Sickle cell nephropathy among children and adolescents with sickle cell disease at Bungoma County Referral Hospital

Abstract

Background: Sickle cell nephropathy (SCN) is one of the complications of sickle cell disease (SCD) in which albuminuria is one of the manifestations. Eighteen percent of those with sickle cell nephropathy progress to end stage renal disease. There is paucity of data on SCN in Bungoma County Referral Hospital which has a high burden of sickle cell disease. This study sought to determine the burden of sickle cell nephropathy among children and adolescents with SCD to advice policy on screening and management. Objectives: To determine proportion of children and adolescents with SCN among those with SCD and their associated clinical-demographic characteristics. Methods: A cross-sectional study was conducted at Bungoma County Referral Hospital pediatric and medical outpatient clinics between January and September 2019. Sample size was determined using Fisher’s formula in which 127 eligible children and adolescents below 19 years of age with sickle cell disease were recruited. Age, gender, anthropometric measurements, number of transfusions, hospitalizations and use of hydroxyurea were recorded in a structured questionnaire. Spot urine sample was collected for urinalysis and albumin to creatinine ratio. Those positive for albuminuria had a repeat urinalysis and albumin to creatinine ratio after one month. Data analysis was done using STATA version 15. Categorical variables were summarized using frequencies and percentages. Continuous variables were summarized using mean and median. Significance of association between albuminuria and categorical variables was tested using Pearson Chi Square test and Fisher’s exact test. Continuous variables were compared using the independent T-test. P-value of <0.05 was considered significant at 95% confidence interval. Results: The proportion of those with SCN was 15.8%. The median age was 7.00(IQR: 1.42,18) years with 65(50.4%) being female. One hundred and eight (85%) were children among whom 14(12.96%) had SCN while among adolescents, 6(31.58%) had SCN. Among the characteristics of those with SCN, 14(21.5%) were female, 9(21.4%) had been transfused, 17(16.2%) had been hospitalized within one year prior to recruitment and 19(17.1%) were not using hydroxyurea. Age was significantly associated with SCN (p=0.047) while gender (p=0.067), number of hospitalizations (p=0.989), number of transfusions (p=0.217) and hydroxyurea use (p=0.228) was not significantly associated with SCN. Conclusion: One in eight children and one in three adolescents had SCN. Older age was significantly associated with SCN but no clinical characteristics were significantly associated with SCN. Recommendation: Screening for sickle cell nephropathy should be done in routine care of children with sickle cell disease during follow up at the clinics and continued throughout adolescence.