Prevalence of glomerular disease among secondary school students in Eldoret, Kenya

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