eGFR (<60ml/ml/min/1.73m2). Other potential renal insults such as HIV infection and Schistosomiasis were also evaluated. At enrollment, 48/153(31.37%) children had renal dysfunction declining to 31(20.3%) at 3 months follow up. Acute chest syndrome (OR 3.04, 95% CI [1.08–8.96], p = 0.044), severe anemia (OR 0.44, 95% CI [0.26–0.76],p = 0.003), urinary schistosomiasis (OR 7.43, 95% CI [2.10–26.32] p<0.002) and acute malnutrition (OR 4.92, 95% CI [1.29–18.84], p = 0.020). were associated with renal dysfunction. Where prevalent, urinary schistosomiasis and acute malnutrition increase the risk for renal dysfunction in children with SCD. We recommend albuminuria routine screening in children with SCD especially those presenting with acute chest syndrome, severe anemia and features of acute malnutrition for early detection of renal dysfunction among children with SCD.
Progressive decline in renal function is a common occurrence among children with Sickle Cell Disease (SCD). This starts during infancy marked by reduced urine concentrating ability, glomerular hyperfiltration and moderately increased albuminuria culminating to severely increased albuminuria, Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) among adolescents and young adults. Progressive renal dysfunction is an important attribute to the reduced life expectancy in SCD patients and is reported to contribute 16–18% of the overall mortality in this population. Homozygous state (HbSS) and HbSβ0 thalasemia tends to have more severe renal involvement than other subtypes of sickle cell anemia such as HbSC and HbSβ+thalasemia.
This was a cross sectional descriptive study with a short follow up component of 3 months post enrolment, conducted at Bugando Medical Center (BMC); a 900-beds tertiary referral hospital for the northwestern zone of Tanzania located in the city of Mwanza.The study was conducted from October 2015 to April 2016 enrolling children with SCD aged 6 months to 12 years who were attending the outpatient clinic for routine SCD care. Ethical Clearance was granted by the CUHAS-Bugando Ethical and Research review Committee and parents/guardians signed an informed consent form before enrollment of their children in our study.
In the region of Sub-Saharan Africa, which harbor more than 75% of the global SCD burden exist, other prevalent conditions with the potential to cause renal damage such as malaria, HIV infection, severe malnutrition and urinary tract schistosomiasis. Little data is available from this region on how the interaction between these common childhood conditions and SCD contribute to the occurrence of sickle cell nephropathy. Our study was conducted in northwestern Tanzania; a region with high prevalence of urinary schistosomiasis and sickle cell disease to estimate the prevalence of renal dysfunction in children with SCD and the effects of other renal insults prevalent in this region to the occurrence of renal dysfunction.