Journal of Advances in Medicine and Medical Research

34(21): 145 - 152, 2022;

Article no.JAMMR.90493ISSN: 2456-8899
PATTERN OF RENAL DISEASES IN CHILDREN SEEN IN FMC OWERRI.
Nwaoha C.,1 Achigbu K.,1 Ohiri J.U.,2
1Department of paediatrics Federal Medical Center, Owerri, Imo State
2Department of Chemical pathology, Federal Medical Center, Owerri, Imo State

ABSTRACT
A prospective assessment of the renal disease reported among children attending the renal
clinic of a tertiary healthcare institution was carried out in Southern Nigeria. There were 99
children between 1 – 16 years reporting with renal diseases at the clinic of the hospital between
a 6-month period. The study showed that most of the children reporting with renal diseases
were between 6 – 16 years old. The distribution of in descending order was Nephrotic
Syndrome (53.5%), Urinary tract infection (21.2%), Acute glomerulonephritis (11.1%), Acute
kidney Injury (5.2%), chronic kidney disease (4%), SCA Nephropathy (2%), Enuresis (1%),
HIV associated nephropathy (1%) and Obstructive Uropathy (1%). The study found no
significant association between the distribution of the renal diseases with age or gender among
the children. The findings of the study concluded that due to the scarcity of financial resources
and the fact that dialysis clinics, equipment, and qualified workers are simply not available to
the general public, prevention is becoming increasingly vital.

Keywords: Children, Kidney diseases, Owerri,

INTRODUCTION
Renal disorders are a leading source of morbidity and death in children admitted to hospitals.
Renal illness in children, especially in the younger ones, might cause nonspecific signs and
symptoms unrelated to the urinary tract. As a result, paediatricians should be aware with the
many manifestations of renal illness and have a high index of suspicion for these disorders[1–
3].

Renal diseases are commonly overlooked in the general population, but due to the nature of the
disease's origins and the ambiguity of the symptoms, children and adolescents are at an even
greater risk[4, 5]. In underdeveloped nations, the patterns of renal illness in children diverge
from those in affluent ones, and paediatric renal disorders account for 4.5-8.7% of all paediatric
hospitalizations. Renal illness in adolescents and young people in hospitals can be difficult to
detect early since it may appear with minimal symptoms and has a different course than in
adults and children tend to respond variously to different treatment. During infancy and early

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childhood unexplained fever or failure to thrive may be the only manifestation of underling
renal disease[6, 7].

Variable patterns of renal disease in the paediatric population have been found in studies from
various geographical locations throughout the world[8, 9]. These differences might be due to a
genetic predisposition, environmental influences, or a lack of understanding of the necessity of
early detection of such problems. Children with potentially curable urological abnormalities
are frequently referred late in the illness process[9, 10].

Despite the difficulties of paediatric nephrology management, developed countries of the world
have recorded considerable improvements in disease outcomes. This is due in great part to the
availability of knowledge, managerial resources, health insurance plans, and screening
programs[2, 4, 9]. This is in contrast to what is available in poorer countries like ours, where
paediatric kidney illness is given low priority, partly owing to a focus on communicable
diseases and partly due to a paucity of data on the condition, with a poor overall prognosis in
this group of children[11, 12]. There are limited studies available on the pattern and outcome
of renal disorders in hospitalized children in developing regions of Africa, Asia and South
America[7, 10, 13]. There are few other African studies on the pattern and outcome of renal
disorders in hospitalized children, with only a couple from Nigeria and Libya[14–16].
However, many of these illnesses can be avoided or even cured. The current study was carried
out to assess the pattern of renal diseases among children attending a tertiary healthcare
institution in Owerri, Imo state, Nigeria.

METHOD

This was a prospective study conducted over a period of one-year at the Federal Medical Centre
Owerri, Imo state, Nigeria. All the cases of renal disorders in the age group of one month to 16
years, reporting to paediatric renal clinic and/or were admitted to paediatric wards were
included in the study.

Data regarding information about demography, clinical features, examinations, investigations,

hospital discharge diagnoses, final outcome, and referral were recorded in a predesigned
proforma.

The cases were categorized into: acute glomerulonephritis (AGN), nephrotic syndrome (NS),
urinary tract infection (UTI), acute kidney injury (AKI), chronic kidney disease (CKD), HIV
associated nephropathy (HIVAN) and others, using standard definitions.

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Article no.JAMMR.90493ISSN: 2456-8899
The study protocol was approved by the Ethics Committee of the Federal Medical Centre,
Owerri. Informed written consent was taken for enrolment and procedure of each patient.

The data collected was analysed using the Statistical Package for Social Sciences (SPSS) v25,
IBM, USA. The summary was presented in frequencies and percentages. Chi-square analysis
(or Fischer’s exact test where applicable) was used to assess the distribution of the renal disease
by demographic variables and a p-value less than 0.05 was considered significant.

RESULTS
Table 1 shows the demographic distribution of the study participants. It was observed that of
the 99 persons included, 34 (34.3%) were between 1 – 5 years and 65 (65.7%) were between 6
– 16 years, there were 28 (28.35) females and 71 (71.75) males.

Table 1: Demographic Distribution of Participants

Variable Units Frequency Percent

Age Groups 1 - 5years 34 34.3

6 - 16 years 65 65.7

Gender Female 28 28.3

Male 71 71.7

Table 2 shows the distribution of the diagnoses among the study participants. The distribution
of in descending order was Nephrotic Syndrome (53.5%), Urinary tract infection (21.2%),
Acute glomerulonephritis (11.1%), Acute kidney Injury (5.2%), chronic kidney disease (4%),
SCA Nephropathy (2%), Enuresis (1%), HIV associated nephropathy (1%) and Obstructive
Uropathy (1%).

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Article no.JAMMR.90493ISSN: 2456-8899
Table 2: Distribution of Diagnosis

Diagnosis Frequency (n=99) Percent (%)

Nephrotic Syndrome 53 53.5
Urinary tract infection 21 21.2
Acute glomerulonephritis 11 11.1
Acute kidney Injury 5 5.2
Chronic Kidney Disease 4 4
SCA Nephropathy 2 2
Enuresis 1 1
HIVAN 1 1
Obstructive Uropathy 1 1
HIVAN; HIV associated nephropathy

Table 3 shows the distribution of the diagnosis by age groups among the subjects. The
nephrotic syndrome was the most common renal disease among both age groups. However,
there was no occurrence of SCA Nephropathy, Enuresis, HIVAN and Obstructive Uropathy
among children between 1 – 5 years. The chi-square analysis shows that the distribution of the
diagnosis by the age groups was not statistically significant (p = 0.784).

Table 3: Distribution of diagnosis by age groups

Diagnosis 1 - 5years 6 - 16 years Fischer’s

n=34 (%) n=65 (%) exact
Nephrotic Syndrome 20(58.82) 33(50.77)

Urinary tract infection 7(20.59) 14(21.54)

Acute glomerulonephritis 3(8.82) 8(12.31)

Acute kidney Injury 3(8.82) 2(3.08) 0.784f

Chronic Kidney Disease 1(2.94) 3(4.62)

SCA Nephropathy 0(0.00) 2(3.08)

Enuresis 0(0.00) 1(1.54)

HIVAN 0(0.00) 1(1.54)

Obstructive Uropathy 0(0.00) 1(1.54)

f: Fischer’s exact
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Table 4 shows the distribution of the diagnosis by gender among the subjects. The nephrotic
syndrome was the most common renal disease among both male and female patients. However,
there was no occurrence of, Enuresis and Obstructive Uropathy among female subjects. The
chi-square analysis shows that the distribution of the diagnosis by the gender was not
statistically significant (p = 0.649).

Table 4: Distribution of renal diseases by gender

Female Male Fischer’s

Diagnosis n = 28, (%) n = 71, (%) exact
Nephrotic Syndrome 13(46.43) 40(56.34)
Urinary tract infection 5(14.71) 16(24.62)
Acute glomerulonephritis 4(11.76) 7(10.77)
Acute kidney Injury 2(5.88) 3(4.62)
0.784f
Chronic Kidney Disease 2(5.88) 2(3.08)
SCA Nephropathy 1(2.94) 1(1.54)
Enuresis 0(0.00) 1(1.54)
HIVAN 1(2.94) 0(0.00)
Obstructive Uropathy 0(0.00) 1(1.54)
f: Fischer’s exact

DISCUSSION
The study showed that most of the patients (65.7%) with renal disease were 6 – 16 years and
male (71.7%). The relatively higher proportion of renal diseases among older children (6 – 16
years) is consistent with findings of other studies. This has been attributed to the variation in
diet and environmental factors where the children live[3, 5, 11, 17].

The most common renal disease was Nephrotic Syndrome (53.5%), followed by Urinary tract
infection (21.2%), Acute glomerulonephritis (11.1%) and Acute kidney Injury (5.2%). This
could be associated with the fact that such cases are typically referred to the study center from
primary healthcare centres and other hospitals. The distribution of renal disease observed in
the current study is consistent with the findings of similar studies carried out in different parts
of Nigeria, where nephrotic syndrome, acute kidney injuries and urinary tract infections are the
most common renal diseases reported among children[14, 17–19]. However, the findings are

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Article no.JAMMR.90493ISSN: 2456-8899
in contrast with reports from studies which reported lower prevalence of nephrotic syndrome
among children in Iraq (15.9%) and Libya (18.9%) [8,9] Pakistan (29%), and Nepal (34.1%)
[12]. This variation in prevalence rates may be related to pattern of referral, genetic and/ or
environmental factors[7, 13, 20].

In this study, urinary tract infection (UTI) was relatively common (21.2%). It is the 2nd most
common renal disease requiring admission to paediatrics ward in this study. This finding is in
contrast to published reports from Libya (10%) [9]. However, other studies from African and
Asian countries had reported higher prevalence rates (30%, 20% and 18.4%, 16.3%)
respectively [4, 5, 8, 10]. In contrast, lower rates had been reported from other areas in these
continents (3.5% and 3.1%, respectively) [3,6]. This variation could be related to variation in
prevalence rates of other underlying renal morbidities. Other studies have reported that most
of UTI cases (71.1%) were diagnosed in association with other renal morbidities (congenital
urinary tract anomalies, urolithiasis/ stones, and CKD)[1, 7, 20]. However, the current study
did not report on the comorbidities of the participants.

Acute kidney Injury (AKI) was diagnosed in 5.2% children in this study. This result is
comparable to other studies from developing countries (3,5,17,20). In the contrary, higher rates
had been reported from Libya (27.1%), Lagos, Nigeria (20%), and Niger Delta, Nigeria
(10.9%) [4,6,8-10]. The profile of CKD observed in the current study is similar to other studies,
with congenital urological malformations being the most common cause of CKD [3,8]. In
contrast, higher figures were reported from other developing countries; Jos, Nigeria (20.3%)
and Iran (14.9%) [15,20]. Lower rates we reported from Venezuela (1.6%) and other Nigerian
studies (2.1%) [18,19].

CONCLUSION
The study shows that the distribution of the renal disease was associated with age or gender.
The primary restrictions among these patients were late presentation and a lack of
interventional therapies such as renal replacement therapy, such as continuous peritoneal
dialysis. Given the scarcity of financial resources and the fact that dialysis clinics, equipment,
and qualified workers are simply not available to the general public, prevention is becoming
increasingly vital.

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