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

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

Öz

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.

Anahtar Kelimeler

• Klinik profil,Demografi,Kronik böbrek hastalığı,Nefroloji kliniği

Kaynakça

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