Abstract:
Background: Glomerular pathology contributes significantly to chronic kidney disease
(CKD), a global public health problem. CKD has many non specific symptoms and
frequently goes unrecognized in its early stages. Early diagnosis is important since
measures can be instituted to curb progression. Existence of glomerular disease can be
implied by glomerular haematuria, persistent proteinuria and elevated blood pressure.
Objective: To determine the prevalence of glomerular haematuria, persistent
proteinuria and elevated blood pressure among secondary school students in Eldoret.
Methods: This was a descriptive cross sectional study. Four public secondary schools
were randomly selected. Probabilistic multi-stage sampling was used to enroll
participants aged 12 to 19 years between June and July 2013. Data was collected and
entered into a predesigned form. Three blood pressure measurements were taken at 5
minute-intervals and the mean calculated. Elevated blood pressure was diagnosed based
on United States of America National Heart, Lung and Blood Institute criteria. Seventh
Report of the Joint National Committee on Prevention, Detection, Evaluation and
Treatment of High Blood Pressure (JNC 7) criteria was used for participants over 17
years. Clean catch, first morning urine samples were obtained. Dipstick urinalysis was
done at schools and urine that tested positive for blood and /or protein was transported
in a cooler box to laboratory and subjected to microscopy. Participants with proteinuria,
haematuria and elevated blood pressures were weighed and blood samples for
measurement of serum creatinine drawn. Using Cockroft-Gault formular, their
estimated glomerular filtration rate (eGFR) was calculated. Participants with
proteinuria and haematuria on first assessment underwent a second test within three
months to ascertain the persistence of these findings.
Results: Out of 395 participants, 51%(200) were male. Mean age was 17(SD: 1.5) with
a range of 13 to 19 years. The prevalence of glomerular haematuria was 2.8%(11) while
that of persistent proteinuria was 2.0%(8). The prevalence of glomerular disease was
3.5%(14). Elevated blood pressure was prevalent at 12.7 % and was found to be
strongly associated with presence of glomerular disease; p<0.0001. Personal history of
features of kidney disease and history of risk factor/s for kidney disease were
associated with presence of glomerular disease; p=0.003 and p=0.023 respectively.
There was no association between reduced eGFR (eGFR<90) and glomerular disease; p
= 0.501.
Conclusion: The prevalence of glomerular disease was 3.5%. Adolescents with
elevated blood pressure, personal history of features suggestive of kidney disease and
risk factor/s for kidney disease were more likely to have abnormal urinalysis findings
consistent with glomerular disease.
Recommendation: Urinalysis together with relevant history and elevated blood
pressure should be embraced as screening tool for glomerular disease in adolescent
population