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REPUBLIC OF CAMEROON REPUBLIQUE DU CAMEROON

PEACE***WORK***FATHERLAND PAIX***TRAVAIL***PATRIE
UNIVERSITY OF BUEA UNIVERSITE DE BUEA
FACULTY OF HEALTH SCIENCES
PROGRAMME IN MEDICINE

MD THESIS

THE CLINICAL SPECTRUM AND OUTCOMES OF PAEDIATRIC

RENAL ADMISSIONS IN REGIONAL HOSPITALS IN
CAMEROON: A TWO CENTRE STUDY
BY
ALEI FRANK FOIN
HS13A012

Supervisor: Prof. Gloria ASHUNTANTANG Co-supervisor: Dr. Denis TEUWAFEU

August 2020
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Outline
I. Introduction
II. Objectives
II. Materials and Methods
III. Results and Discussions
IV. Conclusion and Recommendations
V. French summary

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Introduction (1/5)
 Renal diseases:
• Heterogeneous group of disorders of kidney structure and/or function 1.
• Mortality: - 12th cause of death2.

- 830,000 deaths annualy

• Disability: - 17th cause of disability2.

- 18,467,000 DALYs
• Affects both adults and children.
1. Levey et al, 2013 2. Dirks et al, 2006 4
 Introduction (2/5)
 Renal disease in children:
• Prevalence: 1.2% - 16.5% 3,4.
• Spectrum varies according to study settings5.
• Ranges from acute disorders to chronic conditions.
• Can progress to renal disease into adulthood6.

3.Abdullahi et al, 2017 4.Albar et al, 2016 5.Bhimma et al, 2016 6. Ronit et al, 2018 5
Introduction (3/5)
 Spectrum of renal diseases in children:
Low/middle income
High income countries
countries
• Congenital abnormalities of
• Urinary tract infections
the kidney and urinary
(UTI)
tract (CAKUT)
• Acute Kidney Injury (AKI)

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 Introduction (4/5)
 Outcomes of renal diseases in children:

High income countries Low/middle income

countries
• Mortality: <1.0%7. • Mortality: 14.4%8.

7. Chesnaye et al, 2016 8. Ladapo et al, 2014 7

 Introduction (5/5)
 In Cameroon:

• Most studies on paediatric renal diseases are on

individual renal syndromes9,10.
• Done in tertiary health facilities.

9. Halle et al, 2017 10. Fouda et al, 2018 8

Objective (1/2)
General objective
To describe the clinical spectrum and outcomes of
paediatric renal admissions in selected regional hospitals in
Cameroon.

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Objective (2/2)
Specific objectives
1. To measure the prevalence of renal diseases among
children.
2. To describe the clinical characteristics of these diseases
3. To assess the in-hospital outcomes of these children.

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Materials and Methods (1/5)

• Study Design: cross-sectional descriptive, Hospital

based study

• Study population: paediatric admissions

• Study period: 3-year retrospective (Jan 2017-Dec 2019)

• Study site: Bamenda and Buea regional hospitals

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Materials and Methods (2/5)
Inclusion criteria

Records of admitted
children with confirmed
diagnosis None

Excluded
Records with confirmed
renal disease
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Materials and Methods (3/5)
Study procedure

Ethical
approval and Selection of
Data collection
Administrative cases
authorisations

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Materials and Methods (4/5)
Data entry/storage: census survey pro v7.2

Analysis: SPSS version 25.

Continuous variables: median and inter-quartile ranges.

Qualitative variables: frequencies and percentages.

Chi-squared test: compare categorical variables

Independent median test: compare medians

Statistical significance: p < 0.05

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Materials and Methods (5/5)
Definition of operational terms
• Paediatric: children less than 18 years.
• Renal disease: any structural or functional abnormality of the kidney
and urinary tract on or during the course of hospitalisation
• UTI: positive leucocyte esterase and nitrites on dipstick or bacteriuria
with pyuria on microscopy.
• Complicated UTI: UTI in children <3 months or the presence of
structural urinary tract abnormality or immunodepression (HIV,
malnutrition)
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RESULTS AND DISCUSSIONS

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Results and Discussions (1/10)
Bamenda Regional Buea Regional
Hospital Hospital
4112 3345

Total cases admitted

7457

Renal disease
148
Figure 1: Study consort
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Results and Discussions (2/10)
Characteristics of study population
• Females: 60.1%
• Median (IQR) years: 7.5 (4-12)
• < 5years: 32.4%
• Urban: 56.1%
• Type of admission: Emergency (70.3%)
• Comorbidities (n= 26): Malnutrition (42.3%), sickle cell
anaemia (34.6%), HIV (19.5%)
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Results and Discussions (3/10)
16.50%
Prevalence of renal disease

1.98% 1.70%

our study Okoronkwo et al, 2020 Albar et al, 2016

Worldwide: 1.2 – 16.5% 19

Results and Discussions (4/10)
Types of renal diseases
UTI 76 (51.4%)

AKI 32(21.6%)

Nephrotic sy... 18 (12.2%) El-tigani et al, 2012

Anigilaje et al, 2019
CKD 13 (8.8%) Abiodun et al, 2015
(-)Qader et al, 2016
CKD-5 on MHD 5 (3.4%)

Renal mass* 4 (2.6%)

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*(undefined 03, renal lymphoma 01)
Results and Discussions (5/10)
Table I: Comparison of certain sociodemographic characteristics among renal disease
UTI (n= 76) AKI (n= 32) Nephrotic CKD (n= 18) p-
syndrome (n=18) value

Median age 5 (1 – 11) 8.5 (6 – 13.75) 6 (4 – 8) 13.5 (10.5 – 0.001

(IQR) years 16)

Age groups
<5 37 (48.7%) 5 (15.6%) 6 (31.6%) 0 (0.0%)
5 - 10 18 (23.7%) 13 (40.6%) 10 (57.9%) 4 (22.2%)
>10 - 17 21 (27.6%) 14 (43.8%) 2 (10.5%) 14 (77.8%)
Sex
Female 50 (65.8%) 20 (62.5%) 8 (44.4%) 11 (61.1%) 0.563
IQR: interquartile range 21
Results and Discussions (6/10)
Table II: clinical characteristics of urinary tract infection (n=76)
Variable Category n (%) Comments
Clinical features Fever 62 (81.6)
Abdominal pain 39 (51.3)
vomiting 31 (40.8)
Severity Uncomplicated 69 (90.8)
Complicated 7 (9.2)
• Immunodepression 4
• Age <3 months 3
• CAKUT* 1 Orta et al, 2002
* (Posterior urethral valve 01) 22
Results and Discussions (7/10)
Table III: Clinical characteristics of acute kidney injury (n= 32)
Variable Category n (%) Comments
Clinical features Fever 22 (68.8)
Oligoanuria 18 (56.3)
Severity (KDIGO) Stage 1 3 (9.4) Halle et al, 2017
Stage 2 2 (6.3) Yao et al, 2016
Stage 3 27 (84.4)
Aetiology Malaria 13 (40.6) Anigilaje et al, 2019
Sepsis 13 (40.6) (-)Cleto et al, 2018
Need for dialysis 16 (50)
Access to dialysis 14 (87.5) Fouda et al, 2018
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Results and Discussions (8/10)
Table IV: Clinical characteristics of Nephrotic syndrome (n= 18)
Variable Category n (%) comments
Reasons for
admission
Initiate therapy 15 (83.3)
Infection 6 (33.3)
AKI 1 (5.3) Olowu et al, 2017

AKI: acute kidney injury 24

Results and Discussions (9/10)
Table IV: Clinical characteristics of CKD (non dialysed) (n= 13)
Variable Category n (%) Comments
Clinical features Anaemia 10 (76.9)
Hypertension 8 (61.5)
Oedema 8 (61.5)
Stage Stage 3 1 (7.7)
Stage 5 12 (92.3) Halle et al, 2017
Aetiology Chronic GN 7 (53.8) Orta et al, 2002
CIN 3 (23.1)
CAKUT* 2 (15.4) Peco-antic et al, 2011
HIVAN 1 (7.7)
Need for dialysis (CKD-5) 9 (75)
Access to dialysis 5 (55.5)

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* (Posterior urethral valve 02)
Results and Discussions (10/10)
Table V: In-hospital outcome (n= 148)
Total n(%) UTI AKI Nephrotic CKD p-

n=148 n= 76 n= 32 syndrome n= 18 value

n= 18

Death 7 (4.7%) 0(0.0%) 4 (12.5%) 0(0.0%) 3 (16.7%) 0.684

DAMA 11 (7.4%) 3 (3.9%) 5 (15.6%) 0(0.0%) 3 (16.7%) 0.141

Transfer 2 (1.4%) 0(0.0%) 1 (3.1%) 0(0.0%) 0(0.0%) 0.072

Discharged 128(86.5%) 73(96.1%) 22(68.8%) 18 (100%) 12(66.7%) 0.001

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DAMA: discharged against medical advice
Limitations
• Did not include children seen in urology/surgical units.
• Limited diagnostic facilities; renal histopathology
characterize certain renal diseases.
• Retrospective design

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Conclusion
• Renal diseases are uncommon among admitted children
with a prevalence of 1.98%
• Urinary tract infections, acute kidney injury and nephrotic
syndrome are the most frequent renal diseases
encountered.
• Overall in-hospital mortality is low and seen only in
children with AKI and CKD
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Recommendations (1/2)
To Healthcare professionals
• Early recognition and management of infections and
conditions that could predispose to severe renal disease.
• To emphasize on antenatal screening for early diagnosis
of abnormalities that predispose to renal disease.

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Recommendations (2/2)
To the scientific community
• To carry out prospective studies in other settings in order

to get a better view of renal disease in children.

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RESUME

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Introduction
•Les maladies rénales chez les enfants augmentent le fardeau
des maladies rénales chronique à l’âge adulte.
•Il existe peu de données sur le spectre clinique et les résultats
des maladies rénales dans les admissions pédiatriques, en
particulier dans les milieux à ressources limitées comme le
nôtre.
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Méthodes
• Nous avons menez une étude descriptive à partir des dossiers
d'enfants admis dans les hôpitaux régionales de Buea et
Bamenda entre le 1er janvier 2017 et le 31 décembre 2019
• Nous avons défini une admission rénale comme toute
anomalie fonctionnelle ou structurelle des reins et des voies
urinaires a ou pendant l’hospitalisation.
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Résultats (1/3)
• Au total, 148 (1.98%) des 7457 enfants admis avaient une
maladie rénale.
• L'âge médian des cas était de 7,5 ans (IQR 4-12) et 63.5%
étaient de sexe féminine dont 32.4% étaient de moins de 5
ans.
• L’infection urinaire (51,4%), Insuffisance rénale aigue (IRA,
21,6%), syndrome néphrotique (12,2%), étaient les
diagnostics rénales plus fréquent.

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Résultats (2/3)
• Les enfants avec MRC étaient plus âgés.
• L’infection urinaire compliquée a été observée chez 9.2% des
enfants atteints d’infection urinaire
• L’initiation de la corticothérapie (83.3%) était la raison la plus
courante d’admission chez les enfants atteints du syndrome
néphrotique.
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Résultats (3/3)
• Le paludisme et la septicémie étaient l'étiologie la plus courante de
l'IRA
• La GN chronique était l'étiologie la plus courante de MRC

• Sur les 148 cas, 128 (86,5%) ont obtenu leur avec amélioration, 11
(7,4%) ont quitté contre avis médical, 07 (4,7%) sont décédés et 02
(1,4%) ont été transférés.
• Les décès étaient chez les enfants avec IRA et MRC.
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Conclusion
• Les maladies rénales sont rares chez les enfants admis avec
une prévalence de 1.98%
• L’infection urinaire, IRA et le syndrome néphrotique étaient le
diagnostic rénal les plus courants chez ces enfants.
• La mortalité était faible et identifier seulement chez les
enfants avec IRA et MRC.
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MERCI! THANK YOU!

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