Screening Of Microalbuminuria In Children With Sickle Cell Anaemia

Background: Microalbuminuria(MA)is the earliest marker of various diseases affecting the renal system.Its relevance in children with sickle cell anaemia(SCA),who are known to be prone to renal complications,has not been fully explored in our setting.Several studies elsewhere have shown MA to be prevalent among SCA children.MA in sickle cell can be the indicator of impaired renal function.Objectives: To determine the prevalence of microalbuminuria and its clinical correlates in children and adolescents with SCA attending sickle cell clinic at Mnazi Mmoja Referral Hospital,Zanzibar.Materials and Methods: This was a descriptive,hospital based cross-sectional study.Children and adolescents aged 3– 18 years attending sickle cell clinic from July 2016 to January 2017 were selected.Urine sample of all eligible children and adolescent with SCA was screened for MA by special Micral urine taste strips(Cliawaived Microlalbumin 2-1Combo,USA),with sensitivity of 96.5% and specificity of 98.3%.The resting blood pressure(BP)measurements,haemoglobin level and clinical events associated with MA were recorded.Data were analysed using Statistical Package for Social Science(SPSS)version 17.Chi-square test was used for categorical variables,and student t-test for independent sample means.Binary logistic regression was used to analyse potential effect modifiers of MA.Results: 120 subjects aged 3 to 18 years were included in the study,(53% were females).MA was found in 29/120(24%).None of the clinical characteristics(painful crisis,blood transfusion,abnormal blood pressure)were significantly related with MA.Haemoglobin levels were significantly lower in subjects with MA than in those without MA(5.9±1.2 Vs7.4±1.0 g/dl,respectively)P=0.001.In multivariate logistic regression model of MA,both Hb level and age remain in the final model as clinical correlates of MA.Higher Hb level showed a protective effect against MA(Odds ratio=0.55)P =0.001,while subjects with MA were more likely to have older age.(Odds ratio=1.7)P =0.001.Conclusion: MA is common among children and adolescents with SCA and directly related to age and inversely proportional to haemoglobin levels.Urinary MA measurement screening should be utilized as part of routine health care in children and adolescents with SCA,as it is a simple and non-invasive procedure.