Renal status of children with sickle cell disease in Accra, Ghana.

INTRODUCTION

In West Africa, the prevalence of sickle cell disease (SCD) is 2%. The disease adversely affects growth, development and organ function including the kidneys. There is however a dearth of information about the renal status of SCD children in Ghana.

OBJECTIVES

To assess the renal status of children with SCD in steady state.

DESIGN

A cross-sectional case-control study.

SETTING

Paediatric Sickle Cell Clinic, Korle Bu Teaching Hospital, Accra.

PARTICIPANTS

Cases-357 SCD cases and 70 of their HbAA siblings as controls.

METHODS

Documentation of their socio-demographic data, clinical data and dipstick urinalysis findings, and renal ultrasonography on selected participants.

RESULTS

The mean [SD] age was 7.18 [3.15]yrs for cases and 5.16[3.28]yrs for controls. The genotypes were Hb SS (76.7%), Hb SC (21.8 %), and Hb Sβthal (1.4%). Urinalysis showed leucocyturia in 12.6% versus 5.7% (χ2=62.5 and the p=0.000)), isolated proteinuria in 2.8% versus 1.43% (χ2=10.01 and p=0.001) haematuria in 2.6% versus 0% (χ2=9.233, p=0.002) and nitrites in 2.2% versus 1.4% (χ2=16.3,p=0.02) of cases and controls respectively. The youngest SCD case with proteinuria was 2 yrs. old. Proteinuria prevalence increased with age, , occurring in 5.7% of cases aged 9-11yrs. and 20.6% of cases aged 12 yrs. Two-thirds of the proteinuria cases were aged 9-12 yrs., of whom 50% were aged 12 yrs. Renal ultrasound findings were normal in all those examined.

CONCLUSION

Urinary abnormalities suggesting nephropathy occur early in SCD patients in Ghana. Routine dipstick screening at clinic visits countrywide would help early detection and prompt intervention to limit renal impairment.