Assessing Proteinuria Among Hypertensive Patients at Tema General Hospital, Ghana
Abstract:
Hypertension, a major global health
burden, is a leading cause of cardiovascular and renal complications. In Ghana,
proteinuria an early marker of kidney damage remains underdiagnosed among
hypertensive patients. This study assessed the prevalence and associated risk
factors of proteinuria among hypertensive patients at the Tema General Hospital
in Ghana. A cross-sectional study was conducted among 130 hypertensive patients
aged ≥18 years, excluding those with diabetes, pregnancy, or pre-existing renal
conditions. Participants provided demographic data, medical histories, and
urine samples for dipstick proteinuria testing. Blood pressure and BMI were
also recorded. Statistical analysis was performed using SPSS v20. The
prevalence of proteinuria was 88.5%, with 38.5% having moderate and 26.9%
severe proteinuria. Significant associations were found between proteinuria
severity and higher BMI (p=0.030), prior kidney disease (p=0.010), and stroke
history (p=0.040). No significant associations were observed with age, gender,
smoking, or alcohol use. The high prevalence of proteinuria among hypertensive
patients underscores the need for routine screening and early intervention to
prevent renal deterioration. Targeting modifiable risk factors, particularly
obesity and hypertension control, is crucial to improving outcomes in this
population.
References:
[1]. Mills, K. T., Stefanescu, A., & He, J., 2020, The global epidemiology of hypertension. Nature Reviews Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2
[2]. Tannor, E. K., Nyarko, O. O., Adu-Boakye, Y., Owusu Konadu, S., Opoku, G., Ankobea-Kokroe, F., ... & Ansong, D., 2022, Prevalence of hypertension in Ghana: Analysis of an awareness and screening campaign in 2019. Clinical Medicine Insights: Cardiology, 16, 117954682211200. https://doi.org/10.1177/11795468221120092
[3]. Farhadi, F., Aliyari, R., Ebrahimi, H., Hashemi, H., Emamian, M. H., & Fotouhi, A., 2023, Prevalence of uncontrolled hypertension and associated factors in 50–74 years old Iranian adults: A population-based study. BMC Cardiovascular Disorders, 23(1), 73. https://doi.org/10.1186/s12872-023-03357-x
[4]. Whaley-Connell, A., Nistala, R., & Chaudhary, K., 2011, The importance of early identification of chronic kidney disease. Missouri Medicine, 108(1), 25–28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188457/
[5]. Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K., 2019, Prevention and control of hypertension: JACC Health Promotion Series. Journal of the American College of Cardiology, 72(11), 1278–1293. https://doi.org/10.1016/j.jacc.2018.07.008
[6]. Delles, C., & Currie, G., 2013, Proteinuria and its relation to cardiovascular disease. International Journal of Nephrology and Renovascular Disease, 6, 13–24. https://doi.org/10.2147/IJNRD.S40522
[7]. Shlipak, M. G., Tummalapalli, S. L., Boulware, L. E., Grams, M. E., Ix, J. H., Jha, V., ... & Zoungas, S., 2020, The case for early identification and intervention of chronic kidney disease: Conclusions from a KDIGO Controversies Conference. Kidney International, 99(1), 34–47. https://doi.org/10.1016/j.kint.2020.10.012
[8]. Cravedi, P., & Remuzzi, G., 2013, Pathophysiology of proteinuria and its value as an outcome measure in chronic kidney disease. British Journal of Clinical Pharmacology, 76(4), 516–523. https://doi.org/10.1111/bcp.12104
[9]. Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., ... & Muntner, P., 2018, Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Circulation, 137(12), e67–e492. https://doi.org/10.1161/CIR.0000000000000558
[10]. Bosu, W. K., & Bosu, D. K., 2021, Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis. PLOS ONE, 16(3), e0248137. https://doi.org/10.1371/journal.pone.0248137
[11]. Hall, J. E., do Carmo, J. M., da Silva, A. A., Wang, Z., & Hall, M. E., 2014, Obesity-induced hypertension: Interaction of neurohumoral and renal mechanisms. Circulation Research, 116(6), 991–1006. https://doi.org/10.1161/CIRCRESAHA.116.305697
[12]. Gelber, R. P., Gaziano, J. M., Manson, J. E., Buring, J. E., & Sesso, H. D., 2007, A prospective study of body mass index and the risk of developing hypertension in men. American Journal of Hypertension, 20(4), 370–377. https://doi.org/10.1016/j.amjhyper.2006.10.011
[13]. Tomiyama, M., Horio, T., Yoshii, M., Takiuchi, S., Kamide, K., Nakamura, S., ... & Kawano, Y., 2006, Masked hypertension and target organ damage in treated hypertensive patients. American Journal of Hypertension, 19(9), 880–886. https://doi.org/10.1016/j.amjhyper.2006.03.006
[14]. Iseki, K., Iseki, C., Ikemiya, Y., & Fukiyama, K., 1996. Risk of developing end-stage renal disease in a cohort of mass screening. Kidney International, 49(3), 800–805. https://doi.org/10.1038/ki.1996.126
[15]. Huda, M. N., Alam, K. S., & Harun-Ur-Rashid., 2012, Prevalence of chronic kidney disease and its association with risk factors in a disadvantaged population. International Journal of Nephrology, 2012, 267329. https://doi.org/10.1155/2012/267329
[16]. Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., ... & Roccella, E. J., 2003, Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 42(6), 1206–1252. https://doi.org/10.1161/01.HYP.0000107251.49515.c2
[17]. Hsu, C. Y., McCulloch, C. E., Iribarren, C., Darbinian, J., & Go, A. S., 2006, Body mass index and risk for end-stage renal disease. Annals of Internal Medicine, 144(1), 21–28. https://doi.org/10.7326/0003-4819-144-1-200601030-00006
[18]. Keane, W. F., Brenner, B. M., de Zeeuw, D., Grunfeld, J. P., McGill, J., Mitch, W. E., ... & RENAL Study Investigators, 2003, The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: The RENAAL Study. Kidney International, 63(4), 1499–1507. https://doi.org/10.1046/j.1523-1755.2003.00885.x
[19]. Lamb, E. J., MacKenzie, F., & Stevens, P. E., 2009, How should proteinuria be detected and measured? Annals of Clinical Biochemistry, 46(3), 205–217. https://doi.org/10.1258/acb.2009.008222
[20]. Tuot, D. S., Plantinga, L. C., Hsu, C. Y., Jordan, R., Burrows, N. R., & Powe, N. R., 2013, Chronic kidney disease awareness among individuals with clinical markers of kidney dysfunction. Clinical Journal of the American Society of Nephrology, 8(2), 204–212. https://doi.org/10.2215/CJN.05100510
[21]. Kaze, A. D., Ilori, T., Jaar, B. G., & Echouffo-Tcheugui, J. B., 2018. Burden of chronic kidney disease on the African continent: A systematic review and meta-analysis. BMC Nephrology, 19(1), 125. https://doi.org/10.1186/s12882-018-0930-5
