Bamidele Olumilua University of Education, Science and Technology, Ikere, Ekiti State, Nigeria
CEPI/ISTH Lassa Fever Epidemiology Study, Irrua Specialist Teaching Hospital (ISTH), Irrua, Edo State, Nigeria
Department of Chemical Pathology, Faculty of Medical Laboratory Science, Ambrose Alli University, Nigeria
Center of Excellence and Reproductive Health in Innovation (CERHI), University of Benin, Benin City, Edo
State,Nigeria
Nigeria Field Epidemiology and Laboratory Training Program (NFELTP), Nigeria
Safeway hospital and Maternity, Sangotedo, Eti-Osa, Nigeria
Department of Human Physiology, Ambrose Alli University Ekpoma, Nigeria
Received Date: 07/12/2021; Published Date: 03/01/2022
The determination of serum urea and serum creatinine is of great value in helping to ascertain the renal function in the renal function in the clinical setting. The study was carried out to determine the urea and creatinine of pre- and post-menopausal women in Ekpoma, Edo State. The population of this study was one hundred and twenty (120) women comprising of 60 premenopausal women and 60 postmenopausal women in Ekpoma. Blood samples were collected from the subjects after obtaining their consents. Urea was estimated using Berthelot method, while creatinine was estimated using Jaffe’s method. Data analysis was done using SPSS computer software version 20 and results were presented as mean ± standard deviation. The result obtained showed that Urea was significantly (p<0.05) higher in postmenopausal women (8.64±0.69mmol/l) compared with premenopausal women (4.80±0.94mmol/l). Similarly, creatinine was higher in postmenopausal women (88.82±8.29µmol/l) compared with premenopausal women (72.01±6.24µmol/l) however, the difference was not statistically significant (p>0.05). The study concludes that urea and creatinine is higher in postmenopausal women compared with premenopausal women. When it comes to determining renal function in the elderly, urea appears to be more sensitive than serum creatinine. However, urea and creatinine estimation should be combined with other renal parameter to fully diagnose renal disease.
Keywords: Postmenopausal; Premenopausal; Urea; Creatinine; Women
Menopause, also known as climacteric, is the phase in a woman's life when her menstrual periods stop and she is no longer able to bear children (Warren et al., 2009) [1]. Menopause occurs as a result of a decrease in the synthesis of the hormones estrogen and progesterone by the ovaries (Santoro and Randolph, 2011) [2]. For women, menopause is a significant transitional time that marks the end of their reproductive lives. The age at which a woman reaches natural menopause can be a good sign of her overall health and somatic aging, although there is a lot of variation among women (Snowdon et al., 1989) [3]. Menopause usually occurs between the ages of 45 and 55 (Deotale et al., 2015) [4].
Premenopause refers to the period of a woman's life between her first period and the onset of perimenopause symptoms (McKinlay et al., 1992) [5]. Estrogen and progesterone help to control and facilitate menstruation and conception at this time (McKinlay et al., 1992) [5]. Periods become irregular in most women, which mean they may be longer or shorter in duration, or lighter or heavier in terms of flow (Butler and Santoro, 2013) [6]. While it's common to associate menopause with an increase in renal failure, this is mostly related to advancing age and has nothing to do with menopause (Krause and Nakajima, 2015) [7].
The fourth and final stage of the menopausal process is known as post-menopause. The term "post-menopause" refers to the period following menopause. A woman is technically postmenopausal from the time menopause begins until the end of her life. Most women's menopausal symptoms, such as hot flashes, can subside at this time (Santoro and Randolph, 2011) [2]. The same hormonal changes and external circumstances that create the other stages of menopause also cause postmenopause (Souza, 2013) [8].
Urea, also known as carbamide, is a nitrogen-containing chemical molecule that plays a significant role in animal nitrogen metabolism and is the predominant nitrogen-containing substance in mammalian urine (Crawford, 2005). When measured in the blood, urea is referred to as blood urea nitrogen (BUN). Urea is a byproduct of protein metabolism. Protein consumption, the body's ability to catabolize protein, and appropriate urea excretion via the renal system all influence urea concentration (Decaux, 2010) [9].
Creatinine is created when creatine and phosphor-creatine are broken down, and it can be used to assess renal function. The amino acids arginine, glycine, and methionine are transaminated in the liver, pancreas, and kidneys to produce creatine (Crawford, 2005) [10]. Because serum creatinine is an easily measurable indicator of muscle metabolism that is eliminated unchanged predominantly by the kidneys, mostly through glomerular filtration, but also by proximal tubular secretion, it is an essential indicator of renal health (Shemesh et al., 2008) [11]. The estimated GFR (eGFR) can also be calculated solely based on serum creatinine levels (Hayashi, 2009) [12].
The glomerulus' filtration capability is demonstrated by measuring creatinine concentrations in plasma and urine samples (Raforth and Onstad, 1995) [13]. Although less specific than creatinine, urea can be used to assess renal function (Narayanan and Appleton, 2008) [14]. The onset of moderate renal impairment has been linked to growing older (Seliger et al., 2004) [15]. In Ekpoma, however, there is a smattering of literature on the assessment of renal function in pre- and post-menopausal women. Furthermore, the importance of maintaining middle-aged women's health cannot be overstated, since bad health might influence their job experience and longevity. The need for pre- and post-menopausal women to constantly monitor some renal function parameters such as urea and creatinine which are important marker for detecting renal dysfunction cannot be overemphasized. This study was therefore carried out to determine the urea and creatinine levels of premenopausal and postmenopausal women in Ekpoma, Edo State, Nigeria.
Study Area
This study was carried out in Ekpoma. Ekpoma has a land area of 923 square kilometers. The area lies between latitudes 60 43’ and 60 45’ North of the equator and longitudes 60 5’ and 60 8’ East of the Greenwich median. Ekpoma is a town in Edo state which falls within the rain forest/savannah transitional zone of south western Nigeria. Ekpoma is the administrative headquarters of Esan West Local Government Area of Edo State, Nigeria. The town has an official post office and it is the home of Ambrose Alli University. Ekpoma has a population of 170, 123 people at the 2006 census (World Gazzetter Nigeria, 2007).
Study Population
The population of this study was one hundred and twenty (120) women comprising of 60 premenopausal women and 60 postmenopausal women in Ekpoma, Edo State.
Ethical Approval
Ethical approval was obtained from the Health Research Ethics Committee of Ambrose Alli University, Ekpoma. Informed consent was sought from each participant before sample collection.
Inclusion Criteria
Apparently healthy premenopausal women (between ages 18 to 30 years) and post-menopausal women between the ages of 55 years and above who gave their consent were examined for this study.
Exclusion Criteria
Male subjects, children, pregnant women, lactating mothers, menstruating women, women under age 18yrs and individuals with none kidney disease were excluded from the study.
Sample Collection and Analysis
Four millimeters (4mls) of venous blood was collected from each subject, using the standard vein puncture method. The blood sample was emptied into plain bottle and allowed to clot. It was allowed to stand for one hour to clot. It was then centrifuged at 3000rpm for 10 min in order to separate blood cells and suspended particles from serum. The serum was aliquoted and stored at -40c until required for analysis. Urea was estimated using Berthelot method, while creatinine was estimated using Jaffe’s method (Carl et al., 2008) [16].
Statistical Analysis
The results were presented in tables as mean ± standard deviation (SD). Statistical comparison was made between groups using one-way analysis of variance (ANOVA) and the student’s t-test. Significant difference was accepted at p<0.05.
Table 1 shows the Mean ± S.D of Urea and Creatinine concentration in pre- and post-menopausal women in Ekpoma. The result obtained showed that Urea was significantly (p<0.05) higher in postmenopausal women (8.64±0.69mmol/l) compared with premenopausal women (4.80±0.94 mmol/l). Similarly, creatinine was higher in postmenopausal women (88.82±8.29 µmol/l) compared with premenopausal women (72.01±6.24 µmol/l) however, the difference was not statistically significant (p>0.05).
Table 1: Mean distribution of serum urea and creatinine of premenopausal and postmenopausal women.
The determination of serum urea and serum creatinine is extremely useful in determining renal function in the clinical environment (Bandebuche et al., 2017) [17]. The study was carried out to determine the urea and creatinine of pre- and post-menopausal women in Ekpoma. From the result of the study, the mean value of serum creatinine levels was higher in postmenopausal women (88.82µmol/l) compared with premenopausal women (72.01µmol/l). This could be due to the fact that bone loss accelerates between perimenopause and postmenopause. It's also likely that the decrease in estrogen levels caused kidney injury through affecting the rennin-angiotensin pathway, which has higher rennin levels in postmenopausal women (Ikegwuonu et al., 2020) [18]. The findings of this study are consistent with those of Jones et al. (2009) [19] in US women, Erasmus et al. (2009) [20] in African women, and Atieg (2010) [21] in Sudanese women, who all observed higher creatinine levels in postmenopausal women compared to premenopausal women in separate investigations.
In this study, there was no significant difference (p>0.05) in mean creatinine values between the two groups studied (premenopausal and postmenopausal women). This discovery is also in line with prior research findings (Yoshida, 2008; Erasmus et al., 2009; Feinfeld et al., 2011) [20,22,23]. Yoshida (2008) [22] examined the effect of aging on renal function in women in their thirties to sixties and found no significant difference in creatinine concentration (p>0.05) between the two groups. Erasmus et al. (2009) [20] evaluated the mean serum creatinine values and reference ranges in three groups of Melanesian women and found no significant differences (p>0.05) between them (premenopausal, menopausal and postmenopausal women). Feinfeld et al. (2011) [21] found that serum creatinine levels in the extremely elderly, even those with modest azotaemia, did not necessarily rise with age. The findings of this investigation, on the other hand, did not coincide with those of Albert et al. (2012) and Ikegwuonu et al. (2020) [18], who observed a significant difference (p<0.05) in mean serum creatinine levels at various ages. This disparity could be explained partly by the researchers' sample size and statistical methodology.
In this study, the mean serum urea was significantly (p<0.05) higher in postmenopausal women (8.64mmol/l) compared with premenopausal women (4.80mmol/l). This shows that age has an impact on serum urea levels. This could be due to a decrease in body protein reserve as people get older, resulting in a decrease in urea excretion (Albert et al., 2012). This study's findings are consistent with prior studies' findings (Yoshida, 2008; Ateig, 2010; Fehrman-Ekholm and Skeppholm, 2012; Ano et al., 2013; Bandebuche et al., 2017) [22-24]. When Ateig (2010) [21] estimated the normal values for serum urea in Sudanese women, he discovered that age had a significant (p<0.05) impact on the urea values, as the values increased with age. Women over the age of 50 had considerably (p<0.05) reduced BUN, according to Yoshida (2008) [22], who also looked at the influence of aging on renal function in healthy women. In their work, Ano et al. (2013) [25] estimated the typical ranges of BUN values in elderly participants and a youthful control group. Their findings revealed that the aged patients' mean BUN levels were significantly higher (p<0.05) than the control groups. In a study of renal function, Fehrman and Skeppholm (2012) [24] found a significant association between serum urea levels and age (p<0.05).
The study concludes that urea was significantly higher (p<0.05) in postmenopausal women compared with premenopausal women. Creatinine was also higher in postmenopausal women when compared with premenopausal women, however, the difference was not statistically significant (p<0.05). When it comes to determining renal function in the elderly, urea appears to be more sensitive than serum creatinine. However, urea and creatinine estimation should be combined with other renal parameter to fully diagnose renal disease.
Conflict of Interest
The authors declare no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgements
The authors would like to thank all the Laboratory and technical staffs of the department of Medical Laboratory Science and Microbiology, Ambrose Alli University Ekpoma, Edo State for their excellent assistance and St Kenny Research Consult, Ekpoma, Edo State for providing medical writing support/editorial support in accordance with Good Publication Practice (GPP3) guidelines.