PRACTICE POINTS - Natural history and epidemiology of post transplantation diabetes mellitus

Objective: High patient mortality continues to be the major threat to the success of solid organ transplantation despite improvements in the control of immunologic phenomena post-transplantation with improvements in grafts survival. Post transplantation diabetes mellitus (PTD) occurring commonly in patients receiving immunosuppressives has been identified as a major culprit. Aim: This paper reviews the current concepts of PTD. Methods: A Medline literature search limited to research / review articles in English language, spanning 1984 January – 2004 June on post transplantation diabetes mellitus or hyperglycemia was done. Results: Post transplantation diabetes mellitus is a heterogeneous condition of abnormal glucose tolerance with a variable onset, duration and severity. It is defined as a fasting plasma glucose = 7.0 mmol / L (126 mg / dL) and / or a 2 hour plasma glucose during an OGTT = 11.1mmol / L (200 mg / dL), or a casual plasma glucose = 11.1 mmol / L (200 mg / dL), on 3 or more occasions over a period of at least 3 months. The risk factors predisposing to PTD are age, recipient's ethnicity, immunosuppressive regimen and family history of diabetes. The condition not only increases the risk of graft – related complications such as graft rejection, graft loss and infection,but also is a major determinant of the increased cardiovascular morbidity and mortality. Conclusions: The most important risk factor predisposing to the development of PTD is the immunosuppressive drugs. The selection of immunosuppressive regimen should take into account individuals diabetes risk profile and the relative diabetogenicity and risk for diabetes of each immunosuppressant, balancing minimal risk of diabetes with effective immunosuppression. Keywords: Current concepts, Definition, Diabetes, Epidemiology, Pathogenesis, Post transplantation, Management. African Health Sciences Vol. 5 (3) 2005: pp. 255-26

Addison's Disease

Addison's disease is a rare endocrine disease. This is a report of a case of Addison's disease as seen in a Nigerian female patient to highlight the occurrence in this environment as well as sensitize practitioners as to its possible aetiology, particularly in this era of tuberculosis and the pandemic of HIV/AIDS

PRACTICE POINTS - Natural history and epidemiology of post transplantation diabetes mellitus

Objective: High patient mortality continues to be the major threat to the success of solid organ transplantation despite improvements in the control of immunologic phenomena post-transplantation with improvements in grafts survival. Post transplantation diabetes mellitus (PTD) occurring commonly in patients receiving immunosuppressives has been identified as a major culprit. Aim: This paper reviews the current concepts of PTD. Methods: A Medline literature search limited to research / review articles in English language, spanning 1984 January – 2004 June on post transplantation diabetes mellitus or hyperglycemia was done. Results: Post transplantation diabetes mellitus is a heterogeneous condition of abnormal glucose tolerance with a variable onset, duration and severity. It is defined as a fasting plasma glucose = 7.0 mmol / L (126 mg / dL) and / or a 2 hour plasma glucose during an OGTT = 11.1mmol / L (200 mg / dL), or a casual plasma glucose = 11.1 mmol / L (200 mg / dL), on 3 or more occasions over a period of at least 3 months. The risk factors predisposing to PTD are age, recipient’s ethnicity, immunosuppressive regimen and family history of diabetes. The condition not only increases the risk of graft – related complications such as graft rejection, graft loss and infection,but also is a major determinant of the increased cardiovascular morbidity and mortality. Conclusions: The most important risk factor predisposing to the development of PTD is the immunosuppressive drugs. The selection of immunosuppressive regimen should take into account individuals diabetes risk profile and the relative diabetogenicity and risk for diabetes of each immunosuppressant, balancing minimal risk of diabetes with effective immunosuppression

Ruptured false iliac artery aneurysm - a case report from Nigeria

A 23year old male Nigerian presented to the Nephrology unit of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with features of chronic renal failure secondary to chronic glomerulonephritis. He was referred to the surgical department of the hospital on account of severe torrential uncontrollable bleeding from an infected cannulation site. He was maintained on regular hemodialysis but developed femoral triangle sepsis at the cannulation site and aneurysm of the external iliac artery. The aneurysm later ruptured with severe jet exsanguinations bleeding. Exploration revealed a-4cm rent in the external iliac artery that was sutured with 6/0 prolene, interrupted, using clamp and suture technique. Perfusion was satisfactory in the immediate post-operative period. The patient was transfused with 11 pints of blood within 12 hours and had an uneventful post-operative period

Chronic renal failure at the Olabisi Onabanjo university teaching hospital, Sagamu, Nigeria

Background and objectives of the study: Chronic kidney disease is a common cause of morbidity and mortality in Nigeria. This study aims at determining the pattern of chronic renal failure (CRF) in a Nigerian University Teaching Hospital. Methods: The study was a 10-year retrospective study of consecutive cases of CRF seen at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. Results: The frequency of CRF in the population was 3.6% (182 of 5,107). There were 90 males and 63 females (1.42:1). The peak age was between 20-49 years, with a mean of 39.6+14.8 (range 14 -72years). The commonest causes were chronic glomerulonephritis 63(41.2%), hypertensive nephrosclerosis 40(26.1%) and diabetes mellitus 20(13.1%). The commonest symptoms were oedema, vomiting, oliguria and dyspnea occurring at 118(77.1%), 96(62.7%), 89(58.2%) and 87(56.9%) respectively. The mean creatinine clearance value at presentation was 6.5+8.1mls/min, while the commonest complications were hypertension 68 (44.4%), biventricular failure 32 (20.9%) and urinary tract infection 29 (19%). The mean presenting systolic and diastolic blood pressures were 167.34+37.6mmHg and 106.03+28.9 mmHg respectively. The mean total haemodialysis session per patient was 3.5+1.6 (range 1- 7sessions). Only 34(22.2%) of the patients were able to afford haemodialysis. The majority 21(61.8%) of these could only afford 3 haemodialysis sessions while only 2(5.9%) patients had up to 7 dialysis sessions in the center. Conclusion: Chronic glomerulonephritis, hypertensive nephrosclerosis and diabetes mellitus are the commonest causes of chronic renal failure in Nigeria. Most of the patients presented late. Cardiovascular complications and infections were responsible for a greater morbidity among the patients. African Health Sciences Vol. 6(3) 2006: 132-13