Case Report Neonatal Urinary Ascites: A Report of Three Cases

Urinary ascites in neonates is not a common condition. Three cases of urinary ascites are presented and each of them has a different aetiology. Neonates with urinary ascites usually present as clinical emergency, requiring resuscitation, ventilator support, and subsequent drainage of urine. The ultimate management depends on the site of extravasation and the underlying cause

Estimated glomerular filtration rate in apparently healthy term neonates in Nigeria

Background: Glomerular filtration rate (GFR) is the best measure of renal function. However, the ideal exogenous markers are not routinely used to estimate GFR in clinical settings. Outside Africa, GFR estimates for neonates have been calculated from formulae using creatinine as well as cystatin C. There is a paucity of data on estimated GFR in neonates in Africa. This study was conducted to estimate GFR in healthy term African neonates using cystatin C-based equations.Methods: One hundred and thirteen apparently healthy term babies with normal Apgar scores were recruited at birth. Cystatin C was measured in cord blood at birth and in venous samples from neonates on the third day of life. GFR was estimated using the Filler and Lepage as well as the Zappitelli et al. cystatin C-based equations. These estimates were compared with a reference GFR estimate of 41 ± 15 mL/min/1.73 m2.Results: The median (interquartile range) estimated GFR values based on cord blood and day 3 venous samples using the Filler and Lepage equation were 44.67 (36.35–72.44) and 51.29 (38.90–72.44) mL/min/1.73 m2, respectively. When the Zappitelli equation was applied, the estimates were 38.18 (31.84–61.34) and 43.82 (33.75–61.34) mL/min/1.73 m2, respectively. The GFR estimates derived from both equations did not differ in respect of the gestational age, sex and postnatal ages of the babies.Conclusions: GFR estimates using the Zappitelli equation had values that were closely related to reference GFR measures for neonates whereas the GFR estimates using the Filler and Lepage equation had higher values

Uraemic optic neuropathy – a rare presentation of uraemia

Uraemic optic neuropathy (UON) is an acute but reversible loss of vision in patients with end-stage renal failure. Hypoperfusion of the posterior ciliary arteries, the major blood supply to the optic nerve head, results in ischaemic injury to the nerve. Anaemia, hypertension and elevated nitrogen urea level have been identified as factors contributing to optic nerve neuropathy. Toxic uraemic metabolites affect nerve conduction and their removal with dialysis results in improved vision. Optic neuropathy is a rare complication of uraemia in children. This is the first case of optic neuropathy related to uraemia in a child with end-stage renal disease in Nigeria.

Screening for kidney disease in children on World Kidney Day in Lagos State, Nigeria

Background: Across the world, World Kidney Day (WKD) is marked yearly to increase awareness of kidney diseases. In 2016, its focus was on children for the first time. We report on a WKD screening initiative for kidney disease that was conducted in two public schools in Lagos State, Nigeria.Methods: Participants were recruited after guardians provided signed consent and older children gave assent. Baseline data were obtained which included family history of chronic diseases like sickle cell disease, hypertension, diabetes, renal disease, and the use of herbal medications. Anthropometric parameters such as height, weight and body mass index (BMI) were recorded. Investigations included urinalysis, measurement of serum creatinine and estimation of glomerular filtration rate (eGFR) using the Schwartz formula.Results: A total of 405 children were screened; there were 190 (46.9%) males and 215 females. The children were aged 2 to 17 years with a mean age of 9.1 ± 3.0 years. Over 80% of the children had normal nutritional status. Severe thinness was seen in 22 (6.8%) whereas overweight was present in 10 (3.1%). Only 1 was obese. eGFR was above 90 mL/min/1.73 m2 in 232 (94.3%) of the participants. Hypertension was present in 47 (14.4%), with the highest rate among those 0–8 years old. Proteinuria was detected in 118 (29.2%); none of the children had haematuria. Systolic hypertension, a family history of smoking and the use of herbal medications were associated with proteinuria.Conclusions: The study has highlighted a high rate of proteinuria, associated with the use of herbal medications, hypertension and a family history of smoking. Screening for renal disease in children with appropriate follow-up and timely intervention to avoid progression to end-stage renal disease is imperative

Vitamin D status and serum vitamin D binding protein levels in Nigerian children with nephrotic syndrome

Introduction: Nephrotic syndrome is a chronic relapsing condition associated with urinary loss of albumin and other proteins such as vitamin D binding protein (DBP). We determined vitamin D status and serum DBP levels in children with nephrotic syndrome and compared them to healthy controls. Methods: A cross-sectional study was performed over a six-month period in children less than 18 years of age. The children with nephrotic syndrome were categorised by disease status as either newly diagnosed, in remission, resistant to therapy, or in relapse. Vitamin D levels were regarded as sufficient if ≥75 nmol/L, insufficient if <75 nmol/L but ≥50 nmol/L, deficient if <50 nmol/L, and severely deficient if <25 nmol/L. Serum DBP was also measured. Results: Fifty-five children with nephrotic syndrome and 24 controls were included in the study. There was no significant difference between the median ages of the cases (72.0 months, interquartile range (IQR) 48.0–120.0 months) and the controls (84.0 months, IQR 39.0–129.0 months). Severe vitamin D deficiency, deficiency and insufficient levels were documented in 54.5%, 41.8% and 3.6% of cases, respectively, significantly lower than the controls (P = 0.003). Vitamin D levels were higher in children with nephrotic syndrome in remission than in those who were not (30.3 ± 15.2 nmol/L vs 19.6 ± 11.0 nmol/L, P = 0.004). In the groups who were in remission, newly diagnosed, relapsing, and resistant, the median vitamin D levels were 30.3 nmol/L, 20.1 nmol/L, 19.2 nmol/L and 9.4 nmol/L, respectively (P = 0.031). Conclusions: Hypovitaminosis D occurs frequently in Nigerian children with nephrotic syndrome as well as in apparently healthy controls. Routine supplementation of vitamin D should be considered in children with nephrotic syndrome irrespective of whether the disease is in remission or not, or whether it is steroid-sensitive or not

EOSINOPHILIC MENINGITIS IN A 10-YEAR OLD NIGERIAN BOY: A CASE REPORT

Eosinophilic meningitis is rare, commonly caused by invasion of the central nervous system by helminthes. The present case is that of a 10–year–old boy who presented with history of generalized pruritus not associated with skin eruptions, followed by pain and weakness of the extremities and loss of consciousness. Patient did not receive BCG vaccination. Initial clinical evaluation was suggestive of tuberculous meningitis but cerebrospinal fluid analysis revealed eosinophilic meningitis. Patient made remarkable improvement with treatment with no sequel

Genetic Testing for Steroid-Resistant-Nephrotic Syndrome in an Outbred Population

Background: Steroid-resistant nephrotic syndrome (SRNS) is a leading cause of end-stage kidney disease in children and young adults. Despite advances in genomic science that have led to the discovery of >50 monogenic causes of SRNS, there are no clear guidelines for genetic testing in clinical practice.Methods: Using high throughput sequencing, we evaluated 492 individuals from 181 families for mutations in 40 known SRNS genes. Causative mutations were defined as missense, truncating, and obligatory splice site variants with a minor allele frequency <1% in controls. Non-synonymous variants were considered pathogenic if determined to be deleterious by at least two in silico models. We further evaluated for differences in age at disease onset, family history of SRNS or chronic kidney disease, race, sex, renal biopsy findings, and extra-renal manifestations in subgroups with and without disease causing variants.Results: We identified causative variants in 40 of 181 families (22.1%) with SRNS. Variants in INF2, COL4A3, and WT1 were the most common, accounting for over half of all causative variants. Causative variants were identified in 34 of 86 families (39.5%) with familial disease and 6 of 95 individuals (6.3%) with sporadic disease (χ2p < 0.00001). Family history was the only significant clinical predictor of genetic SRNS.Conclusion: We identified causative mutations in almost 40% of all families with hereditary SRNS and 6% of individuals with sporadic disease, making family history the single most important clinical predictors of monogenic SRNS. We recommend genetic testing in all patients with SRNS and a positive family history, but only selective testing in those with sporadic disease

Neonatal Urinary Ascites: A Report of Three Cases

Urinary ascites in neonates is not a common condition. Three cases of urinary ascites are presented and each of them has a different aetiology. Neonates with urinary ascites usually present as clinical emergency, requiring resuscitation, ventilator support, and subsequent drainage of urine. The ultimate management depends on the site of extravasation and the underlying cause

Skinfold Thickness Measurement in Term Nigerian Neonates: Establishing Reference Values

Skin fold thickness (SFT) measurement is a reliable, cheap, simple, noninvasive method of body fat estimation at all ages including the neonatal period. Objective. To determine reference values of biceps, triceps, subscapular, and suprailiac skinfold thickness measurements in term Nigerian newborns. Method. A prospective cross-sectional study over a six-month period (Dec 2010–May 2011) was carried out on term and healthy neonates delivered between 37 and 41 weeks. The anthropometric measurements were taken within the first 48 hours of life including the skinfold thickness. The skinfold thickness measurements were taken at four sites, namely, triceps, biceps, subscapular, and suprailiac, using Harpenden skinfold calipers. The mean of two readings was recorded. Result. A total of one thousand one hundred and sixty-eight neonates were studied. The birth weight ranged between 2000 g and 5000 g with a mean birth weight of the neonates at 3259±470 g. The mean birth weight of the males (3339±0.45) was significantly higher than that of females (3200±0.44) (p<0.0001). Female neonates had higher mean values of triceps, subscapular, and suprailiac skinfold thickness (p<0.001, resp.) while male neonates had higher mean value of biceps skinfold thickness (p=0.008). Females also had higher mean values of the sum of skinfold thicknesses at all four sites and the sum at the two truncal sites at every stratified gestational age. Conclusions. The sex specific percentile chart developed for skinfold thickness measurements can be used to detect deviation from the reference population such that infants who are at risk of nutritional or health problems are identified early, and intervention is instituted promptly