Chronic kidney disease in children as seen in a tertiary hospital in Enugu, South-East, Nigeria

Background: The prevalence of chronic kidney disease (CKD) in children has been reported to be rising locally and globally. There is a dearth of data and inadequate facilities for the management of CKD in children in most of the developing countries like Nigeria.Objectives: The objective of this study is to ascertain the prevalence of CKD among children seen at University of Nigeria Teaching Hospital (UNTH), Enugu, South‑East Nigeria and also to determine the stage of CKD at presentation, possible etiology, treatment options offered and the outcome.Materials and Methods: A retrospective review of pediatric ward admissions in UNTH over a 5 year period (July, 2007 to June, 2012) was done. Information, including the age at presentation, symptoms, level of renal function, management and outcome, were obtained from the medical case notes.Results: There were 3002 pediatric admissions within the period of review, of which 98 (3.3%) had CKD, giving incidence of 3.0 new cases per million‑child population per year and the prevalence of 14.9 per million children population. Majority (54.1%) of those with CKD were over 10 years of age. Edema, oliguria and hypertension were the most frequent clinical features. The most common etiology was glomerular disease (63.6%) and 44.9% presented in CKD stage 4 and 5. Renal replacement therapy (RRT) was offered to 25 (25.5%) of the patients; 6 (24%) of whom had hemodialysis and 3 (12%) had acute peritoneal dialysis while 16 (64%) were managed conservatively. None of the patients had chronic or adequate dialysis. The overall outcome showed that 8 (8.2%) died while on admission, 15 (15.3%) left against medical advice (discharge against medical advice) because of financial constraints and could not access the therapy, 25 (25.5%) were discharged on conservative management and lost to follow‑up while another 50 (51.0%) were discharged and still on follow‑up.Conclusion: CKD in children poses myriad of challenges in management in our setting with late presentation of patients and limited resources being prominent. The majority of patients could not access and sustain RRT and the outcome continues to be daunting.Key words: Children, chronic kidney disease, Enugu, Nigeria, prevalenc

Prune Belly Syndrome in a Nigerian infant: a case of inevitable or preventable death?

Background: Prune Belly Syndrome is a rare congenital disorder comprising deficient anterior abdominal musculature, undescended testes and urinary tract abnormalities. In Nigeria, the incidence is unknown but majority of the few reported cases were seen in the South west region of the country. Despite its poor prognosis, a coordinated multidisciplinary management may prevent early mortality.Case Report: We report a 6-week old male infant brought to our health facility with the complaints of abdominal distension and abnormal feet since birth. Physical examination revealed a lax anterior abdominal wall, undescended testes, as well as bilateral talipes equinovarus. Radiologic evaluation showed urinary tract abnormalities such as dilated left ureter and pelvis and right multi-cystic, dysplastic kidney. The patient was treated with the appropriate antibiotic for culture-proven urinary tract infection after which he was referred to the Paediatric Surgeons. Few weeks after his discharge by the Paediatric Surgeons for subsequent follow-up in their clinic, the patient’s sudden demise at home was reported to us.Conclusion: The sudden mortality of this infant has brought to the fore the gaps in treatment which could have affected his longevity. This report underscores the need for a coordinated multidisciplinary approach in the management of this rare congenital anomaly in order to improve survival outcome in a resource-limited setting.&#160

Timing of cardiac surgery and other intervention among children with congenital heart disease: A review article

Background: Early diagnosis and improved facilities are necessary for determining the optimal timing of surgery and other interventions in children with congenital heart diseases in Nigeria. This is because late presentation, late diagnosis and delayed surgery can lead to mortality and affect the quality of life among these children. Objectives: This review article is aimed at enumerating the timing of cardiac surgeries and other interventions and to seek if there is any factor associated with the timing of cardiac surgery. Methods: A search on PubMed database, World Health Organization libraries, Google scholar, TRIP database, and reference lists of selected articles on timing of cardiac surgery in children was done. The Cochrane Database of Systematic Reviews was also searched. We noted few data from African setting. Key words such as timing of cardiac surgery; children, congenital heart defect were used. Conclusion: Appropriate timing for cardiac surgery in children with congenital heart disease is very important as late surgical intervention could result in several morbidities and mortality