The prevalence of albuminuria in children with chronic kidney disease in two tertiary hospitals in Nairobi, Kenya
Date of Award
Master of Medicine (MMed)
Dr. Doris Kinuthia
Professor. Geoffrey Omuse
Paediatrics and Child Health (East Africa)
Background: Chronic kidney disease (CKD) is a major health problem globally. In Africa, the burden in children remains unclear and is often reported as low. In developing countries, it is mainly due to secondary causes and nephrotic syndrome, while in the developed countries it is mainly due to congenital anomalies of kidney and urinary tract (CAKUT). The Kidney Disease: Improving Global Outcomes (KDIGO) defines CKD and utilises glomerular filtration rate (GFR) and albuminuria as an additional factor. Albuminuria is significant in prognostication of individuals with CKD as it is a marker of kidney damage. It is correlated with outcomes including disease progression to renal replacement therapy, cardiovascular disease and all-cause mortality. Common causes of albuminuria include CAKUT and glomerulonephritis. The identification of CKD and albuminuria at an earlier stage of the disease process allows the possibility of intervention thus retarding the disease progression and initiation of relevant care.
Objectives: The primary objective was to determine the prevalence of albuminuria in children with CKD in two tertiary hospitals in Nairobi, Kenya. The secondary objectives were to stage CKD, determine CKD aetiology and to determine the correlation of eGFR and UACR.
Methods: A cross sectional study of children aged two -18 years with CKD on follow up in two tertiary hospitals in Nairobi, Kenya was conducted. Sampling was purposive in view of the small population size to obtain an adequate sample size (61). Data on aetiology of CKD based on KDIGO criteria were used. Data were collected using a questionnaire. A spot urine sample for albuminuria (UACR) and a blood sample for creatinine (to calculate eGFR) were collected at the point of recruitment.
Results: A total of 61 participants were included of whom 67.2% were male. At recruitment, the median age of participants was 7 years with 4 years as the median age at diagnosis. Majority were CKD stage 1 based on eGFR (70.5%) with a median eGFR 109.2ml/minute/1.73m². The leading aetiology of CKD was found to be obstructive uropathy (32.8%). Clinically significant albuminuria (>three mg/mmol) occurred in 36% of the participants. Though not statistically significant albuminuria increased with every unit increase in estimated glomerular filtration rate.
Conclusion: Albuminuria an important prognosticating factor in chronic kidney disease was found in a third of the participants. Its application in the follow up of these children should be identified and implemented to help reduce the disease associated morbidity and mortality.
Githumbi, M. W. (2021). The prevalence of albuminuria in children with chronic kidney disease in two tertiary hospitals in Nairobi, Kenya (Unpublished master's dissertation). Aga Khan University, East Africa.