Evaluation of Microalbuminuria in Relation to Asymptomatic Bacteruria in Nigerian Patients with Sickle Cell Anemia

Studies have identified microalbuminuria (MA) and asymptomatic bacteruria (ASB) as co-morbid factors in sickle cell anemia (SCA). However, the relationship between these comorbid factors remains unclear and data are lacking for Nigerian patients. This study determined the prevalence of MA and ASB in a cohort of patients with SCA in a steady state, in Lagos, Nigeria. Early morning mid-stream urine samples were collected in sterile bottles from 103 patients comprising 48 males and 55 females with a mean age of 10.4 years. Aerobic culture and colony count of organisms was done using conventional methods. Serum creatinine and hematological indices, including irreversibly sickled cells (ISC), were also assayed. Of the 103 urine samples screened, 23 (22.3%) had albuminuria (ALB), and consisted of nine males and 14 females (P > 0.05); 16.5% of the cases had MA (P <0.05). Age at onset of MA was seven years, and children accounted for 23.5% of all cases with ALB (P >0.05). The prevalence of confirmed ASB was 14.6%, with females accounting for 14 of 19 probable ASB cases (P <0.05). Univariate regression analysis demonstrated a significant (P <0.05) association between age at onset of MA, hemoglobin level, reticulocyte count, ISC and occurrence of ASB, but with only ISC evolving as an independent predictor. Twenty-eight bacterial isolates predominated by Escherichia coli (39.3%; P <0.05), of whom 89.3% were multi-drug resistant, were recovered from the ASB urine samples. In conclusion, both MA and ASB are common in Nigerian SCA patients, with the former occurring from the first decade of life.