Introduction:Chronic kidney disease [CKD], as defined by the
NationalKidney Foundation/Kidney Disease and Outcome Quality
Initiative (KDOQI) Group, refers to bilateral kidney injury and/or
impaired kidney function of at least 3 months duration. Persistent proteinuria
has been recognized as one of the early markers of chronic kidney disease and
has been associated with persistent and progressive damage in both children and
adult. This study was conducted with the aim of determining the prevalence and
severity of persistent proteinuria over three months in primary school children
in Ile-Ife. It was a cross-sectional study done over a period of six months.
The subjects were 1335 primary school pupils, aged 6 to 14 years selected by
multi stage random sampling method from twelve primary schools from a total of
96,301 pupils in the two Local Government Areas (LGA) of Ile-Ife, after meeting
the recruitment criteria. The biodata, physical examination, blood pressure
measurements and urine testing by dipstick were carried out on all the
recruited pupils according to standard protocols while serial monitoring of
proteinuria and estimated glomerular filtration rate was done for those with
persistent proteinuria over 6 months. Results: Initially 34 (2.6%) of
the subjects recruited had significant proteinuria with a M:F ratio of 1:1.6
following first screening and it was persistent in six (0.4%) of them
subsequently over three months with a M:F ratio of 1:1.5. The severity of the
persistent proteinuria was in the range of 30 mg/dL to 100 mg/dL. Three of them
(50%) had worsened level of proteinuria from 30mg/dL to
100
References
[1]
Bergstein, J.M. (1992) The Urinary System and Paediatric Gynaecology In: Behrman, R.E., Ed., Nelson Textbook of Paediatrics, Saunders, Philadelphia, 1323-1358.
[2]
Warady, B.A. and Chadha, V. (2007) Chronic Kidney Disease in Children: The Global Perspective. Pediatric Nephrology, 22, 1999-2009.
https://doi.org/10.1007/s00467-006-0410-1
[3]
Hogg, R.J., Portman, R.J., Milliner, D., Lemley, K.V., Eddy, A. and Ingelfinger, J. (2000) Evaluation and Management of Proteinuria and Nephrotic Syndrome in Children: Recommendations from a Pediatric Nephrology Panel Established at the National Kidney Foundation Conference on Proteinuria, Albuminuria, Risk, Assessment, Detection, and Elimination (PARADE). Pediatrics, 105, 1242-1249.
https://doi.org/10.1542/peds.105.6.1242
[4]
Kashif, W., Siddiqi, N., Dincer, A.P., Dincer, H.E. and Hirsch, S. (2003) Proteinuria: How to Evaluate an Important Finding. Cleveland Clinic Journal of Medicine, 70, 535-547.
[5]
James, J.A. (1976) Proteinuria and Haematuria in Children: Diagnosis and Assessment. Pediatric Clinics of North America, 23, 807-816.
https://doi.org/10.1016/S0031-3955(16)33362-4
[6]
National Kidney Foundation (2002) Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Part4. Definition and Classification of Stages of Chronic Kidney Disease. American Journal of Kidney Diseases, 39, S46-S75. https://doi.org/10.1053/ajkd.2002.30943
[7]
Agarwa, R., Panesar, A. and Lewis, R.R. (2002) Dipstick Proteinuria: Can It Guide Hypertension Management? American Journal of Kidney Diseases, 39, 1190-1195.
https://doi.org/10.1053/ajkd.2002.33389
[8]
Anochie, I. and Eke, F. (2003) Chronic Renal Failure in Children: A Report from Port Harcourt, Nigeria (1985-2000). Pediatric Nephrology, 18, 692-695.
https://doi.org/10.1007/s00467-003-1150-0
[9]
Olowu, W.A. (2003) Renal Failure in Nigerian Children: Factors Limiting Access to Dialysis. Pediatric Nephrology, 18, 1249-1254.
https://doi.org/10.1007/s00467-003-1255-5
[10]
Michael, I.O. and Gabreil, O.E. (2004) Chronic Renal Failure in Children of Benin, Nigeria. Saudi Journal of Kidney Diseases and Transplantation, 15, 79-83.
[11]
Al-Mosawi, A.J. (2002) The Etiology of Chronic Renal Failure in 54 Iraqi Children. Pediatric Nephrology, 17, 463-464. https://doi.org/10.1007/s00467-001-0774-1
[12]
Ali, E.-T.M.A., Abdelraheem, M.B., Mohamed, R.M., Hassan, E.G. and Watson, A.R. (2009) Chronic Renal Failure in Sudanese Children: Aetiology and Outcomes. Pediatric Nephrology, 24, 349-353. https://doi.org/10.1007/s00467-008-1022-8
[13]
Bhimma, R., Adhikari, M., Asharam, K. and Connolly, C. (2008) The Spectrum of Chronic Kidney Disease (Stages 2-5) in KwaZulu-Natal, South Africa. Pediatric Nephrology, 25, 871-875. https://doi.org/10.1007/s00467-008-0871-5
[14]
Vachvanichsanong, P., Dissaneewate, P. and McNeil, E. (2008) Childhood Chronic Kidney Disease in a Developing Country. Pediatric Nephrology, 23, 1143-1147.
https://doi.org/10.1007/s00467-008-0775-4
[15]
U.S. Renal Data System (2004) USRDS 2004 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda.
[16]
Akor, F., Okolo, S.N., Agaba, E.I. and Okolo, A. (2009) Urine Examination Findings in Apparently Healthy New School Entrants in Jos, Nigeria. South African Journal of Child Health, 3, 60-63.
[17]
Abdurrahman, M.B., Chakrabarty, D.P. and Ochoga, S.A. (1978) Bacteriuria and Other Urinary Abnormalities among Primary School Children in Kaduna. Nigerian Journal of Paediatrics, 5, 21-24.
[18]
Ikimalo, F.E., Eke, F.U., Nkanginieme, K.E.O. and Ikimalo, J. (2003) Urinary Screening for Detection of Asymptomatic Haematuria and Proteinuria in Children in Urban and Periurban Schools in Port Harcourt. Nigerian Journal of Paediatrics, 30, 1-6. https://doi.org/10.4314/njp.v30i1.12013
[19]
Aladekomo, T.A., Oyelami, O.A., Ademola, O.G. and Akinsola, A. (2007) Proteinuria in the Rural Primary School Setting in Nigeria Using Combi Test Strips. The Internet Journal of Third World Medicine, 4.
[20]
Ajasin, M.A. (1986) The Prevalence of Isolated Proteinuria in Asymptomatic Primary School Children in Mushin, Lagos. West African Journal of Medicine, 5, 215-218.
[21]
Bello, A.B. (1988) Proteinuria, Haematuria and Pyuria in Asymptomatic School Children. Clinical Medicine, 1, 14-16.
[22]
2006 Population Census Report. National Bureau of Statistics.
https://www.nigerianstat.gov.ng./
[23]
Magnani, R. (1997) Sampling Guide. IMPACT Food Security and Nutrition Monitoring Project. ISTI, Inc., Washington, 41-45.
[24]
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics, 114, 555-561.
[25]
Lahti-Koski, M. and Gill, T. (2004) Obesity in Childhood and Adolescence. Pediatric & Adolescent Medicine, 9, 8-10.
[26]
Cole, T.J., Bellizzi, M.C., Flegal, K.M. and Dietz, W.H. (2000) Establishing a Standard Definition for Child Overweight and Obesity Worldwide: International Survey. BMJ, 320, 1240-1243. https://doi.org/10.1136/bmj.320.7244.1240
[27]
Schwatz, G.J., Munoz, A., Schneider, M.F., et al. (2009) New Equations to Estimate GFR in Children with CKD. Journal of the American Society of Nephrology, 20, 629-637. https://doi.org/10.1681/ASN.2008030287
[28]
Iseki, K., Ikemiya, Y., Iseki, C. and Takishita, S. (2003) Proteinuria and the Risk of Developing End-Stage Renal Disease. Kidney International, 63, 1468-1474.
https://doi.org/10.1046/j.1523-1755.2003.00868.x
[29]
Matsushita, K., van der Velde, M., Astor, B.C., Woodward, M., Levey, A.S., de Jong, P.E., et al. (2010) Association of Estimated Glomerular Filtration Rate and Albuminuria with All-Cause and Cardiovascular Mortality in General Population Cohorts: A Collaborative Meta-Analysis. Lancet, 375, 2073-2081.
https://doi.org/10.1016/S0140-6736(10)60674-5
[30]
Cho, B.-S., Kim, S.-D., Choi, Y.-M. and Kang, H.-H. (2001) School Urinalysis Screening in Korea: Prevalence of Chronic Renal Disease. Pediatric Nephrology, 16, 1126-1128. https://doi.org/10.1007/s004670100043
[31]
Vehaskari, V.M. and Rapola, J. (1982) Isolated Proteinuria: Analysis of a School Age Population. The Journal of Pediatrics, 101, 661-668.
https://doi.org/10.1016/S0022-3476(82)80287-4
[32]
Yap, H.K., Quek, C.M., Shen, Q., Joshi, V. and Chia, K.S. (2005) Role of Urinary Screening Programmes in Children in the Prevention of Chronic Kidney Disease. Annals of the Academy of Medicine of Singapore, 34, 3-7.
[33]
Lin, C.Y., Sheng, C.C., Lin, C.C., Chen, C.H. and Chou, P. (2001) Mass Urinary Screening and Follow-Up for School Children in Taiwan Province. Acta Paediatrica Taiwanica, 42, 134-140.
[34]
World Health Organization (2009) Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. WHO, Geneva.
https://apps.who.int/iris/handle/10665/44203
[35]
Cravedi, P. and Remuzzi, G. (2013) Pathophysiology of Proteinuria and Its Value as an Outcome Measure in Chronic Kidney Disease. British Journal of Clinical Pharmacology, 76, 516-523. https://doi.org/10.1111/bcp.12104
[36]
Athavale, A. and Roberts, D.M. (2020) Management of Proteinuria: Blockade of the Renin-Angiotensin-Aldosterone System. Australian Prescriber, 43, 121-125.
https://doi.org/10.18773/austprescr.2020.021
[37]
Sharma, S. and Smyth, B. (2021) From Proteinuria to Fibrosis: An Update on Pathophysiology and Treatment Options. Kidney and Blood Pressure Research, 46, 411-420. https://doi.org/10.1159/000516911
[38]
Abbate, M., Zoja, C. and Remuzzi, G. (2006) How Does Proteinuria Cause Progressive Renal Damage? Journal of the American Society of Nephrology, 17, 2974-2984.
https://doi.org/10.1681/ASN.2006040377
[39]
Lewis, E.J., Hunsicker, L.G., Bain, R.P. and Rohde, R.D. (1993) The Effect of Angiotensin-Converting-Enzyme Inhibition on Diabetic Nephropathy. New England Journal of Medicine, 329, 1456-1462. https://doi.org/10.1056/NEJM199311113292004
[40]
Maschio, G., Alberti, D., Janin, G., Locatelli, F., Mann, J.F., Motolese, M., et al. (1996) Effect of the Angiotensin-Converting–Enzyme Inhibitor Benazepril on the Progression of Chronic Renal Insufficiency. New England Journal of Medicine, 334, 939-945. https://doi.org/10.1056/NEJM199604113341502
[41]
The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia) (1997) Randomised Placebo-Controlled Trial of Effect of Ramipril on Decline in Glomerular Filtration Rate and Risk of Terminal Renal Failure in Proteinuric, Non-Diabetic Nephropathy. Lancet, 349, 1857-1863.
https://doi.org/10.1016/S0140-6736(96)11445-8
[42]
Olowu, W.A., Adefehinti, O. and Aladekomo, T.A. (2013) Epidemiology and Clinicopathologic Outcome of Pediatric Chronic Kidney Disease in Nigeria, a Single Cenetr Study. Arab Journal of Nephrology and Transplantation, 6, 105-113.
[43]
Dodge, W.F., West, E.F., Smith, E.H. and Bunce III, H. (1976) Proteinuria and Hematuria in Schoolchildren: Epidemiology and Early Natural History. The Journal of Pediatrics, 88, 327-347. https://doi.org/10.1016/S0022-3476(76)81012-8
[44]
West, C.D. (1976) Asymptomatic Hematuria and Proteinuria in Children: Causes and Appropriate Diagnostic Studies. The Journal of Pediatrics, 89, 173-182.
https://doi.org/10.1016/S0022-3476(76)80440-4
[45]
Vehaskari, V.M., Rapola, J., Koskimies, O., Savilahti, E., Vilska, J. and Hallman, N. (1979) Microscopic Hematuria in Schoolchildren: Epidemiology and Clinicopathologic Evaluation. The Journal of Pediatrics, 95, 676-684.
https://doi.org/10.1016/S0022-3476(79)80710-6
[46]
Modesti, P., Bamoshmoosh, M., Rapi, S., Massetti, L., Bianchi, S., Al-Hidabi, D., et al. (2013) Relationship between Hypertension, Diabetes and Proteinuria in Rural and Urban Households in Yemen. Journal of Human Hypertension, 27, 572-579.
https://doi.org/10.1038/jhh.2013.18
[47]
Cravedi, P., Sharma, S.K., Bravo, R.F., Islam, N., Tchokhonelidze, I., Ghimire, M., et al. (2012) Preventing Renal and Cardiovascular Risk by Renal Function Assessment: Insights from a Cross-Sectional Study in Low-Income Countries and the USA. BMJ Open, 2, e001357. https://doi.org/10.1136/bmjopen-2012-001357
[48]
Ogunlesi, T.A. and Olanrewaju, D.M. (2010) Socio-Demographic Factors and Appropriate Health Care-Seeking Behavior for Childhood Illnesses. Journal of Tropical Pediatrics, 56, 379-385. https://doi.org/10.1093/tropej/fmq009
