Glomerular filtration rate in homozygous sickle cell disease children in steady state and healthy Nigerian children: a comparative study in north-eastern Nigeria

Background: Homozygous sickle cell disease (HSCD) is the most common inherited blood disorder of public health importance worldwide, with Sub-Saharan Africa accounting for a third of the global burden. The effect of HbS on the kidneys results in sickle cell nephropathy, which contributes to increased mortality among HbSS patients beyond third decade of life. Glomerular filtration rate (GFR) is an important renal function test for evaluating progress of sickle cell nephropathy, however, this is seldom done to HbSS patients especially in the insurgency that devastated the North-eastern part of Nigeria, where displacement of people has led to increase in diarrhoeal diseases with its complications which also contributes to renal diseases, hence the need for this study. Objective: To determine the baseline glomerular filtration rate of homozygous SCD in steady state and compare same with normal controls. Methods: This is a prospective comparative study conducted at the University of Maiduguri Teaching Hospital (UMTH). The study population consisted of age and sex matched HbSS subjects in steady state and children with haemoglobin AA genotypeaged 3-14 years. The study was conducted over a period of 6 months. Anthropometry and serum creatinine of the subjects were determined and GFR calculated using Schwartz formula. Results: Two hundred and twenty children consisting 110 HbSS and 110 controls were enrolled. This consist of 106 males and 114 females with M:F ratio of 0.9:1. Mean ages of HbSS patients and HbAA subjects were 8.2years and 7.9 years respectively. The mean GFR (SD) was 125.9 (31.9) ml/min/1.73m2 and 93.0 (16.1) ml/min/1.73m2 for the HbSS and HbAA controls, the difference between the means was significant (P<0.001). The normal GFR range for the controls was 77 to 109 ml/min/1.73m2. Sixty-seven (61%) casesand 86 (78%) controls had GFRs within normal range. There was statistically significant difference for GFRs above and below the normal range (Z-score=6.2 & -2.9, p<0.001 & p<0.004). Conclusion: About a third of HbSS children in steady state have elevated GFR, this suggests the presence of moderate renal pathology. Regular monitoring of these children will lead to improvements in management of sickle cell nephropathy and their quality of life

Effect of Glycaemic Control on Glomerular Filtration rate in Diabetes Mellitus Patients

Background: Glomerular filtration rate (GFR) is a widely accepted parameter in assessing overall renal function. This study sought to assess the effect of glucose lowering on GFR in diabetic patients admitted for short term therapy at Mulago hospital. Methods: This was a descriptive study where consenting patients were consecutively recruited. Glomerular filtration rate was measured using creatinine clearance in 40 type I and II diabetes mellitus patients admitted on the basis of a glucometer reading of RBS = 300mg/dl both at admission and discharge. Data was analyzed using a paired sample t-test and p-value set at 0.05 (95CI). Results: A total of 40 patients were assessed. Their mean age was 49.8 years. 82.5of them had type II DM while only 17.5had type I DM. The average duration of disease was 7years. GFR was found to decrease from 157.4ml/min on admission to 86.4ml/min at discharge (p=0.001). Random blood sugar levels decreased from 332.2mg/dl on admission to 119.8mg/dl at discharge (p=0.000). Conclusion/ Recommendation: Results imply that glycaemic control lowers the GFR in diabetic patients admitted for short term treatment. A reduction in GFR reflects reduction of hyperfiltration; a process that starts diabetic nephropathy. Good glycaemic control will go along way to delay onset of diabetic nephropathy