Comparative usefulness of Serum Creatinine and Microalbuminuria in detecting early Renal Changes in Children with Sickle Cell Anaemia in Benin City

Abstract

Abstract Background: Microalbuminuria as an early marker of certain diseases including those affecting the renal system is widely acknowledged. Its performance in this regard vis a vis routine use of serum creatinine in sickle cell anaemia (SCA) patients known to be prone to renal complications has however not been fully explored, particularly in the study locale. Objective: To compare the usefulness of serum creatinine and microalbuminuria in the early detection of renal changes in children with SCA in Benin City.

Methods: A cohort of 69 children with SCA aged 1-16 years were consecutively enrolled into this cross sectional and descriptive studywhich was conducted between November 2006 and February 2007. Using the Micral Test strips, microalbuminuria in early morning urine specimen (spot) was determined in each subject. Also determined were serum creatinine, urea, electrolytes and creatinine clearance.

Results: The prevalence of microalbuminuria in the study subjects was 20.3 percent. Serum creatinine values in all subjects were normal but increased with increasing age. Similarly, serum urea, creatinine clearance and electrolytes in the subjects were within normal limits. Apart from the negative predictive value of 79.7 percent, other indices such as sensitivity (0.0 percent), specificity (0.0 percent) and positive predictive value (0.0 percent) of serum creatinine were low as a gold standard in the early detection of renal changes when compared with microalbuminuria.

Conclusion and recommendation: Microalbuminuria is common enough in children with SCA to warrant routine screening for it. Reliance on serum creatinine for the detection of early renal changes would be misplaced. Measures that could assist in the early detection of ensuing renal diseases and improve case management of the child with SCA, who is particularly prone to renal complications, are warranted and these could be partially determined by using the presence of microalbuminuria. Interventional measures known to retard the rate of deterioration of kidney function following prolonged proteinuria could thus be instituted.

Keywords: Serum creatinine, Predictive value, Microalbuminuria, Sickle Cell Anaemia, Children.