Micro-albuminuria in Ugandan children with sickle cell anaemia: a cross-sectional study.

BACKGROUND: In patients with sickle cell anaemia (SCA), recurrent episodes of sequestration, micro-infarction, ischaemia and necrosis within the renal cortex cause nephron damage. Micro-albuminuria results from compensatory mechanisms aimed at preserving the glomerular filtration rate. AIMS: To establish the prevalence of micro-albuminuria among children with SCA and to describe associated factors. METHODS: A cross-sectional study of patients aged 2-18 years with SCA was undertaken at the sickle cell clinic, Mulago Hospital, Kampala between November 2007 and April 2008. Haemoglobin was measured and urine dipstick was used to determine protein, glucose, red blood cells and nitrites, serum creatinine and albumin and urine creatinine and albumin. Binary logistic regression was performed to determine factors associated with micro-albuminuria. RESULTS: Of 305 children studied, 48·2% were male. The mean (SD) age of the study participants was 9·7 (4·9) years. The prevalence of micro-albuminuria (30-300 µg/mg) was 28·2% (86/305, 95% CI 23·1-33·3). Use of diclofenac (p = 0·01) and ibuprofen (p = 0·001) were found to increase the risk of micro-albuminuria only by bivariate analysis. By multivariate analysis, increasing age (p = 0·001), a higher number of blood transfusions (p = 0·001) and presence of urine nitrites (p = 0·031) were associated with a risk of micro-albuminuria, whereas high levels of haemoglobin (p = 0·018) were protective. There was no association between estimated glomerular filtration rate and micro-albuminuria. CONCLUSIONS: The prevalence of micro-albuminuria among children with SCA is relatively high. SCA patients over 5 years of age should be screened for micro-albuminuria. Those with lower haemoglobin levels should be monitored closely because of its association with micro-albuminuria.

Selective protein index and clinical features of childhood nephrotic syndrome in Kampala [see comment]

A cross sectional study was carried out to determine Selective Protein Index (SPI) and relate it to some clinical features that might be useful in deciding on the treatment of children with the nephrotic syndrome in four hospital in Kampala; Uganda. Radial immunodiffusion technique in commercially prepared plates was used for the determination of SPI. High selective protein index was found in 23 out of 60(38) and low selective protein index was found in 37 out of 60(62) of the patient studies. In patients who were not on antihypertensive or diuretic therapy; the clinical features found to be significantly associated with high Selective Protein Index (SPI) were: normal blood pressure and generalised oedema. When these features occurred together in a patient; their positive predictive value for high SPI was found to be 71. Normal blood pressure and generalised oedema appear to be the clinical features that may be used in combination to select children with nephrotic syndrome who are likely to have high Selective Protein Index and therefore to respond to steroid therapy

Comparison of vaccination status of children born in health units and those born at home.

BACKGROUND: The Expanded Programme of Immunisation schedule starts at birth, yet a significant number of child births in Uganda occur at home, where there are no vaccines. A child born at home may therefore have less chances of being vaccinated than a child born in a health unit. OBJECTIVES: To investigate vaccination status of the under-fives and to establish whether vaccination status of children born in health units is better than those born at home. DESIGN: Cross-sectional descriptive. SETTING: Paediatrics out-patient clinic of Jinja Hospital, a regional referral health facility in Eastern Uganda. METHODS: Children under five years were enrolled consecutively as they arrived at the registration desk. The child health card and physical examination for BCG scar were used to establish the vaccination status of each child. A structured questionnaire was used for collecting relevant data. RESULTS: Of the 486 children sampled, 79 had been born at home, and 407 had been born in health units. Overall, 68% of the children were fully vaccinated for age. A child born in a health unit was significantly more likely to have a BCG scar (p = 0.0087), and to be up to date with their vaccination (p = 0.0173), compared to a child born at home. Vaccine drop-out rate was similarly high irrespective of whether the children were born at home or in health units. CONCLUSION: Being born at home was found to be a risk factor for incomplete or non-vaccination. Continuation of vaccination was similarly poor in children born at home and those born in health units.

Selective protein index and clinical features of childhood nephrotic syndrome in Kampala.

A cross sectional study was carried out to determine Selective Protein Index (SPI) and relate it to some clinical features that might be useful in deciding on the treatment of children with the nephrotic syndrome in four hospitals in Kampala, Uganda. Radial immunodiffusion technique in commercially prepared plates was used for the determination of SPI. High selective protein index was found in 23 out of 60(38%) and low selective protein index was found in 37 out of 60(62%) of the patients studied. In patients who were not on antihypertensive or diuretic therapy, the clinical features found to be significantly associated with high Selective Protein Index (SPI) were: normal blood pressure and generalised oedema. When these features occurred together in a patient, their positive predictive value for high SPI was found to be 71%. Normal blood pressure and generalised oedema appear to be the clinical features that may be used in combination to select children with nephrotic syndrome who are likely to have high Selective Protein Index and therefore to respond to steroid therapy.