Tropical Journal of Nephrology is the official Journal of the Nigerian Association of Nephrology which aims at providing a medium for the exchange of ideas and promotion of knowledge of nephrology in the tropics through the publication of research works, innovative clinical experiences, authoritative review articles on topical issues.
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Strengthening Advocacy for Renal Care in Nigeria
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Genetic Determinants of Increased Burdens of Cardiovascular Disease inPatients with Chronic Kidney Disease: A Narrative Review of theLiterature
Cardiovascular disease (CVD) is responsible for up to 37% of deaths among individuals with CKD, making it a leading cause of mortality among patients with CKD.3 Also, the burden of CVD increases with worsening kidney function and CKD is regarded as a major CVD risk factor.Despite the high burden of CVD among individuals with CKD, the mechanisms underlying the increased prevalence of CVD burden in patients with CKD is not completely known. In addition, little is known about the genetic and environmental factors that determine the initiation and progression of CVD in patients with CKD. The incidence of CVD is rising in sub-Saharan African region and CKD is one of the major contributor to this increase.The excess burden of CVD in CKD suggests that both the traditional CVD risk factors and factors specific to kidney disease play important role in the rising burden of CVD in the population. Among the major kidney disease factors that contribute to the high burden of CVD are Chronic Kidney Disease – Mineral Bone Disease (CKD-MBD), anaemia, hypertension, albuminuria, endothelial dysfunction, dyslipidemia and peripherial arterial disease.Furthermore, the role of genetic factors in the excess burden of CVD in CKD is yet to be determined. Variants in the gene encoding Apolipoprotein 1 (APOL1) have been established as the major genetic risk factors for excess of CKD in individuals of African descent. However, their role in excess CVD burden is not clearly defined. This narrative review article examine and discuss thegeneticburden and aetiopathogenesis of CVD among patients with CKD.
Abstracts Presented at the Nigerian Association of Nephrology Scientific Conference, 2016 Sokoto, Sokoto State, Nigeria
Abstracts Presented at the Nigerian Association of Nephrology Scientific Conference 2023, Kano, Kano State
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Non-communicable Diseases: An Emerging Epidemic in Nigeria
Non-communicable diseases (NCDs) include cardiovascular diseases, mental illnesses, diabetes mellitus, chronic respiratory diseases, chronic kidney disease, and cancers. Globally, NCDs are responsible for 41 million deaths each year, which is a staggering 74% of all deaths. Furthermore, 17 million people die from NCDs before they reach the age of 70, and 86% of these premature deaths occur in low- and middle-income countries. As for NCD deaths, cardiovascular diseases (CVDs) are responsible for most (~18 million), followed by cancer (9 million), chronic respiratory diseases (~ 4 million), and diabetes mellitus including diabetic nephropathy (2 million). Put together, these four groups of diseases account for over 80% of all premature NCD deaths. NCDs do pose a threat to progress towards the 2030 Agenda for Sustainable Development, which includes a target of reducing the probability of death from any of the four main NCDs between ages 30 and 70 years by one-third by 2030. In many low- and lower-middle- income countries, most health services and medications are still purchased out of pocket or by donors. Healthcare costs for NCDs quickly deplete household resources with attendant serious consequences. The exorbitant costs of NCDs, including treatment, which is often lengthy and expensive, combined with a loss of income, force millions of people into poverty annually and stymie national development. What’s more, adults who have grown up amid widespread poverty and deprivation are more likely to suffer functional declines from NCDs at younger ages.
Purple Urine Bag Syndrome in a Nigerian with Gastrointestinal Bleeding: case report
Purple urine bag syndrome (PUBS) is an unusual presentation of urinary tract infection (UTI) which has scarcely been reported from Africa and has never been reported in patients with gastrointestinal bleeding (GIB). We hereby report the first case of PUBS in a Nigerian with GIB and a short duration of urethral catheterization. Furthermore, this report provides pictorial evidence that supports the current knowledge on the pathogenesis of PUBS and describes, for the first time, differences between the colors of urine sediments obtained directly from the urethral catheter and that obtained from the urine bag.
ACUTE KIDNEY INJURY AMONG TRAUMA PATIENTS SEEN AT THE NATIONAL TRAUMA CENTER ABUJA: RISK FACTORS AND SHORT-TERM OUTCOMES.
BACKGROUND: Patients who have experienced trauma may develop acute kidney injury (AKI), which is associated with greater morbidity and mortality rates. OBJECTIVES: The aim was to identify incidence, risk factors and short-term outcome of AKI in trauma patients admitted to the National Trauma Centre in National Hospital Abuja. METHODS: This was a cohort study of 239 adult trauma patients who underwent screening and classification for AKI based on the criteria established by the Kidney Disease Improving Global Outcome guidelines. Those that developed AKI were compared with those without AKI. Outcomes were observed up to Day 30 of the study or earlier if discharged or died. RESULTS: Among 20.9% patients who developed AKI, risk factors observed were older age (adjusted OR 1.04, 95% CI 1.00-1.09, P= 0.04), admission to intensive care unit (adjusted OR 4.12, 95% CI 1.1–15.35, P=0.04), abdominal trauma (adjusted OR 22.41, 95% CI 6.66-75.36, P <0.0001), multiple injuries (adjusted OR 3.34, 95% CI 1.33-8.4, P= 0.01), and length of hospital stay (adjusted OR 1.04, 95% CI 1.0- 1.08, P= 0.04). Majority had rapid reversal of AKI, 8% had Acute Kidney Disease and 16% had persistent AKI. In-hospital mortality was higher with AKI (20% versus 0.5%). Twelve percent of AKI patients had intermittent hemodialysis and mortality was higher in the RRT vs conservative group (83.3% vs 11.4%, p=0.001). CONCLUSION: Increased vigilance and prevention of AKI is warranted in managing trauma patients, given the increased risk. KEY WORDS: Acute kidney injury, trauma patients, KDIGO criteria, risk factors, short-term outcome.
The Inflammatory Role of the Neutrophil Platelet Ratio in Health, Hypertension and Chronic Kidney Disease
Background: Inflammation is a known associate and accelerator of kidney disease. Both are associated with changes in the hemogram, particularly elevated neutrophils and platelets counts, in association with reductions in the lymphocyte count. Methods: The data of 298 participants (146 healthy, 94 hypertensives, and 58 with CKD) was studied, and the associations between the neutrophil platelet ratio (NPR) and urinary, and serum indices of kidney function in health, hypertension and CKD were accessed. Results: The participants mean age was 54.91± 64 years; the CKD cohorts were older, p<0.0001. The blood pressures and urine albumin creatinine ratio (UACR) were higher in the elderly. The absolute neutrophil count was higher in hypertension than CKD (p<0.001), and the platelet count was higher in CKD than hypertension (p<0.001). The neutrophil platelet ratio (NPR) was significantly higher in hypertension than CKD (p=0.02) and in males than females, p=0.007. The NPR had a stronger negative correlation with the UACR and glomerular filtration rate (GFR) in hypertension than CKD. Elevated NPR was associated with advancing age (p<0.001), female gender (p<0.001), hypertension (p<0.001), elevated absolute neutrophil count (ANC) (p<0.001), elevated UACR (p=0.01), higher GFR (p<0.001) and reduced kidney volume (p=0.02). Only hypertension (OR-2.93, 95% CI-2.15-9.48) and ANC (OR-2.14, 95% CI- 1.96-5.07) were independent associates of elevated NPR. Conclusion: The NPR was higher in hypertension than CKD, it tended to be an inflammatory marker in hypertension but as an anti-inflammatory marker in CKD. Future studies involving multi-racial populations are needed to ascertain the definitive inflammatory (or otherwise) role of the NPR in kidney disease.
Gender Differences in Response to Hemodialysis Treatment: Determinants and Clinical Correlates. Findings from Two Tertiary Health Centers in Southwest Nigeria
Background: The physiologic and hormonal differences between males and females could be impactful on dialysis treatment. The differential response is further heightened by differences in socioeconomic, cultural, educational, and genetic makeup. Aim: We compared the determinants and correlates of the dialysis dose in the two sexes. Methodology: It was a two-center, hospital-based prospective study in which 1248 dialysis sessions were studied. Participants’ sociodemographics, clinical findings, pre and post-dialysis renal biochemistry and hematocrit results and prescribed dialysis doses were documented and the dialysis dose (urea reduction ratio and urea clearance as a unit of its distribution volume) were calculated. Results: Dialysis sessions of 232 participants were studied. The majority (61.6%) were males, but the females were older (50.3 + 9.1yrs versus 48.7 + 6.4yrs. Compared with females, the males had higher educational attainment (P<0.001), more sessions (P=0.002), erythropoietin doses (P<0.001), blood flow rate (P<0.001) and ultrafiltration volume (P=0.003). Intradialytic hypotension (IDH) was more common in females (P<0.001) while intradialytic hypertension (IDHT) was commoner in males (P=0.04). The dialysis dose was higher in men (P=0.02). Dialysis termination was more common with females (P<0.001). The independent predictors of dialysis dose were SPO2, predialysis albumin and PCV, dialysis duration, blood flow rate and frequency of EPO use. The correlation between Kt/V and URR was very strong (r=0,895, P<0.001). Conclusion: Males received more dialysis and erythropoietin treatment and had higher dialysis doses. IDH and dialysis termination were commoner in females while males had more IDHT, higher ultrafiltration volume, more permanent dialysis catheters. Dialysis formulation should therefore reflect gender disparity in order to address the imbalances. Keywords: Gender differences, Hemodialysis, urea reduction ratio, intradialytic hypotension, intradialytic hypertension.
Renal Function Assessment in Adults with Occupational Heavy Metal Exposure in Yenagoa, Bayelsa State, Nigeria
BACKGROUND: Heavy metal exposure has been associated with numerous health effects including renal involvement. The exposure to heavy metals is still notably prevalent, and possibly on the rise particularly in some occupations. Crude oil exploration and other related industrial activities could be a contributory factor in some regions. OBJECTIVES: The study aimed to determine the level of blood heavy metals and associated renal function of occupationally exposed persons in Yenagoa. METHOD: Three hundred and ten (310) adults (157 study participants and 153 controls of similar age and sex) aged 18 years and above were recruited for the study via simple random sampling. The participants included smelters, auto-mechanics, vulcanizers, artisan refinery workers and petrol station attendants with each occupation categorized as clusters and non-proportionate allocation of participants for each cluster who met the inclusion criteria. The control group consisted of individuals in other occupations with less probable risk of exposure. The participants were evaluated for Urinalysis, Serum Creatinine, Haemoglobin, blood lead and cadmium. The outcome was analyzed via descriptive statistics using version 25.0 of Statistical Package for Social Sciences (SPSS) software. RESULTS: A total of 310 participants took part in the study with 235 (75.8%) males and 75 (24.2%) females with a male to female ratio of 3.1:1. The mean age of the study population was 35.6 ± 10.7 years with most of them between 18 to 30 years (35%). The mean level for lead and Cadmium was 48.29 ± 26.29µg/dl and 4.56 ± 3.07µg/l respectively which was higher than that of control (Pb - 27.42 ± 11.17µg/dl, Cd - 2.65 ± 1.62 µg/l). The mean eGFR was significantly lower in the exposed population, 77.39mls/min/m2 as compared with control (82.57mls/min/m2). The mean Haemoglobin level was also significantly lower in the exposed populations as compared with the controls. CONCLUSION: This study shows elevated levels of serum heavy metals in the occupationally exposed individuals with probable impact on their renal function in the Niger Delta region of Nigeria. The level of environmental exposure was also high in the control. There is a need for occupational health education to help in the prevention of excessive heavy metal exposure and curb its impact on health of all involved.
Clinical Outcomes of Acute Kidney Injury in Federal Medical Center Owo: Patterns and Determinants
Introduction: Acute Kidney injury (AKI) is a serious disorder of kidney function associated with prolonged hospital stay and mortality. The differences seen between developed and developing countries in the epidemiologic pattern of AKI include, the individuals affected, the etiology of AKI, the setting in which AKI occurs, the modalities of renal replacement therapy available, and the patient outcomes Methods: We present a retrospective 3 year review of AKI patients admitted to a tertiary level hospital, Federal Medical Center. The medical records of all adult patients admitted during the period from January 1st, 2018 to December 31st, 2020 were extracted and reviewed for the presence or diagnosis of AKI. Acute kidney injury was defined in accordance with Kidney Disease Improving Global Outcome (KDIGO) guidelines. The medical records of 86 patients with AKI were reviewed. About a quarter of the studied population (26.1%) died in the course of the treatment. Results: Dialysis treated AKI patients contributed to >70% of the population. 45.3% of our patients who had dialysis-requiring AKI and survived did recover sufficient kidney function to become dialysis independent over a short period of time. Age is a significant predictor of mortality in this study. Serum creatinine, hyponatremia and elevated blood pressures are also predictors of mortality and progression to CRF in this study. Conclusion: Our data highlight the public health importance of AKI and the need for adequate resources for Nephrology.
Assessment of Malnutrition among Chronic Kidney Disease Patients in a Tertiary Hospital in Nigeria: A Cross-Sectional Analysis
Introduction: Malnutrition is common among patients with chronic kidney disease (CKD) and it contributes significantly to high morbidity and mortality. Early identification and treatment of malnutrition are important so as to improve outcomes. The aim of this study is to assess the prevalence and severity of malnutrition among CKD patients using simple and easily available tools. Methods: This was a cross-sectional study involving 35 CKD patients, 15 pre-dialysis and 20 on maintenance haemodialysis (MHD). Thirty-five apparently healthy patients with no CKD were studied as the comparison group. Assessment of nutritional status was done using body mass index (BMI), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), and serum albumin. Malnutrition was present when BMI was< 18.5kg/ m2, TSF and MAMC were less than 90% of the ideal, and serum albuminwas < 35g/L. Results: The prevalence of malnutrition in all the CKD patients was significantly higher (88.6%) compared to 42.8% in the controlgroup with no CKD(P= <.001). Malnutrition prevalence was 73% among patients yet to commence dialysis and 100% among hemodialysis patients(P= 0.026).The prevalence of malnutrition based on the triceps skinfold thickness (TSF) alone was 45.7%, 85.7%,73 and 95% in the control, all CKD, pre-dialysis and MHD groups respectively. Conclusion: This study confirms that malnutrition is common in CKD patients especially in the hemodialysis group.Clinicians should make concerted efforts to optimise the nutritional care of patients with CKD.
Abstracts Presented at the Nigerian Association of Nephrology Conference 2022
These abstracts were reviewed by the Scientific Conference of the Conference.
Childhood Acute Post-infectious Glomerulonephritis: A Study of Clinical Profile and Outcomes at the University of Abuja Teaching Hospital, Abuja, Nigeria, 2016 to 2021
Background: Acute post-infectious glomerulonephritis (PIGN) is a common cause of childhood morbidity in developing countries, the burden of which reflects low socio-economic conditions and poor environmental and personal hygiene. In Nigeria, temporal and geographical variations exist for the epidemiology of PIGN but more information is needed. Materials and Methods: A retrospective review of socio-demographic factors and clinical outcomes of childhood PIGN at the University of Abuja Teaching Hospital, Abuja, from January 2016 to December 2021. Results: Out of 13,823 children, 506 were renal cases, and 55 were PIGN, with PIGN accounting for 10.9 % of renal cases. Among the 50 PIGN studied, 32 were males (64%), with a male-to-female ratio of 1.7: 1 (p<0.009). The age range was 4 to 15 years, with a median age of 8 years, and a majority (50%) were of the school-age group (5-10 years) (p <0.0031). Affected children were mostly (38, 76%) from low socio-economic households (p=Â 0.0001). The typical clinical features were passage of cokecoloured urine (100%), peripheral oedema (90%) and hypertension (90%); while the commonest laboratory features were haematuria (100%), proteinuria (94%) and decreased complement C3/normal C4 levels (30 of 30 subjects) Acute complications comprised acute kidney injury (56%), congestive heart failure (16%) and urinary tract infections (14%). A majority (92%) were discharged with a low case fatality rate of 4% (2 deaths). Conclusion: PIGN is common in our setting but with a good clinical outcome. The need to improve the citizenry’s socio-economic status and personal and environmental hygiene cannot be over-emphasized.
Abstracts Presented at the Nigerian Association of Nephrology Conference, 2021
These abstracts were submitted and peer-reviewed by the Scientific Conference of Nigerian Association of Nephrology Conference 2021
A Remembrance: Professor Oladipo O. Akinkugbe
Prevalence, Correlates and Predictors of Carotid Intima Media Thickness among Nigerian Chronic Kidney Disease Patients
Background: Chronic kidney disease (CKD) is a major public health burden with global increase in prevalence, morbidity and mortality. Cardiovascular disease is the major cause of morbidity and early mortality in chronic kidney disease patients. Carotid intima media thickness (CIMT) correlates with future cardiovascular and cerebrovascular events and measurement of CIMT has been suggested as a suitable, valuable and evidence-based tool to predict and evaluate cardiovascular risk. The study assessed the prevalence, correlates and predictors of CIMT among CKD patients attending Usmanu Danfodiyo University Teaching Hospital Sokoto. Methods: The study was cross-sectional in design. A total of 80 CKD patients and 80 healthy control subjects were enrolled. Socio-demographic, clinical and laboratory data were obtained using a structured proforma. CIMT was measured using 7.5MHZ linear probe in B mode regime and dynamic range set at 60db. An average of six measurements; 3 from each side of the carotid was taken as the final CIMT. Clinical and laboratory data were collected using a structured proforma. Data was analysed using SPSS version 25. Results: The prevalence of increased CIMT among CKD patients was 63.7% and a statistically significant difference in mean CIMT between the CKD group 0.96±0.15mm and control 0.5±0.15mm, pvalue< 0.001. The mean CIMT increased across the stage of CKD with a statistically significant difference, p-value<0.01. There was no statistically significant difference in CIMT across aetiology of CKD. A positive correlation existed between increased CIMT measurements with age, serum creatinine, intact parathyroid hormone and high sensitivity C-reactive protein (hsCRP) but a strong negative correlation was observed between CIMT and eGFR. Using multiple linear regression, the strongest predictor of CIMT was found to be hsCRP. Conclusion: There is a significantly higher CIMT measurements in CKD patients compared to age and gender matched controls.
Risk Factors for Cognitive Impairment among CKD Patients in Usmanu Danfodiyo University Teaching Hospital, Sokoto
ABSTRACT Introduction: The association between cognitive impairment and chronic kidney disease has been documented. Cognitive impairment in CKD may affect adherence to treatment, including diet, medications and quality of life, furthermore, it is an independent risk factor for mortality. Hence the need to identify risk factors for cognitive impairment among CKD patient in our study. Methods: All consecutively seen, eligible and consenting CKD patients 18 years with no barrier to Neuropsychological assessments were recruited between June – August, 2019. Structured proforma was used for data collection including the Montreal Cognitive Assessment tool (MoCA). SPSS version 20.0 was used for data analysis. Results: 40 participants were recruited with M:F ratio of 3:1. Mean age was 45.03±12.89 years. 89.7% of the CKD patients were cognitively impaired using MoCA scores of 26 as cut off. Significant difference was seen in the MoCA scores of cognitively impaired compared to cognitively normal patients. (17.69±3.28 and 27.75±1.26; p = < 0.001). BMI and systolic blood pressure were found to be associated with cognitive impairment (p = 0.004 and p = 0.047 respectively). No association was found with waist circumference, diastolic blood pressure, aetiology of CKD, duration of diagnosis of CKD and eGFR. Conclusion: Cognitive impairment may be common in our CKD patients and its assessment with emphasis on risk factors should form part of evaluation of all CKD patients.
Addressing Cardiovascular Disease in Chronic Kidney Disease
Tropical Journal of Nephrology Supplement Vol 1 No 1 2023
Tropical Journal of Nephrology Supplement Vol 1 No 1, 2023
Abstracts Presented at the Nigerian Association of Nephrology Conference, 2020
Haemodialysis Practice in Sierra Leone – A call for urgent action
The rising burden of chronic kidney disease is approaching epidemic proportions. This has led to escalated deaths as well as morbidity resulting from CKD. In Sierra Leone, the provision of sustained haemodialysis commenced in December 2016. In this article, we described how it all started, the patient characteristics, the progress made so far as well as the challenges impeding the smooth delivery of this service to the nation. We have made a few recommendations including the need for funding and support in terms of training of staff by the Government of Sierra Leone, private organizations and international partners like WHO or World Bank
An Assessment of Haemodialysis Adequacy Among Patients on Maintenance Haemodialysis in a Tertiary Hospital in South-West Nigeria
Background: kidney replacement therapy (dialysis and kidney transplantation) is the definitive treatment for end-stage kidney disease (ESKD). We set out to assess the adequacy of haemodialysis of our patients and how this relates with the occurrence of complications during dialysis. Methodology: The study was an observational, single arm, paired survey. At the end of a month of dialysis on a specified prescription: URR and Kt/V were calculated for each patient. The data obtained from this study was analyzed using SPSS version 20. Results: The mean age of study participants was 42.9(±11.5) years, with a male preponderance of 63.9%. The mean urea reduction ratio (URR) was 54.2(±18.3)%, 67.2% had URR less than 65%. The mean Kt/V was 0.9(±0.5), 75.4% had Kt/V < 1.2.There is a positive correlation between URR and Kt/V (r=0.87,P<0.001). Conclusion: Our findings suggestthat many of our patients are inadequately dialyzed. Also, a direct positive correlation URR and Kt/V was noted as well as the occurrence of more intradialytic complications in patients with inadequate dialysis.
Characteristics of Patients with Chronic Kidney Disease Receiving Dialysis Treatment at a Specialist Hospital in Delta State, Nigeria
Background: There is a growing concern for gender differences associated with HIV patients with chronic kidney disease. However, studies have been conducted on the differences in age and sex of dialysis patients but this study aims to determine the age, sex, and HIV distribution among chronic kidney disease patients receiving dialysis treatment at a specialist hospital in Delta State, Nigeria Methods: This retrospective study utilised data from patients who attended a dialysis center in Delta State, Nigeria between June 2016 and May 2022. In this study, a self-developed proforma was used to extract patients’ records for age, sex and human immunodeficiency virus (HIV) status Result: The majority of the chronic kidney patients undergoing dialysis had a mean age of 50.36±17.16 years. Most patients were middle-aged individuals between 41-60 years during the first 3 years when compared to the last 3 years of review. Less than one-quarter 1041(14.0%) of haemodialysis patients were HIV positive while more than 8 out of 10 (6391(85.9%) patients were HIV negative. Males were majorly affected by kidney disease more that the female participants with 4766(61.4%) and 2671(35.9%) respectively. Conclusion: There is a growing increase in the prevalence of CKD globally and in this study the population of CKD patients was higher at the second quarter than the first. Less than one-fifth of the total haemodialysis patients were HIV positive, more in males and the adult age group (41-60).
A A STUDY OF THE CLINICO-HISTOLOGIC PATTERNS OF ADULT GLOMERULONEPHRITIDES IN SOUTHWESTERN NIGERIA.
BACKGROUND- Glomerulonephritis (GN) is one of the major causes of chronic kidney disease (CKD) worldwide. It remains the leading cause of End Stage Kidney Disease (ESRD) in many developing countries. It is presumed to be responsible for more than half of patients with ESRD in Africa. The clinical course, pattern and presentation of glomerular disease varies world-wide and may be due to differences in genetics of underlying population or exposure to putative antigens or agents that induce or trigger these responses. This study evaluated the clinicopathologic patterns of glomerular diseases in a homogenous black population in the hope that it will provide a more robust data on glomerulonephritides in our black population. The study is aimed at describing the pattern of biochemical abnormalities and histopathologic variants of glomerulonephritides observed in adult patients in our environment. METHODS –The study was cross-sectional in nature involving seventy (70) consecutive adult patients with features of glomerulonephritis who presented at the nephrology and other medical out-patient department (MOPD) clinics, general out-patient department (GOPD) as well as the hospital staff clinic. A structured 4-part proforma was drawn up and administered to obtain information on socio-demographic, clinical, anthropometric parameters and laboratory investigation results. Relevant laboratory tests and investigations were performed. Renal function was assessed and renal biopsy performed after obtaining written informed consent. The renal tissues obtained were subjected to light microscopy and immunoperoxidase staining with IgA, IgM, IgG and C3 antibodies and the results interpreted. RESULTS-A total of seventy patients participated and completed the study. Three (3) patients had inadequate renal tissue for histologic diagnosis hence data analysis was based on the remaining sixty seven (67) patients.The age range of the study population was between 18 and 65 years with a mean age of 28.43 (±10.33) years. Forty- five males (67.2%) and twenty-two females (32.8%) participated in the study population with an overall male to female ratio of 2:1. The most common clinical manifestation was nephrotic syndrome which was present in 41 (61.2%) of the study population. The most common histological diagnosis was focal segmental glomerulosclerosis (FSGS) seen in 30 patients (44.8%). CONCLUSION- Focal segmental glomerulosclerosis (FSGS) was the commonest histological type found in these patients with glomerulonephritis, while the commonest clinical presentation was nephrotic syndrome. KEY WORDS- Glomerulonephritides, histologic diagnosis, nephrotic syndrome, renal biopsy, focal segmental glomerulosclerosis.
Locally improvised acute peritoneal dialysis using nasogastric tube and fluids in a resource-limited setting in southern Nigeria – A case report.
Acute gastroenteritis remains a major reason for consults to the emergency room and can be complicated with electrolyte derangements, sepsis and acute kidney injury. We present a 24-month-old boy who had acute gastroenteritis with sepsis and who developed oliguric acute kidney injury. He had improvised acute peritoneal dialysis (PD) done using a nasogastric feeding tube and peritoneal dialysis fluids (Ringers Lactate and Dextrose intravenous fluids). He had 18 sessions of PD for 4 days with complete recovery of renal functions and discharged after 11 days. Children with gastroenteritis and sepsis that develop acute kidney injury should be offered improvised PD in resource-limited settings, as illustrated in this case report.
Chronic kidney disease in children at the University of Abuja Teaching Hospital, Abuja, Nigeria (2017-2020)
Background Childhood chronic kidney disease (CKD) is increasing globally and it is associated with significant morbidity and mortality. This article describes the incidence, pattern and outcomes of childhood CKD seen at the University of Abuja Teaching Hospital (UATH), Abuja, Nigeria. Materials and Methods This was a retrospective review of children aged 1 month to 16 years seen at the Department of Paediatrics, UATH, from January 2017 to December 2020. Results Ninety-four cases of CKD were seen with an incidence rate of 36 per million-child population per year. The age range was between 1 month and 16 years, with a mean age of 7.7 ± 4.1 years, and a majority (41, 43.6%) was between 5 and 10 years. The commonest causes of CKD were nephrotic syndrome (NS) (58, 61.7) and posterior urethral valve (PUV) (14, 14.8%). There was a male predominance (71/94, 75.5%) which was not statistically significant (p=0.157). Eleven (11.7%) subjects in end-stage kidney disease (ESKD) had chronic intermittent haemodialysis over a mean duration of 2 months before cardiovascular-related mortality ensued. Most of the mortality was from steroid-resistant idiopathic NS (5/11, 45.5%) and PUV (2/11, 18.2%). A child with idiopathic steroid-resistant NS who had living unrelated renal transplantation is surviving. Conclusion The incidence of childhood CKD is high and it is commoner among school-age children. The commonest CKD was NS and PUV. Financial constraints limit the accessibility of kidney replacement therapy (KRT) among those with ESKD. The need for preventive nephrology and public-funded KRT cannot be over-emphasized.
AKI IN A NIGERIAN PATIENT WITH COVID 19 AND A SHRUNKEN KIDNEY
A case report of a 42-year-old Nigerian male who presented with complaints of high-grade intermittent fever, dry unproductive cough, and difficulty in breathing of 3 days duration; with an associated history of protracted vomiting and generalized body weakness. There was no history of recent travels and he was not aware of exposure to a COVID-19. A reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-COV2 was positive and he was treated for COVID-19 pneumonia. During the illness, he had AKI with azotaemia, hyponatremia, hyperkalemia, acidosis, and anuria and had several sessions of haemodialysis amidst several medications. A renal ultrasound scan done showed a shrunken right kidney and normal-sized left kidneys. He developed deep vein thrombosis subsequently during admission and was commenced on treatment. Renal function returned to near normal and he is being followed up in the clinic. The case report highlights the multifactorial risk factors of AKI in the setting of COVID-19 and the challenges of care in a low-resource setting.