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Hassan MO, Arogundade FA, Osasan SA, Gbadegesin BA, Omotoso BA, Okunola OO, Sanusi AA, Adelusola KA, Akinola NO, Akinsola A. Clinicopathologic Study of Sickle Cell-associated Kidney Disease: A Nigerian Experience. Niger Postgrad Med J 2024; 31:53-61. [PMID: 38321797 DOI: 10.4103/npmj.npmj_213_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Improvements in sickle cell disease (SCD) care have resulted in the survival of many patients into adulthood, although this is accompanied by the increased incidence of end-organ damage, including chronic kidney disease (CKD). OBJECTIVES This study assessed the prevalence, pattern and predictors of renal dysfunction in SCD patients and investigated the associated renal histopathologic changes. METHODS We evaluated 105 patients with SCD, for proteinuria, estimated glomerular filtration rate (eGFR), and tubular dysfunction. Renal biopsy was conducted on 22 patients who qualified. Data were analysed using SPSS package version 23. RESULTS Thirty-seven (35.2%) of the 105 patients had CKD, as defined by an eGFR of 60 ml/min/1.73 m2 and/or proteinuria. The fractional excretion of potassium (FEK) was elevated in all patients, whereas the fractional excretion of sodium (FENa) was elevated in 98.1%. Glomerular filtration rate was negatively correlated with irreversible percentage sickle cell count (r = -0.616, P = 0.0001), FEK (r = -0.448, P = 0.0001) and FENa (r = -0.336, P = 0.004). Age, irreversible percentage sickle cell count, haemoglobin levels and FENa were the major predictors of CKD. The histological pattern in the 22 patients who had biopsies was consistent with mesangioproliferative glomerulonephritis 11 (50%), minimal change disease 6 (27.3%), focal segmental glomerulosclerosis 3 (13.6%) and interstitial nephritis 2 (9.1%). CONCLUSIONS CKD was prevalent in SCD patients, and it was characterised by tubular dysfunction and mesangioproliferative glomerulonephritis. The main predictors of CKD were increased age, severity of vaso-occlusive crisis, worsening anaemia and tubular dysfunction.
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Affiliation(s)
- Muzamil Olamide Hassan
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Medicine, Renal Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Fatiu Abiola Arogundade
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Medicine, Renal Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Stephen Adebayo Osasan
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Babajide A Gbadegesin
- Department of Internal Medicine, LAUTECH Teaching Hospital, Ogbomoso, Osun State, Nigeria
| | - Bolanle Aderonke Omotoso
- Department of Medicine, Renal Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
- Department of Medical Pharmacology and Therapeutics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Oluyomi Oluseun Okunola
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Medicine, Renal Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Abubakr Abefe Sanusi
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Medicine, Renal Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Kayode A Adelusola
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Norah O Akinola
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adewale Akinsola
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
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Adigwe OP, Onavbavba G, Onoja SO. Impact of Sickle Cell Disease on Affected Individuals in Nigeria: A Critical Review. Int J Gen Med 2023; 16:3503-3515. [PMID: 37601802 PMCID: PMC10438428 DOI: 10.2147/ijgm.s410015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/08/2023] [Indexed: 08/22/2023] Open
Abstract
Sickle cell disease is an autosomal recessive disorder of the beta-globin gene, with resultant deformation of the red blood cells and variable clinical outcomes. Nigeria is recognised as the country with the highest burden of sickle cell disease globally. This study aimed at critically reviewing available literature on impact of sickle cell disease in Nigeria. A literature search was carried out on four databases, and a total of 116 articles that met the inclusion criteria were included in the critical review. It was observed that majority of the studies were carried out in South-Western part of Nigeria (47.4%), whilst the North-East had the least number of studies undertaken in this area, more than a quarter of the studies (27.6%) were related to hematologic and serologic screening. Major themes that emerged from this review were morbidity and mortality; prevalence of sickle cell disease; issues relating to blood transfusion; psychosocial impact; and anatomical dysfunction in sickle cell disease. Intervention programs from both government and non-governmental organizations aimed at reducing the burden of sickle cell disease and its socio-economic impact were identified as key to strategies aimed at overcoming challenges associated with the disease. Findings from this study also revealed that education and awareness interventions were central to reducing the prevalence of sickle cell disease in this setting.
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Affiliation(s)
- Obi Peter Adigwe
- National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria
| | - Godspower Onavbavba
- National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria
| | - Solomon Oloche Onoja
- Department of Medical Laboratory Sciences, University of Nigeria, Enugu, Nigeria
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Hanna D, Beshir M, Khalifa N, Baz E, Elhewala A. Assessment of cystatin C in pediatric sickle cell disease and β-thalassemia as a marker of subclinical cardiovascular dysfunction: a case-control study. Pediatr Hematol Oncol 2021; 38:620-632. [PMID: 33724143 DOI: 10.1080/08880018.2021.1894280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiovascular complications represent the main determinant of survival in patients with hemoglobinopathies. Serum cystatin C is a well-known marker of nephropathy in sickle cell disease (SCD) and β-thalassemia patients that has recently emerged as a strong predictor of cardiovascular dysfunction in patients with and without kidney disease. We performed a case control study to determine the role of cystatin C as a predictor of subclinical cardiovascular dysfunction in SCD and β-thalassemia patients. We enrolled 40 SCD patients with a mean age of 12.4 years, 40 β-thalassemia patients with a mean age of 11.4 years and 40 age and sex-matched controls. We assessed hematological profile, serum ferritin, urinary albumin-creatinine ratio (UACR), serum cystatin C, echocardiography and carotid intima media thickness (CIMT). UACR, cystatin C and CIMT were higher in SCD and β-thalassemia patients compared to controls (p < .001). Significantly higher cystatin C levels were observed in SCD and β-thalassemia patients with nephropathy or left ventricular systolic dysfunction (shortening fraction <30%, or ejection fraction <55%; p < .001). Moreover, SCD patients with pulmonary hypertension had significantly higher cystatin C levels. Cystatin C levels were positively correlated with CIMT in SCD (p = .02) and β-thalassemia patients (p < .001) while negatively correlated with ejection fraction and shortening fraction (p < .001). The cutoff values of cystatin C ≥ 16.03 and ≥ 13.2 (ng/mL) could detect subclinical cardiac dysfunction risk among SCD and β-thalassemia patients respectively. Cystatin C appears to be a promising marker for subclinical cardiovascular dysfunction in SCD and β-thalassemia patients.
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Affiliation(s)
- Diana Hanna
- Pediatric Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Mohamed Beshir
- Pediatric Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Naglaa Khalifa
- Clinical pathology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Eman Baz
- Pediatric Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Ahmed Elhewala
- Pediatric Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
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Ugwu N, Okike C, Ugwu C, Ezeonu C, Iyare F, Alo C. Assessment of zinc level and its relationship with some hematological parameters among patients with sickle cell anemia in Abakaliki, Nigeria. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_178_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chronic Kidney Disease amongst Sickle Cell Anaemia Patients at the University of Maiduguri Teaching Hospital, Northeastern Nigeria: A Study of Prevalence and Risk Factors. Mediterr J Hematol Infect Dis 2019; 11:e2019010. [PMID: 30671216 PMCID: PMC6328039 DOI: 10.4084/mjhid.2019.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Involvement of the kidneys in patients with sickle cell anaemia is a well recognised chronic complication. This study seeks to determine the prevalence of chronic kidney disease in patients with homozygous sickle cell disease (HbSS) and to identify risk factors associated with its development. Methodology The subjects consisted of adolescents and adults with HbSS recruited sequentially from the adult haematology outpatient clinic and Daycare ward of the unit. Clinical variables including age at diagnosis of SCA, the frequency of vaso-occlusive crisis and transfusion therapy, as well as laboratory data including haematological profile and renal function tests were obtained. The glomerular filtration rate was estimated (eGFR) using the ‘modification of diet in renal disease’ (MDRD) formula. Results Two hundred and eighty-four HbSS patients were recruited. The prevalence of CKD amongst them was 38.9%. Further stratification of the patients based on eGFR showed that sixty-nine (26.8%) had hyperfiltration; 35 (13.6%) stage 1 CKD; 53 (20.6%) stage 2 CKD; 33 (12.8%) stage 3a CKD; 28 (10.9%) stage 3b CKD; 30 (11.7%) stage 4 CKD and 9 (3.5%) had end stage renal disease. There was significant association between eGFR and clinical parameters such as age (r −0.353, p=0.000), SBP (r −0.148, p= 0.021), DBP (r −0.213, p=0.001) and total number of blood received (r −0.276, p=0.000); and laboratory parameters such as PCV (r 0.371, p=0.000); urea ( r 0.527, p=000); creatinine (r 0.625, p=0.000) and uric acid ( r −0.419, p=0.000). Conclusions The present study has revealed a high prevalence of CKD amongst patients with SCA in our region. Clinical and laboratory predictors of CKD using eGFR were identified to include age, SBP, number of units of blood transfusion, PCV, urea, creatinine and uric acid levels.
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Aneke JC, Huntley N, Porter J, Eleftheriou P. Effect of automated red cell exchanges on oxygen saturation on-air, blood parameters and length of hospitalization in sickle cell disease patients with acute chest syndrome. Niger Med J 2016; 57:190-3. [PMID: 27397962 PMCID: PMC4924404 DOI: 10.4103/0300-1652.184073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Red cell exchanges (RCEs) lead to improvement in tissue oxygenation and reduction in inflammatory markers in sickle cell disease (SCD) patients who present with acute chest syndrome (ACS). The aim of this study is to evaluate the effects of automated-RCE (auto-RCE) on oxygen saturation (SpO2) on-air, blood counts, the time to correct the parameters and length of hospitalization after the exchange in SCD patients presenting with ACS. Subjects and Methods: This was 2 years study involving five SCD patients; the time for SpO2 on air to increase to ≥95% and chest symptoms to resolve, postprocedure, as well as the length of in-patient hospitalization was recorded. All data were entered into Statistical Package for Social Sciences Version 20.0 (SPSS Inc., Chicago, IL, USA) computer software for analyses. Results: The study involved 4 (80%) hemoglobin (Hb) SS and 1 (20%) HbSC patients. The median time of SpO2 recovery was 24 h, ranging from 6 to 96 h. About 60% (3/5) of patients achieved optimal SpO2 within 24 h post-RCE, while discharge from intensive care unit was 24 h after auto-RCE in one patient. The Hb concentration was significantly higher, while the total white cell and absolute neutrophil counts were significantly lower at the time of resolution of symptoms, compared to before auto-RCE (P < 0.05). The average post auto-red cell transfusion symptoms duration was 105.6 (24–240) h while mean inpatient stay was 244.8 (144–456) h. Conclusion: Auto-RCE could reverse hypoxia in ACS within 24 h.
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Affiliation(s)
- John C Aneke
- Department of Haematology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria; Department of Haematology, Red Cell Unit, University College London Hospital, London, UK
| | - Nancy Huntley
- Department of Haematology, Red Cell Unit, University College London Hospital, London, UK
| | - John Porter
- Department of Haematology, Red Cell Unit, University College London Hospital, London, UK
| | - Perla Eleftheriou
- Department of Haematology, Red Cell Unit, University College London Hospital, London, UK
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Ackoundou-N'Guessan C, Guei CM, Lagou DA, Gbekedi S, Tia MW, Coulibaly PA, Nzoue S, Konan S, Koffi G, Gnionsahe DA. [Chronic renal failure in sickle cell disease: A retrospective analysis of 100 adults sickle cell patients from black Africa]. Nephrol Ther 2015; 12:149-55. [PMID: 26653399 DOI: 10.1016/j.nephro.2015.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 12/13/2022]
Abstract
The prevalence of chronic renal failure (CRF) in sickle cell disease (SCD) patients could vary from one country to another depending on the modalities of management. The aim of the present study was to appreciate the epidemiology of CRF in SCD patients from black Africa in order to search for promoting factors. One hundred SCD adult patients have been considered for the study. The glomerular filtration rate (GFR) has been estimated according to the CKD-EPI formula. Three groups of patients have been identified according to the value of their GFR. The mean age of the patients was 30.84±8.26 years. Male gender has represented 51% of the study population. The mean GFR value was 175.4±86.2 mL/min/1.73 m(2). The prevalence of CRF was 11%. About 3% of them had severe CRF. Subjects with normal GFR were 20%. Subjects with glomerular hyperfiltration (HF) were 69%. By univariate analysis, when subjects with HF were compared with those presenting normal GFR, the following factors have appeared to be significantly associated: female gender (female 60.9% versus male 39.1%; P<0.01), weight <60 kg (weight <60 kg; 53.67±9.45 kg versus weight >60 kg; 59.9±9.41 kg; P<0.008), age <30 years (younger age 29.36±7.9 years versus older age 35.14±8.02 years; P<0.001), lower hemoglobin value (9.38±2,3 g/dL versus 10.33±2.61 g/dL; P<0.04). By logistic regression analysis, age <30 years (age >30 years; OR=0.12 [CI95% 0.03-04]; P<0.001), female gender (male gender; OR=0.17 [0.04-0.64]; P<0.01), weight <60 kg (weight >60 kg; OR=0.19 [CI95% 0.05-0.72]; P<0.01) were associated with HF. By univariate analysis, when subjects with CRF were compared with those presenting normal GFR, a lower hemoglobin value was significantly associated with CRF (7.92±2.7 g/dL versus 10.43±2.5 g/dL; P<0.009). There was a trend for subjects not being under maintenance therapy to more experience CRF (36.4% versus 70%; P<0.07). By logistic regression analysis, only a low hemoglobin value was associated to CRF (higher hemoglobin level; OR=0.55 [0.20-6.3]; P<0.01). In total, CRF and HF are frequent complications in SCD adult patients from black Africa.
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Affiliation(s)
- Clément Ackoundou-N'Guessan
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire.
| | - Cyr Monley Guei
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Delphine Amélie Lagou
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Serges Gbekedi
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Mélanie Weu Tia
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Pessa Albert Coulibaly
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Sita Nzoue
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Serges Konan
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Gustave Koffi
- Service d'hématologie clinique, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Daze Apollinaire Gnionsahe
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
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Adewoyin AS. Management of sickle cell disease: a review for physician education in Nigeria (sub-saharan Africa). Anemia 2015; 2015:791498. [PMID: 25667774 PMCID: PMC4312619 DOI: 10.1155/2015/791498] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/18/2014] [Accepted: 12/17/2014] [Indexed: 11/27/2022] Open
Abstract
Sickle cell disease (SCD) predominates in sub-Saharan Africa, East Mediterranean areas, Middle East, and India. Nigeria, being the most populous black nation in the world, bears its greatest burden in sub-Saharan Africa. The last few decades have witnessed remarkable scientific progress in the understanding of the complex pathophysiology of the disease. Improved clinical insights have heralded development and establishment of disease modifying interventions such as chronic blood transfusions, hydroxyurea therapy, and haemopoietic stem cell transplantation. Coupled with parallel improvements in general supportive, symptomatic, and preventive measures, current evidence reveals remarkable appreciation in quality of life among affected individuals in developed nations. Currently, in Nigeria and other West African states, treatment and control of SCD are largely suboptimal. Improved knowledge regarding SCD phenotypes and its comprehensive care among Nigerian physicians will enhance quality of care for affected persons. This paper therefore provides a review on the aetiopathogenesis, clinical manifestations, and management of SCD in Nigeria, with a focus on its local patterns and peculiarities. Established treatment guidelines as appropriate in the Nigerian setting are proffered, as well as recommendations for improving care of affected persons.
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Affiliation(s)
- Ademola Samson Adewoyin
- Department of Haematology and Blood Transfusion, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State, Nigeria
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