Prevalence of proteinuria in kathmandu city.

Thesis Report.

ABSTRACT:

AIM: The purpose of this study was to determine the prevalence of proteinuria in Kathmandu City.

Method:

a Study design: All individuals over 14 years of age who participated in voluntary basis in mass health screening programme in Kathmandu City were eligible for the study. the samples were collected in cluster sampling method from 25 different sites of urban population of Kathmandu City. Kathmandu City lies in the central region of Nepal and includes municipality and Village Development Committees. These are further divided into different wards. Kathmandu is the capital of Nepal.
b. Mass screening Strategy: A house -to- house census was performed prior to the survey. The samples were selected by cluster sampling of all residents aged 14 years and over, who were listed by household and street, family and given names, and sex and date of birth. This list was used to prepare invitations to the survey and to monitor response. 25 Cluster were selected purposively and each cluster eligible subjects were enumerated. After the informed consent, each subject was provided a clean vial on the previous day and was instructed to keep his/her early morning specimen of the urine. The subjects were invited to attend on the next day during health camps at different location of Kathmandu for the survey. Different voluntary organizations, eg., Taudal youth Club, Balaju Bais Dhara Club, United Youth Clube, Thapathali Janakalyan Pariwar, Tilingtar Secondary School, Dhapasi and other non Governmental organizations were involved in organizing health camps during the field work. A team of local medical and paramedical staff was recruited separately for each survey, selection being on the basis of assessed professional performance. Each team was trained in survey procedures and supervised by the author. Participants arrived at the site early in the morning (6-8 AM) with urine samples, underwent for the registration and the questionnaire was administered according to the written pro forma.Urine samples were collected from them and tested for proteinuria by Ames dipstick made by Bayer Diagnostic India Ltd. The results of the urine tests were interpreted by the physicians or their assistants and were recorded as nill (-), trace (+/-), (1+), (2+). (3+), and (4+). The results were graded as negative (less than 10mg/dL), 1+ (30mg/dL), 2+ (100mg/dL), 3+ (300mg/dl) or 4+(1000mg/dL) as per manufacturers instruction. The result defined as, (-) and (+/-) is normal and the rest as abnormal. Blood pressure was recorded under basal conditions on the right arm of the subject in sitting position100 by auscultatory method with mercury sphygmomanometer. Three consequent readings were taken for both systolic and diastolic blood pressures.The mean of three were used in subsequent analysis. The Clinical hypertension was defined as systolic blood pressure greater than or equal to 140mmHg and diastolic blood pressure (phase V) greater and or equal to 90 mmHg. Subjects taking current, regular anti-hypertensive medication were considered to be hypertensive, regardless of their blood pressure. Subjects who have history of diabetes and currently taking regular oral hypoglycemic agents or insulin were considered to be diabetic. Those subjects claim to be diabetic and on diet restriction were not considered diagnosed diabetics in this study. Present analysis was conducted in a total of 5119 participants over 14 years of age, among them 2592(50.63%) were men and 2527(49.36%) were women. Results: The prevalence of proteinuria in Kathmandu city was 6.3%. The prevalence of 1+, 2+ and 3+ proteinuria, among the total participants in our study were 5.12% (n=262), 0.96%(n=49) and 0.21%(n=11) respectively. Similarly 1+,2+ and 3+ proteinuria were 5.25% (n=136), 0.93 (n=24) and 0.3% (n=6) in men and 4.99% (n=126), 0.99% (n=25), 0.2% (n=5) in women respectively. 4+ proteinuria was not detected among the studied participants. In men, the prevalence of proteinuria increased linearly with age, from 2.4% in the 14 to 24 year age group to 10.0% in those over 75 years of age and above (p= 0.0013). in women, also the prevalence of proteinuria increased linearly with age, from 2.3% in the 14 to 24 year age group to 9.6% in those over 75 years of age and above. (p=0.0002). The prevalence of proteinuria in men was not significantly higher than that in women (p=o.7782). Likewise, total population of hypertensive participants in our study was 9.5% (n=488). Among them prevalence of proteinuria was 21.11% (n=103) which was significant in comparison with hypertension and diabetes (p=0.00008). Similarly total diabetic participants in our study were 8.34% (n=427). Among them prevalence of proteinuria was 28.34% (n=121) which was significant in comparison with hypertension (p=0.0111). Similarly total population of Diabetes with hypertension was 1.2% (n=62) and prevalence of proteinuria among them was 43.55% (n=27) (p=0.0148). Overall (p=0.0001).

Conclusion: In this pioneer study of proteinuria in Kathmandu city, the prevalence of proteinuria was 6.3%. In men and women the prevalence of proteinuria increased linearly with age, and insignificantly higher in men than women. Proteinuria was three times as common in hypertensive persons and also occurred in excess of four times in diabetics and seven times as common in both hypertension and diabetes patients. Proteinuria in the ambulatory general population is not a benign condition and carries serious prognosis. Primary care physicians play an important role in the outpatient evaluation of proteinuria, a common finding in everyday medical practice. a simple urine dipstick usually is the first step, but factors leading to false-negative results must be considered. They should be encouraged to identify and screen patients at increased risk of renal disease in conjunction with secondary or tertiary centers, to make referral services available. So there is fair evidence to include urine dipstick screening for proteinuria in the periodic health examination of asymptomatic adults. There is good evidence to include urine dipstick screening for proteinuria in the periodic health examination of adults with diabetes, hypertension and both.

Eng.