Renal Anaemia

Introduction

Urinary tract infection (UTI) is a common cause of kidney disease in the tropics and causes a significant morbidity 2, 3 and 4 of the mortality of children, especially when it is asymptomatic, is not detected and treated early.

Children with sickle cell disease have increased susceptibility to develop UTI due to slugging of sickle cell into the vascular system causing renal papillary necrosis and loss of urinary concentrating and acidifying ability of the nephrons causing abnormally dilute urine and bacterial alkaline which promotes proliferation.5 This predisposes to urinary tract infections and kidney after injury. Studies 6, 7 have noted that children with sickle cell anemia are more likely to develop urinary tract infections and other bacterial infections than their counterparts with normal hemoglobin.

Children with sickle cell disease may have compromised renal function from repeated episodes of vaso-occlusive and recurrent UTI 8 These factors tend to accelerate their development of the MRC. However, this trend can be prevented by the presence of asymptomatic bacteriuria can be detected early and appropriate treatment instituted.

The current study therefore examines the asymptomatic bacteriuria in children with sickle cell anemia, compared to their counterparts with normal hemoglobin. The results of this study will be useful to formulate recommendations on measures to restrict the development of UTI in patients with sickle cell anemia and reduce the load and subsequent morbidity and mortality resulting from this fact.

Subjects and methods

        This was a prospective study in which children have sickle cell anemia two years to 12 years who attended the clinic weekly hemoglobinopathy University of Nigeria Teaching Hospital (UNTH), Enugu were examined over a period of eight months (December 2007-July 2008). A total of 100 children (57 males and 43 females) were selected consecutively as they presented to the clinic. Another 100 schools children of the same age with normal hemoglobin were also selected from nurseries, kindergartens and primary schools in Enugu urban act as witnesses. The children who had fever or have had antibiotics in the last two weeks or had symptoms suggestive of urinary tract infection were excluded from the study.

Ethical approval for the study were obtained from the Ethics and Research Committee UNTH, Enugu whether consent was obtained from parents and caregivers before starting the study.

Spot midstream urine samples were collected in bottles of boric acid and transported in an ice box containing analysis. Venous blood samples were collected from the controls to determine their genotype using cellulose acetate electrophoresis (pH = 8.6).

The urine test was done using Oxidant-9 ® test strips. urine sediment of urine from each child after centrifugation at 2000 rpm for five minutes was examined for red blood cells, white cells, casts, crystals and bacteria.

Urine samples were cultured in cystine lactose electrolyte deficient (CLED) and blood agar media in time for the collection of urine using the semiquantitative method as described by Guttmann and Stokes.9 A loop Wire properly calibrated standard 3 mm internal diameter and Delivers.