Clinical and demographic characteristics of patients with kidney disease presenting at a tertiary hospital for expert care in south-west Nigeria

Year 2019, Volume: 3 Issue: 4, 311 - 315, 28.04.2019

Samuel Dada , Mojeed Rafiu Olusola Akanbi Oluwamayowa Dada

https://doi.org/10.28982/josam.552956

Cited By: 1

Abstract

Aim: Although chronic kidney disease (CKD) remains an important health challenge in our environment, late presentation of the patient for nephrology care is common. We opined that dissemination of information on the sociodemographic distribution, clinical presentation and common etiology of CKD among our patient will increase individual and medical professionals’ awareness of the disease. In addition, it is believed that this will ultimately result in lower threshold for screening and early referral for specialist renal care.

Methods: This was a cross-sectional descriptive study involving 152 patients with any form of renal disease either seen primarily at, or referred to the adult nephrology clinic of the hospitals between January 2013 and December 2015. The socio-demographic parameters, clinical characteristic and laboratory data were extracted with a proforma designed for data collection.

Results: Of the 152 patients analyzed, 87 (57.24%) were males. The mean age was 49.29±15.92 years. About one quarter were within the age range 51-60 years. More than half (53.9%) were rural dweller. Common indication for referral includes abnormal renal ultrasound findings, elevated serum creatinine and urea, and abnormalities in urine analysis. Malaise, reduce urinary flow and body swelling were the common symptoms at presentation in 50.65%, 40.1% and 34.2% respectively among the patients. The median eGFR was 18.78 (7.86-84.55) ml/min/1.73m2. Across all age groups, majority (48.0%) presented in stage 5 CKD. Hypertensive nephrosclerosis (27.0%), chronic glomerulonephritis (14.5%) and diabetes nephropathy (9.2%) were found to be the leading causes of CKD. Majority of the patients (40.8%) were worked up for and commenced on hemodialysis soon after presentation. Among the end stage renal disease patient, only 7 (4.6%) had renal transplantation at referred centers. Focal segmental glomerulosclerosis was the commonest histological findings among the nephrotic syndrome patient while membranous nephropathy was documented in only 2 patients. 

Conclusion: Most patients present to the nephrology clinic of our hospital at advanced stage of CKD. We observed that hypertensive nephrosclerosis and glomerulonephritis are the leading causes of their kidney disease.

Keywords

Clinical profile, Demography, Chronic kidney disease, Nephrology clinic

Güneybatı Nijerya'da uzman bakımı için bir üçüncü basamak hastaneye başvuran böbrek hastalığı olan hastaların klinik ve demografik özellikleri

Abstract

Amaç: Her ne kadar kronik böbrek hastalığı (KBH), çevremizdeki önemli bir sağlık sorunu olsada, nefroloji bakımı için hastanın geç sunumu sıktır. Sosyodemografik dağılım, klinik prezentasyon ve KBH’ın ortak etiyolojisi hakkındaki bilgilerin yayılması, bireysel ve tıbbi profesyonellerin hastalık bilincini artıracağını belirledik. Ek olarak, bunun sonuçta tarama için daha düşük eşik ve uzman böbrek bakımı için erken sevk ile sonuçlanacağına inanılmaktadır.

Yöntemler: Ocak 2013 ve Aralık 2015 tarihleri arasında hastanelerin yetişkin nefroloji kliniğinde ya da öncelikle görülen veya herhangi bir renal hastalığı olan 152 hastayı kapsayan ve kesitsel tanımlayıcı bir çalışmadır. Sosyo-demografik parametreler, klinik özellikler ve Laboratuar verileri, veri toplama için tasarlanmış bir proforma ile çıkarıldı.

Bulgular: Analiz edilen 152 hastanın 87'si (%57,24) erkekti. Yaş ortalaması 49.29 (15,92) idi. Yaklaşık dörtte biri 51-60 yaş aralığındaydı. Yarıdan fazlası (%53,9) kırsalda yaşayanlardandı. Yönlendirme için ortak endikasyon anormal renal ultrason bulgularını, yüksek serum kreatinin ve üre ve idrar analizindeki anormallikleri içerir. Malaise, üriner debiyi azaltan ve vücut şişmesi, hastalar arasında sırasıyla %50,65, %40,1 ve %34,2 oranında sık görülen semptomlardı. Medyan eGFR, 18.78 (7.86-84.55) ml/dk/1,73 m2 idi. Tüm yaş gruplarında çoğunluk (%48,0) evre 5 KBH’da ortaya çıkmıştır. KBH'ın başlıca nedenleri arasında hipertansif nefroskleroz (%27,0), kronik glomerülonefrit (%14,5) ve diyabet nefropatisi (%9,2) bulundu. Hastaların çoğunluğu (%40,8) başvuru yapıldıktan kısa bir süre sonra hemodiyaliz için çalışmaya başlandı. Son dönem böbrek hastaları arasında sadece 7'sine (%4,6) sevk edilen merkezlerde böbrek nakli yapıldı. Fokal segmental glomerüloskleroz, nefrotik sendromlu hasta arasında en sık görülen histolojik bulgulardı, sadece 2 hastada membranöz nefropati kaydedildi.

Sonuç: Çoğu hasta, hastanemiz nefroloji kliniğine KBH'nin ileri evresinde başvurmaktadır. Hipertansif nefroskleroz ve glomerülonefritin, böbrek hastalıklarının önde gelen nedenleri olduğunu gözlemledik.

Keywords

Klinik profil, Demografi, Kronik böbrek hastalığı, Nefroloji kliniği

References

• 1. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. Jama. 2007;29817:2038-47.
• 2. Sumaili EK, Krzesinski JM, Zinga CV, Cohen EP, Delanaye P, Munyanga SM, et al. Prevalence of chronic kidney disease in Kinshasa: results of a pilot study from the Democratic Republic of Congo. Nephrol Dial Transplant. 2009;241:117-22.
• 3. Afolabi MO, Abioye-Kuteyi AE, Arogundade FA, Bello IS. Prevalence of chronic kidney disease in a Nigerian family practice population. South African Family Practice. 2009;512.
• 4. Naicker S. End-stage renal disease in Sub-Saharan Africa. Kidney International Supplements. 2013;32:161-63.
• 5. Akinsola W, Odesanmi WO, Ogunniyi JO, Ladipo GO. Diseases causing chronic renal failure in Nigerians--a prospective study of 100 cases. Afr J Med Med Sci. 1989;182:131-7.
• 6. Arogundade FA, Barsoum RS. CKD prevention in Sub-Saharan Africa: a call for governmental, nongovernmental, and community support. Am J Kidney Dis. 2008;513:515-23.
• 7. Nugent RA, Fathima SF, Feigl AB, Chyung D. The burden of chronic kidney disease on developing nations: a 21st century challenge in global health. Nephron Clin Pract. 2011;1183:c269-77.
• 8. Levin A, Stevens PE. Early detection of CKD: the benefits, limitations and effects on prognosis. Nat Rev Nephrol. 2011;78:446-57.
• 9. Fogarty DG, Taal MW. A stepped care approach to the management of chronic kidney disease. Brenner and Rector's The Kidney 10th ed Philadelphia, PA: Elsevier. 2016.
• 10. Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int. 2011;801:17-28.
• 11. Amoako YA, Laryea DO, Bedu-Addo G, Andoh H, Awuku YA. Clinical and demographic characteristics of chronic kidney disease patients in a tertiary facility in Ghana. Pan Afr Med J. 2014;18:274.
• 12. Ulasi, II, Ijoma CK. The enormity of chronic kidney disease in Nigeria: the situation in a teaching hospital in South-East Nigeria. J Trop Med. 2010;2010:501957.
• 13. Eghan BA, AMOAKO‐ATTA K, Kankam CA, NSIAH‐ASARE A. Survival pattern of hemodialysis patients in Kumasi, Ghana: a summary of forty patients initiated on hemodialysis at a new hemodialysis unit. Hemodial Int. 2009;134:467-71.
• 14. Ouattara B, Kra O, Yao H, Kadjo K, Niamkey E. Characteristics of chronic renal failure in black adult patients hospitalized in the Internal Medicine department of Treichville University Hospital. Nephrol Ther. 2011;77:531-34.
• 15. Sakhuja V, Sud K. End-stage renal disease in India and Pakistan: burden of disease and management issues. Kidney Int Suppl. 200383:S115-8.
• 16. Yao HK, Konan SD, Sanogo S, Diopoh SP, Diallo AD. Prevalence and risk factors of chronic kidney disease in Cote D'Ivoire: An analytic study conducted in the department of internal medicine. Saudi J Kidney Dis Trans. 2018;291:153.
• 17. Sabi K, Noto-Kadou-Kaza B, Amekoudi Y, Tsevi M, Kossidze K, Amedegnato D. Profil épidémioclinique des patients en primoconsultation néphrologique au Togo. Médecine et Santé Tropicales. 2014;242:169-71.
• 18. Coulibaly G, Guissou C, Lengani A. Primo-consultation néphrologique au Centre Hospitalier Universitaire Yalgado Ouedraogo de Ouagadougou (Burkina Faso). Néphrol Thér. 2011;75:369.
• 19. Kaze FF, Halle M-P, Mopa HT, Ashuntantang G, Fouda H, Ngogang J, et al. Prevalence and risk factors of chronic kidney disease in urban adult Cameroonians according to three common estimators of the glomerular filtration rate: a cross-sectional study. BMC Nephrol. 2015;161:96.
• 20. Naicker S. End-stage renal disease in sub-Saharan and South Africa. Kidney Int Suppl. 200383:S119-22.
• 21. Madala ND, Thusi GP, Assounga AGH, Naicker S. Characteristics of South African patients presenting with kidney disease in rural KwaZulu-Natal: a cross sectional study. BMC Nephrol. 2014;151:61.
• 22. Navaneethan SD, Aloudat S, Singh S. A systematic review of patient and health system characteristics associated with late referral in chronic kidney disease. BMC Nephrol. 2008;9:3.
• 23. Martins D, Agodoa L, Norris KC. Hypertensive chronic kidney disease in African Americans: strategies for improving care. Cleve Clin J Med. 2012;7910:726-34.
• 24. Toto RB. Hypertensive nephrosclerosis in African Americans. Kidney Int. 2003;646:2331-41.
• 25. Young JH, Klag MJ, Muntner P, Whyte JL, Pahor M, Coresh J. Blood pressure and decline in kidney function: findings from the Systolic Hypertension in the Elderly Program (SHEP). J Am Soc Nephrol. 2002;1311:2776-82.
• 26. Lionakis N, Mendrinos D, Sanidas E, Favatas G, Georgopoulou M. Hypertension in the elderly. World J Cardiol. 2012;45:135-47.
• 27. Seck SM, Guéye S, Tamba K, Ba I. Peer Reviewed: Prevalence of Chronic Cardiovascular and Metabolic Diseases in Senegalese Workers: A Cross-Sectional Study, 2010. Prev Chronic Dis. 2013;10.
• 28. Halle MP, Takongue C, Kengne AP, Kaze FF, Ngu KB. Epidemiological profile of patients with end stage renal disease in a referral hospital in Cameroon. BMC Nephrol. 2015;161:59.
• 29. van Rensburg BWJ, van Staden AM, Rossouw GJ, Joubert G. The profile of adult nephrology patients admitted to the Renal Unit of the Universitas Tertiary Hospital in Bloemfontein, South Africa from 1997 to 2006. Nephrol Dial Transplant. 2009;253:820-24.