CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Diabetes is a chronic disease that cannot be cured, but can be treated and controlled. It is
caused by a lack or lack of use of a hormone called insulin. When there is a lack of insulin, or
when it does not perform its function effectively, as is the case in a person with
diabetes, glucose cannot be used as a fuel for
cells.
It
then
accumulates in the blood and
causes an increase in sugar level (hyperglycemia). In the long run, high blood sugar causes
complications, including eye, kidney, nerve, heart and blood vessel complications (Ignatiev, Reva,
Pervov, Kotsyurbii & Yatsenko, 2020; Birham, 2019). There are different types of diabetes:
prediabetes, type 1 diabetes, type 2 diabetes, gestational diabetes and other rarer types; Type 1
diabetes, accounts for 10 to 15% of diabetes cases. It occurs most often in a non-obese
subject before the age of 30 (Srivastava & Singh, 2013).
Diabetes type
2
known
as
fatty or mature
diabetes,
noninsulin-dependent
diabetes mellitus (NIDDM) is a metabolic disorder characterized by chronic excess of blood
sugar (hyperglycemia). The peripheral use of sugar in the cells: insulin, a hormone made by the
pancreas, allows cells to
collect and use glucose. Gestational Diabetes affects 3 to 20% of
pregnant women. Diabetic is an important non-communicable disease in Nigeria. It is believe that
lack of awareness, late diagnosis, less accessibility and higher costs for renal replacement therapy
have led to increased morbidity and mortality. Studies conducted by Abdulla, Al-kotany and
Mahdi (2012) on renal patients revealed that up to 90% were found to have oral symptoms of
uremia like ammonia like taste and smell, stomatitis, gingivitis, decreased salivary flow,
xerostomia and parotitis. Diabetes is recognized today, supported by figures like a global epidemic
1
and a tsunami whose human, social and economic consequences are devastating. Type 1 diabetes
and type 2 diabetes are distinct disorders resulting primarily from either a lack of pancreatic insulin
in the former or due to development of insulin’s ineffectiveness to maintain blood glucose within
the physiologic range in the latter (Karla, 2012). In genetically pre-disposed persons, the
combination of excess caloric intake and less physical activity can lead to obesity which in turn,
can induce a state of resistance to the action of insulin (Kahan, 2003). This disease as suggested
by Himmelfarb and Ikizler (2010) should be actively addressed to meet the United Nation’s
Sustainable Development Goal target to reduce premature mortality from non-communicable
diseases by a third by 2030. Treatment costs for diabetic rose after the 1960s, with availability of
renal replacement techniques making possible the long-term application of life-saving but costly
treatment for patients with end-stage kidney disease (ESKD). That is what triggered the researcher
to evaluate on creatinine, urea and uric acid level in patients with diabetic in specialist hospital
Jalingo, Taraba State, Nigeria.
However, creatinine test is a measure of how well your kidneys are performing their job of filtering
waste from your blood. Creatinine is a chemical compound left over from energy-producing
processes in your muscles. Healthy kidneys filter creatinine out of the blood. Creatinine exits your
body as a waste product in urine. The Doubling Serum Creatinine (DSC) can be simple to monitor
and is almost comparable to a halving of the estimated glomerular filtration rates (eGFR), and it
accounts for the substances of the events containing the composite renal end points (Badve, 2016).
Similarly, Mann (2008) pointed that the components of the Doubling Serum Creatinine are wellrecognized and accepted parts of the composites, because of the changes observed in the serum
creatinine (SCr) through longer-time, it is implicate to reflect the structural kidney function
deteriorations. In this note, some waste product like uric acid are likely to cause infectious of renal
2
disorder especially in aged people. Even Stryer, Tymoczko and Berg (1997) stated that Creatinine
is produced after the pyrophosphate cleavage of phosphocreatine to produce energy for muscle
activity. Serum creatinine level is one of the markers for renal function examination. Age, gender,
protein intake, and muscle mass influence serum creatinine levels.
Uric acid is a waste product found in blood. It’s created when the body breaks down chemicals
called purines. Most uric acid dissolves in the blood, passes through the kidneys and leaves the
body in urine. Food and drinks high in purines also increase the level of uric acid. These include:
Seafood (especially salmon, shrimp, lobster and sardines), Red meat, Organ meats (liver, Food
and drinks) with high fructose corn syrup, and alcohol (especially beer, including non-alcoholic
beer).
Urea is the chief product of protein metabolism in the body. The importance of the urea
concentration in blood lies in its value as an indicator of kidney function. Relatively, a decrease in
the urea plasma level may be associated with acute dehydration, malnutrition, and pregnancy.
Overproduction of Uric Acid causes gout. It may also lead to progressive renal insufficiency.
Hyperuricemia is also associated with Hypertension, Diabetes mellitus, Hypertriglyceridemia and
Obesity. Additionally, Macias et al., (1978) hinted that it has also been documented a decrease in
sodium reabsorption in the thick ascending loop of Hen-le in very old healthy people. This lower
local sodium reabsorption, leads to the following alterations: (1) De- creased free water clearance,
with the subsequent inability to dilute urine; (2) Reduced medullar tonicity, with the subsequent
inability to reabsorb free water by the collecting tubules in a state of antidiuresis (vasopressin
release).
3
In line with the contributions of other researchers as highlighted, the researcher intends to evaluate
on the study of creatinine, urea, and uric acid level in patients with renal disorder who visits
specialist Hospital Jalingo, Taraba State, Nigeria.
1.2 Statement of the Problem
Even nowadays the limits that separate the changes considered typical of the normal ageing
process of patients who suffer from high prevalent illnesses characteristic of this period are not
clear. It has pose vacuum to contributions by researchers and that has interest the researcher to
study on diabetic patients with variables creatinine, urea and uric acid level. Pertinent to this note,
most patient with diabetic are prone to have a renal dysfunction which is influenced by thyroid
status. Changes in routine clinical chemical indicators of renal function in the hypothroid status
are not well characterized, and are infrequently discussed in standard internal medicine textbooks.
It is believe further that all physiological changes of the aged kidney are the same in both genders
(Male and female). As observe by the World Health Organization (WHO) estimates that high level
blood glucose is one of the important risk factors for premature mortality. Currently around 415
million in the world have diabetes and 318 million of adults have an impaired glucose tolerance
(i.e. adults who have blood glucose levels higher than normal but not sufficiently to be classified
as diabetics) which expose them to a high risk for developing diabetes in the future, which can
gradually leads to renal disorder. As pointed by Ford, Giles and Mokdad (2004) the metabolic
disease has been identified with some disorders such as mild kidney disease, endothelial
dysfunction and oxidative stress. In both developed and developing countries, chronic kidney
disease (CKD) is one of the main causes of morbidity and mortality.
Looking at the problem in hand, this research work will attempt to answer the following question;
what is the level of creatinine in patient with renal disorder in specialist Hospital Jalingo? What is
4
the urea level in patient with renal disorder in specialist hospital? What is the uric acid level in
patients with renal disorder in specialist hospital in Jalingo? The researcher will empirically
attempt to find out answers to those questions with a view to evaluates the creatinine, urea and uric
acid level in patients with diabetes who visits Specialist Hospital Jalingo, Taraba State.
1.3 Research Questions
The following research Questions are formulated to guide the study: i.
What is the demographic variables of diabetic patients who visit specialist hospital
Jalingo, Taraba State?
ii.
What are the symptoms of kidney diseases experienced by the diabetic patients who
visits Specialist hospital Jalingo?
iii.
What is the Creatinine level, Urea level and Uric Acid level of Diabetic Patients in
Specialist Hospital Jalingo, Taraba State?
iv.
What is the duration of Diabetes among Patients who visits Specialist Hospital Jalingo,
Taraba State, Nigeria?
1.4 Objectives of the Study
The following are the objectives of the present study: i.
Determine the demographic variables of diabetic patients who visit specialist hospital
Jalingo, Taraba State.
ii.
Find out the symptoms of kidney diseases experienced by the diabetic patients who
visits Specialist hospital Jalingo
iii.
Determine the Creatinine level, Urea level and Uric Acid level among Diabetic Patients
in Specialist Hospital Jalingo, Taraba State, Nigeria.
5
iv.
Assess the duration of the disease among Diabetes Patients in Specialist Hospital
Jalingo, Taraba State, Nigeria.
1.5 Research Hypothesis
At 5% level of significance, the research will test the below hypothesis:HO1: There is no Significant Difference on the duration of diabetes among patients who visits
Specialist Hospital Jalingo.
HO2: There is no Significant Difference on Creatinine level, Urea level and Uric Acid level among
Diabetic Patients in Specialist Hospital Jalingo, Taraba State, Nigeria.
1.6 Scope of the Study
Based on the variables outline and the area of the study, there are three scope view to the present
research work that the researcher will used to achieve the objectives. First, the content scope, this
will cover creatinine, urea and uric acid among renal disorder patients. Secondly, the geographic
scope will be conducted in Specialist Hospital Jalingo. Thirdly, time scope, this research will take
a period of six months to achieve the objectives of the study.
1.7 Significance of the Study
This study will be beneficial to patients living with diabetes to realize the accurate level of their
creatinine, urea and uric acid level in the body. The review of literature in this research work will
serves as a referencing material to other scholars/researchers who will conduct similar study
elsewhere. It is believe that findings from this research work will suggest relevant information to
ministry of health in Taraba State to provide amenities and hospital equipment that will promote a
healthy free society in Jalingo and Taraba State at large. The study will contribute to existing
literature and that will in turned replicate knowledge among health practitioners in the State.
6
1.8 Operational Definition of Terms
Renal Disorder (RO): As used in this study is the inactiveness of the kidney due to diseases.
Patients: Someone who is physically not composed (healthy) due to illness.
Creatinine: is a chemical compound left over from energy-producing processes in your muscles.
Urea: is the chief nitrogenous end product of the metabolic breakdown of proteins in all mammals
and some fishes.
Uric acid: is a chemical created when the body breaks down substances called purines.
7
CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
The present study focuses on the conceptual framework and Review Empirical studies.
2.2 Conceptual Framework
2.2.1 Concept of Creatinine
Creatinine clearance measured without (CC) or with cimetidine (CCWC), which is almost the
same as inuline clearance due to the blocking effect that cimetidine has on the proximal tubular
secretion of creatinine, has proved to be significantly lower in the very old healthy people in
comparison to that documented on the younger population (Hilbrands, Artz & Wetzels, Koene,
1991; Schuck, 1984): Creatinine Clearance: 43 mL/min per 1.73 m2 (aged) vs 144 mL/mi per 1.73
m2 (young), (P = 0.01); CCWC: 50 mL/min per 1.73 m2 (aged) vs 112 mL/min per 1.73 m2
(young), (P = 0.01). The observed difference in the creatinine filtration between the studied age
groups could be justified as a consequence of the decrease in the number of glomerular units
secondary to their obliteration due to the glomeruloscrerosis which accompanies ageing (Zhou,
Laszik & Silva, 2008). Even though, the above mentioned creatinine renal filtration difference
between the age groups, there is no significant difference regarding their serum creatinine value
between them. This phenomenon can be explained as the decrease in the creatinine levels due to
the senile diminution in lean body mass (tissues from where creatinine comes).
8
When this phenomenon was explored in the context of over hydration, it was observed that there
was practically no change in the AC/ACC ratio neither in the young (ratio: 1.26) nor in the oldest
old (ratio: 0.87). However, when this phenomenon was explored in the context of dehydration, it
was observed that while there was practically no change in the AC/ACC ratio in the young
(ratio:1.3), conversely there was a significant reduction in AC/ACC value in the oldest old (ratio:
0.76), P = 0.02. These finding could be interpreted as the fact that the dehydration over expresses
the habitual senile creatinine back filtration. It could be hypothesized that the phenomenon of net
creatinine tubular reabsorption documented on very old people could be explained due to the senile
structural tubular changes (atrophy, etc.) which would make the proximal tubule more permeable
and thus more susceptible to present the observed creatinine back-filtration pattern. Something
similar was documented in the newborns but in this case it was attributed to tubular immaturity
since this finding disappeared as they grew older (Musso et al., 2009). The renal functionnormalized SUA (SUA/SCr ratio and SUA*GFR/100) is studied before as the biomarker of the
chronic obstructive pulmonary disease, metabolic syndrome and higher in the population with high
prevalence of metabolic syndrome and T2DM (Garcia-Pachon, Padilla-Navas & Shum, 2007).
Because of the many formulas of the eGFR including sex, weight, race and many mathematic
numbers were used in the clinical practice and provided the different results. But the SUA/SCr
ratio is easier calculation by using the general biochemical markers no any additions.
2.2.2 Concept of Urea and Uric Acid Level
It is already known that there is a significant difference between urea and uric acid renal handling
in very old healthy people. On one hand, it has been documented that fractional excretion of urea,
in volume contraction as well as in volume expansion, was significantly higher than the one
reached by the young: 40% vs 24% (P = 0.017) and 65% vs 53% (P = 0.04) respectively. Due to
9
the fact that a reduction in the number of urea channels (UT1) has been documented in the
collecting tubules of very old rats, it could be suggested that the senile increase in urea excretion
may be the consequence of a lower reabsorption of urea at the distal tubules. Clinical
consequences: This increase in the urea urinary excretion, as well as the low protein diet that aged
people usually have, both explain the normal serum urea value characteristically found in the
elderly, despite of their reduced glomerular filtration rate (Macias-Nunez & Lopez, 2008).
Additionally, the high urea urinary excretion documented in the very old could be one of the factors
which explains the senile medullar hypotonicity (reduced urea medullar content) and the nocturia
(urea osmotic diuresis) usually found in the very old patients (Musso, 2005).
2.2.3 Correlation of Urea, Creatinine and Uric Acid Level
In the study conducted by Akagunduz & Akcakaya (2021) found out that mean urea:
30.5±14.8mg/dl, creatinine: 0.7±0.1mg/dl, uric acid: 4.1±1.1mg/dl in the control group. Serum
urea level was found to be 35.6±7.1mg/dl in patients with overt hypothyroidism, which was
statistically significantly higher than the control group (p=0.002). The creatinine value in patients
with overt hypothyroidism was found to be 0.8±0.1mg/dl, and it was significantly higher than the
control group (p=0.001). The uric acid level was also found to be 5.5±1.3mg in patients with overt
hypothyroidism and was significantly higher than the control group (p<0.001). In patients with
subclinical hypothyroidism, urea: 31.5±6.4mg/dl, creatinine: 0.7±0.2 mg/dl, uric acid:
4.3±1.1mg/dl. It was not significantly higher than the control group (p = 0.708, p= 0.934, p =
0.334).
2.2.4 Renal Disorder
10
Renal disorder is defined as a persistent abnormality in kidney structure or function (eg, glomerular
filtration rate [GFR] <60 mL/min/1.73 m2 or albuminuria ≥30 mg per 24 hours) for more than 3
months, CKD affects 8% to 16% of the population worldwide. In developed countries, CKD is
most commonly attributed to diabetes and hypertension. However, less than 5% of patients with
early CKD report awareness of their disease. Among individuals diagnosed as having CKD,
staging and new risk assessment tools that incorporate GFR and albuminuria can help guide
treatment, monitoring, and referral strategies. Optimal management of CKD includes
cardiovascular risk reduction (e.g, statins and blood pressure management), treatment of
albuminuria (e.g, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers),
avoidance of potential nephrotoxins (eg, nonsteroidal anti-inflammatory drugs), and adjustments
to drug dosing (eg, many antibiotics and oral hypoglycemic agents). Patients also require
monitoring for complications of CKD, such as hyperkalemia, metabolic acidosis,
hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia. Those at
high risk of CKD progression (eg, estimated GFR <30 mL/min/1.73 m2, albuminuria ≥300 mg per
24 hours, or rapid decline in estimated GFR) should be promptly referred to a nephrologist.
Renal disorder is defined by a glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2,
albuminuria of at least 30 mg per 24 hours, or markers of kidney damage (eg, hematuria or
structural abnormalities such as polycystic or dysplastic kidneys) persisting for more than 3
months,5 Chronic Kidney Disease is more prevalent in low- and middle-income than in highincome countries.6 Globally, Chronic Kidney Disease is most commonly attributed to diabetes
and/or hypertension, but other causes such as glomerulonephritis, infection, and environmental
exposures (such as air pollution, herbal remedies, and pesticides) are common in Asia, sub-Saharan
Africa, and many developing countries.4 Genetic risk factors may also contribute to CKD risk. For
11
example, sickle cell trait and the presence of 2 APOL1 risk alleles, both common in people of
African ancestry but not European ancestry, may double the risk of CKD (Jha et al., 2013;
Genovese et al., 2010)
2.2.5 Effect of Diabetes Disease
Diabetes Mellitus is a chronic disorder that is associated with cardiovascular complications, renal
complications and various types of microangiopathies including metabolic syndrome. The
International Federation of Diabetes, reported that around 415 million adults around all over the
world are suffering from diabetes, and they estimated that the numbers are likely to reach around
642 million by 2040 (Akhtar & Dhillon, 2017). Evidences show that renal function has been
impaired in part of diabetic patients with normoalbuminuria. Recent studies by Ebar and Hassan
(2022) found that some renal function parameters between cases and control group, the results
revealed that the mean blood urea, serum creatinine levels and blood glucose (random)
concentration of the case group were significantly high when compared with the control group
(0.000). In Gender-wise correlation of renal function tests (RFT) in the cases, the results showed
that male patients had higher blood urea and serum creatinine levels when compared with female
patients.
Diabetes mellitus (DM) is one of the most common health problems in affecting about 6-7% of
the world’s population (Adeghate, Schattner & Dunn, 2006) According to WHO, diabetes affects
more than 170 million people worldwide. Obesity, hyperlipidemia, dyslipidemia, hypertension and
visceral adiposity, are the suggestive risk factors that increases the comorbid risk of developing
12
chronic kidney disease and cardiovascular diseases. Some studies have shown that measurement
of blood urea and serum creatinine are easily available tests which can assist in detection and
prevention of diabetic kidney diseases at an early stage thereby, limit the progression to end stage
renal disease (Vargatu, 2016; Zimmet, Alberti & Shaw, 2001)
2.3 Review of Empirical Studies
Jose, Bes-Rastrollo, Monedero, Jokin and Francisco (2007) conducted a study on Prognosis and
serum creatinine levels in acute renal failure at the time of nephrology consultation: an
observational cohort study. The objectives of their study was to: identify and quantify a correlation
between acute serum creatinine changes in ARF, measuring them at the time of nephrology
consultation, and mortality and recovery of renal function. Prospective cohort study of 1008
consecutive patients who had been diagnosed as having ARF, and had been admitted in the
university-affiliated hospital over 10 years. Demographic, clinical information and outcomes were
measured. After that, 646 patients who had presented enough increment in serum creatinine to
qualify for the RIFLE criteria were included for subsequent analysis. The population was divided
into two groups using the median serum creatinine change (101%) as the cut-off value.
Multivariate non-conditional logistic and linear regression models were used. Results was shown
that A ≥ 101% increment of creatinine respect to its baseline before nephrology consultation was
associated with significant increase of in-hospital mortality (35.6% vs. 22.6%, p < 0.001), with an
adjusted odds ratio of 1.81 (95% CI: 1.08–3.03). Patients who required continuous renal
replacement therapy in the ≥ 101% increment group presented a higher increase of in-hospital
mortality (62.7% vs 46.4%, p = 0.048), with an adjusted odds ratio of 2.66 (95% CI: 1.00–7.21).
Patients in the ≥ 101% increment group had a higher mean serum creatinine level with respect to
13
their baseline level (114.72% vs. 37.96%) at hospital discharge. This was an adjusted 48.92%
(95% CI: 13.05–84.79) more serum creatinine than in the < 101% increment group.
Akagunduz and Akcakaya (2021) conducted a research on Evaluation of the Correlation of Urea,
Creatinine, and Uric Acid Levels with TSH in Patients with Newly Diagnosed Overt and Subclinic Hypothyroidism. The objectives of the study was to determine the relationship between renal
function and different degrees of thyroid dysfunction. The research design was a cross-sectional
retrospective study, thyroid and kidney function tests were analyzed in 201 patients of whom 120
were subclinical hypothyroidism and 81 patients were overt hypothyroidism. These were
compared with 203 age-and sex-matched euthyroid control group. Results shows that Overt
hypothyroid subjects showed significantly raised serum urea, creatinine and uric acid levels as
compared to controls but subclinical hypothyroid patients did not showed significant increased
levels of serum urea, uric acid and creatinine levels.
Divya, Kumar and Ravi (2016) also conducted a study on the Assessment and Correlation of Urea
and Creatinine Levels in Saliva and Serum of Patients with Chronic Kidney Disease, Diabetes and
Hypertension. A Research Study. The study objective was to assess and correlate the serum and
salivary urea and creatinine levels of CKD, diabetes mellitus and hypertensive subjects. A crosssectional study was done on 120 subjects involving 30 CKD, 30 diabetic, 30 hypertensive subjects
and 30 healthy controls. After collection of saliva and blood samples, urea was analyzed by
enzymatic calorimetric method and creatinine by Jaffe’s method. Kruskal Wallis test and Mann
Whitney U test were used for comparison between different groups and correlations between
serum and salivary parameters were evaluated by applying Spearman’s correlation test. The pvalue <0.05 was considered statistically significant. The median serum and salivary urea and
creatinine levels were highest in CKD group followed by diabetic, hypertensive groups and
14
controls. The correlation coefficient for serum urea and salivary urea was 0.977 and for serum
creatinine and salivary creatinine was 0.976, with p-value <0.001.
Malekmakan, Khajehdehi, Pakfetrat, Malekmakan, Mahdaviazad, and Roozbeh (2013) conducted
a research on Prevalence of Chronic Kidney Disease and Its Related Risk Factors in Elderly of
Southern Iran: A Population-Based Study. The objective was to assess CKD prevalence and its
related risk factors in elderly population of Fars province. A cross sectional study was adopted with
a total of 1190 elderly people were used, and demographic and medical data were obtained. Data
were analyzed by SPSS, and Probability of less than 0.05 was considered as statistically
significant. Results shows that Prevalence of CKD stages III–V was 27.5% in the 60–69 years age
group, 36.5% in the 70–79 years age group, and 40% in the ≥80 years age group. The prevalence
of CKD increased with ageing in both men and women. Female gender was the strongest risk
factor for CKD. It was concluded in their reports that Prevalence of CKD in elderly is high in
Southern Iran, which has become an important health problem while it can be prevented or delayed
in progression.
Richard, Augustine, Okafor, Chime, Jide, Francis, Okorie, Nworgu, Adaobi, Ebute (2017)
undertook a study on Serum urea, uric acid and creatinine levels in diabetic mellitus patients
attending Jos University Teaching Hospital, North central Nigeria. The objective of the study
was to compare between urea, uric acid and creatinine concentration in the serum of diabetic
(control group). 150 individuals were recruited for this study, seventy four (74) apparently
healthy (non-diabetic) subjects were recruited as control and seventy six (76) diabetic subjects.
The diabetic consist of thirty eight (38) male and thirty eight (38) females. The non-diabetics
consist of equal number of thirty seven (37) females and males respectively. The subjects were
enlightened and given informed consents prior to the research. They were fasted overnight (12hr)
15
and 5ml pre-prandial blood were collected from cubital vein in the arm the following morning with
a sterile syringe, tourniquet and 75% alcohol and needle and the blood transferred to an
Ethylenediaminetetraacetic acid (EDTA) bottle and kept at temperature of 20C and later
analyzed. The result shows the level of serum (7.9±3.8) and creatinine (200±7.8) uMol/L
significantly increased (p<0.05) in diabetic subjects. In male diabetic subjects the serum urea
(7.4±3.2) uMol/l and creatinine (218±7.9) were significant. There was also a significant
increase (p>0.05) in the female diabetic subjects. Though the serum uric acid level was higher in
male diabetic (243±10.6) than the female diabetic (222±10.8), yet there was no significant
difference (p>0.05). These values were also higher in male non-diabetic (179±8.4). This study
therefore confirms that the assay of serum urea and creatinine concentrations have an
important role in the management of diabetic mellitus patients.
Simbolon, prianti, Nurahmi and Kuniawan (2020) conducted a study on the Analysis of Serum
Uric Acid Level in Patients with and without Diabetic Nephropathy. The study was to analyze
serum uric acid levels in patients with and without diabetic nephropathy and determine its
correlation with diabetic nephropathy. It was performed at Dr. Wahidin Sudirohusodo Hospital,
Makassar, by taking the data from the medical record of type 2 DM patients from January to April
2018. Fifty-nine patients with diabetic nephropathy and 150 patients without diabetic nephropathy
participated in their study. An independent T-test and Pearson's correlation test was used for
statistical analysis. There was a significant difference in uric acid level between patients with and
without diabetic nephropathy (9.57±3.42 mg/dL vs. 6.41±2.86 mg/dL, p < 0.001). There was
significant correlation between uric acid serum levels with urea (p < 0.001, r=0.585), creatinine
(p<0.001, r=0.413) and eGFR (p < 0.001, r=-0.525) in patients with diabetic nephropathy. Uric
acid levels in patients with diabetic nephropathy were higher than patients without diabetic
16
nephropathy. Higher levels of urea and the serum creatinine led to higher levels of serum uric acid.
Contrastingly, a lower eGFR rate led to higher levels of uric acid.
CHAPTER THREE
RESESARCH METHODOLOGY
3.1 Research Design
The study adopted cross sectional research design for the present research work. A cross sectional
research design is a type of observational study design. It measures the outcome and the exposures
in the study participants at the same time. The need to consider this design is to evaluate the
creatinine level, urea and uric acid level of patients with renal disorder specialist hospital in Jalingo
metropolis, Taraba State. Also, the researcher will only consider existing records of patients with
renal disorder in the hospital who have also been tested various levels of their creatinine, urea and
uric acid.
3.2 Characteristics of Study Population
Specialist Hospital Jalingo as at time (year) of this research recorded 2,320 patients with various
diseases including those on admission and visitors to the hospital out of which 1,080 are females
and 1, 240 are males. It is the only Specialist Hospital in Taraba State located at GRA area of
Jalingo local government area of Taraba State, Nigeria. The hospital was established in 2007 and
is presently is under the leadership of a chief medical director. The hospital has the following
departments thus: head of clinical, Administration board secretary, finance & supply, and Nursing.
17
Like other popular hospitals gives functional roles, specialist hospital Jalingo is not in exception
among some of these roles are; specialized medical care and services in various fields; radiology,
laboratory medicine, obstetrics and Gynaecology, family medicine, internal medicine, surgery,
ophthalmology, ENT and others. However, the essence of selecting specialist hospital for this
research work is geared towards finding out the creatinine level, urea and uric acid of patients with
renal disorder. It is believe that the hospital in it capacity have attended to victims of renal disorder
in the decades of services render in the state.
3.3 Sampling Techniques
In the cause of the research study, the researcher will used Purposive sampling procedure to sought
out number of Patients with Renal disorder (diabetes), a sample size of 100 patients will be used
for the study. Purposive sampling is also refer to as judgmental or selective sampling. In this
sampling procedure, the researcher only rely on their own judgment when choosing members of
the population to participate in their surveys. That is, the judgment to be considered here in this
research are patients with renal disorder (diabetic).
3.4 Data Collection Instruments
The instrument to be used by the researcher in this study is Patient with Diagnosis Check list
(PRDCL) and a Questionnaire known also as Diabetic Patients Questionnaire (DPQ) targeted
within the sampling size to be used in the research work. The 100 patients will be both male and
females who visits specialist hospital Jalingo. This instrument will be presented and subjected to
scrutiny for clarity purposes to two Lecturers from Medical Laboratory Department and Public
Health within Faculty of Health Science, Taraba State University Jalingo before proceeding to the
field for data collection.
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3.5 Data Presentation
The data to be presented in this research are what the respondents choose from the distributed
Questionnaires and Checklist obtained from the Hospital. To get the data for the presentation, the
researcher will involve health worker of the Hospital especially laboratory attendant of the
Hospital after presenting letter of request/introduction to the Chief Medical Officer of the Hospital
from the Department of Medical Laboratory Science, Taraba State University, Jalingo. Then the
researcher will guide the attendant on how the Checklist will be filled and compiled based on the
demographic variables of the Patients who visits Specialist Hospital Jalingo. Presentation will be
made in a tabular form to structure out results that will enable comparison and major findings.
3.6 Method of Data Analysis
The Researcher will used IBM SPSS Statistics 23 license for the findings. This is to provide
accurate computing of results using the Computer.
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REFERENCES
Adeghate E, Schattner P & Dunn E, (2006) An Update on the Etiology and Epidemiology of
Diabetes Mellitus, Ann N Y Acad Sci, 2006, 1084:1-29. https://doi.org/10.
1196/annals.1372.029
Abdulla H.I, Al-Kotany M.Y & Mahdi K.A. (2012). Assessment of oral manifestations of patients
with renal failure undergoing hemodialysis by serum and salivary biomarkers. MDJ.
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