Clinical Microbiology: Open Access

Abstract

Environmental Factors in Renal Disease: The Contribution of Urinary Tract Infections in Nigerian Renal Disease Burden-Research

Tobias I Ndubuisi Ezejiofor

Background: Asymptomatic and mild nature of urinary tract infections (UTIs) make them underrated, overlooked but dangerous, because they are prelude to most renal diseases. Like asymptomatic UTIs, some renal diseases are symptomless until they have reached advanced stage, making their victims easily vulnerable to complications before actual diagnosis of renal disease may be made. This study was aimed at surveying the environmental factors responsible for the renal disease burden of Nigeria with a particular focus on the contributions of UTIs.
Method: Urine samples from renal disease patients of the University of Nigeria teaching hospital (UNTH), Enugu, Nigeria were analyzed for bacteriuria using standard microbiological procedures.
Results: An overall incidence of 28% bacteriuria was obtained, based on the criterion of significant bacteriuria (> 105 colonies/ml). While fungal yeasts, Candida albicans contributed 30%, various bacterial species jointly accounted for 70% of the entire microbial agents responsible for UTIs among the subjects. Subsequent Gram’s, microscopy and biochemical characterization tests revealed seven bacterial species viz Escherichia coli (29%), Klebsiella spp (22%), Proteus mirabilis (14%), Pseudomonas aeruginosa (7%), Streptococcus faecalis (7%), Staphylococcus aureus (7%) and Staphylococcus epidermidis (14%). Gender distribution of the isolates showed that S. aureus was isolated from the males while E. coli, Proteus mirabilis, Streptococcus faecalis and Pseudomonas aeruginosa from the females; Klebsiella spp was isolated from the males (33%) and females (67%) respectively, while S. epidermidis was isolated equally (50%) from both sexes. Adoption of leucocytes’ presence in urine as part of diagnostic criteria revealed significant bacteriuria with significant pyuria (21%), significant pyuria without significant bacteriuria (52%), and significant bacteriuria without significant pyuria (7%), no significant bacteriuria without significant pyuria (20%). Also, urinalyses gave proteinuria (84%), haematuria (45%) and glycosuria (6%).
Conclusions: The study revealed an overall incidence of 28% bacteriuria. Though UTIs by sundry bacterial organisms and fungal Candida albicans made reckonable contributions to the renal disease load of UNTH, Enugu, additional evidence from urinalyses revealing proteinuria, glycosuria and haematuria, etc., suggest that apart from the UTIs, diabetes mellitus and/or urinary schistosomiasis (possibly accounting for the haematuria) are part of the diseases complex defined by yet-to-be identified factors (possibly including chemical entities) in our environment that determine the burden and patterns of renal diseases profile of Nigeria. Further search is thus warranted.