Urinary Abnormalities in Children with Sickle Cell Anaemia

Background: Sickle cell anaemia (SCA) is a health problem worldwide. Almost all the organs of the body are affected by the combined effect of chronic hypoxia; repeated infarction and recurrent infections. Renal function may be progressively impaired in them as a result of sickling in the renal medulla. Microscopic hematuria; proteinuria; urinary concentrating defects; distal renal tubular acidosis and nephrotic syndrome are some of the renal abnormalities complicating SCA. The chronic nephropathy often seen in adults with SCA may actually have its onset in childhood.Objective: To find out whether children with SCA had significant urinary abnormalities. Method: Children with SCA in steady state (subjects) and healthy non-SCA children (controls) matched for age and sex were prospectively studied (using a dip-stick urinalysis) for significant proteinuria; significant haematuria; specific gravity and pH.Results: A total of 144 children were studied; seventy-two with sickle cell anaemia and the 72 others with HbAA (37 females and 35 males in each group).The ages of the children ranged from 16 months to 16 years. Significant proteinuria was seen in 5(7). Significant haematuria was also seen in 8(11) of the subjects. None of the controls had significant proteinuria nor haematuria. The mean serum creatinine level of the 13 children with s i g n i f i c a n t p r o t e i nu r i a / h a e m a t u r i a wa s 53.2 mol/L (range 42-65 mol/L). Defects in urinary concentrating ability was found in 13(18.1) and impaired urinary acidification in 50(69) of the subjects.Conclusion: Significant urinary abnormalities do occur in children with SCA. Urinalysis should therefore be done routinely for all children with SCA especially those older than five years as a screening test to detect at an early age any renal pathology

Chronic renal failure in childhood : report of 15 cases

The case reports of 15 consecutive children seen over a period of 6 years are outlined. Renal biopsy in one patient showed focal segmental glomerulosclerosis. Hypertension was found in 60 per cent of the children and nephrotic syndrome in 40 per cent. These two clinical features should prompt early referral for investigations and treatment; while the need for a long-term dialysis-transplant programme is now imminent