Evaluation of urinary tract infection and nephropathy in adult Nigerians with sickle cell anaemia

Abstract

Background: Improved survival of sickle cell anaemia subjects has led to a growing population of adult sicklers. The pattern of urinary tract infections(UTI) and prevalence of nephropathy in adult Nigerians with sickle cell anaemia remains largely speculative as available data are mainly on paediatric population.

Methodology: Bio-data, information on symptoms of UTI/kidney damage and urine specimens were obtained from 100 consecutive stable Hemoglobin-SS subjects and 100 age and sex-matched healthy haemoglobin–AA controls aged were subjected to urinalysis, microscopy, culture and sensitivity as well as albumin and creatinine estimation.

Results: Significant bacteriuria was more frequent in subjects with HbSS than haemoglobin-A controls: 24(24%) vs 5 (5%), p=0.0002.

Escherichia coli, Staphylococcus aureus and Klebsiella spp. accounted for 45.8%, 37.5% and 16.7% respectively of the isolates in HbSS subjects. Twenty-seven (27%) HbSS subjects had Albumin/ Creatinine ratio >300mg/dl out of which 8 (29.6%) of these had UTI.

Antibiotics sensitivities in the HbSS subjects were: ceftazidime (79.1%), ciprofloxacin (58.6%), perfloxacin (58.3%), gentamycin (58.3%), nalidixic acid (37.5%) and nitrofurantoin (45.8%).

Conclusion: Urinary tract infection is commoner in HbSS than HbAA subjects. E.coli is the commonest cause. Empirical use of ceftazidime or ciprofloxacin, an oral preparation is suggested while awaiting sensitivity results.

Keywords: UTI, nephropathy, adults, sickle cell anaemia.