Substance use among secondary school adolescents in Gwagwalada Area Council, Abuja, Nigeria

Background: Adolescent substance use is a growing epidemic that is placing heavy burdens on individuals, families and communities hence the stimulus for this study.Aim/Objectives: To determine the prevalence and pattern of substance use among secondary school adolescents in Gwagwalada Area Council, Abuja, Nigeria.Methods: A questionnaire-based, cross-sectional, descriptive study done over a three-month period among secondary school adolescents aged 10 to 18 years old after obtaining appropriate ethical approvals, consent and assent.Results: A total of 1,196 questionnaires were analysed, of which 641 (53.6%) were females and 1,052 (87.96%) from public schools. The overall prevalence rate for lifetime use was 72.7%. The substance with the highest prevalence rates for lifetime, annual and current use was kola nut (44.3%, 24.4 and 11.0%, respectively) and lowest for heroin (0.7%, 0.6% and 0.5%, respectively). There was a statistically significant male preponderance for licit substance use and a non-statistically significant female preponderance for illicit substance use. 507(42.4%) students were single substance users while 363 (30.35%) students were multiple substance users. Age at first use was at ten years of age or less.Conclusion and recommendations: There is need for strengthening substance use prevention programmes and implementing regulatory laws on sale and use of substances. Stiffer penalties for offenders are recommended.Keywords: Prevalence;substance use; adolescent; secondary school; Nigeri

Microalbuminuria in Children with Human Immunodeficiency Virus (HIV) Infection in Port Harcourt, Nigeria

Microalbuminuria is an early manifestation of HIV associated nephropathy (HIVAN). This study was to determine the prevalence and risk factors for microalbuminuria in children with HIV infection in Port Harcourt, Nigeria : Urine specimen of 50 children with HIV infection seen over a 4months period (October 2007- February 2008) was assayed for albumin and creatinine to determine urinary albumin to creatinine ratio (ACR). Microalbuminuria was defined as urinary albumin to creatinine ratio (ACR) of greater than 2.5 -25mg/mmol. The glomerular filtration rate (GFR) was calculated using the Schwartz formula. : There were 28 (56%) males and 22 (44%) females with a male to female ratio of 1.3:1. They aged 1 month to 18 years with a mean age of 4.07 ± 3.61years. Microalbuminuria occurred in 6 (12%) patients; 3 males and 3 females, mean age of 5.5 ± 4.6 years. Five (83.3%) of the patients with microalbuminuria had clinical AIDS and CD4 cell count 0cells/ L. All the patients with microalbuminuria were not receiving highly active antiretroviral therapy (HAART) at the time of study. One (16.7%) patient had overt HIV-associated nephropathy (HIVAN) with ACR greater than 2.5 mg/mmol, elevated serum creatinine 400μmmo/L, urea of 20mmol/Land aGFRof 69ml/min/1.73m . : The prevalence of microalbuminuria in Nigerian children with HIV infection is high, and it occurs mainly in older children with clinical AIDS who are not on HARRT.Key words: Microalbuminuria, HIV infection, children. Port Harcourt, Nigeria

Knowledge, attitude and practice of renal biopsy among consultant nephrologists and senior nephrology residents

Background. Although clinical diagnosis, prognosis, appropriate treatment and monitoring of renal diseases depends on percutaneous renal biopsy-enabled histologic diagnos is , this procedure is uncommonly utilized in Nigeria.Materials and Methods. This was aquestionnaire based cross sectional study involving consultant nephrologists and senior residents present at an interventional nephrology workshop held at the University of Port Harcourt Teaching hospital, Nigeria in July 2017 as respondents. Questionnaires sought to assess the knowledge, attitude and practice of the respondents to renal biopsy.Results. The study showed that 89% and 71% of the responding consultants and senior residents respectively, considered renal biopsy important in diagnosis of renal diseases, 90% of the consultants did not perform renal biopsy during their residency training and while 70% did not observe the procedure at all. Also, 41% and 24% percent of the senior residents have neither tried their hands on life renal biopsy nor observed the procedure at all, respectively for upwards of a year in their rank. Eleven percent and 29% of the consultants and senior residents respectively considered renal biopsy unimportant in making diagnosis and 89% relied on serum electrolytes, urea, creatinine, urinalysis and ultrasound scan for diagnosis. High cost and out of pocket payment were the reasons the respondents advanced as being responsible for patients decline from renal biopsy.Conclusion. The knowledge and attitude of renal biopsy among nephrologists in Nigeria is good, the practice is however low. This is attributable to the inadequate exposure of nephrology residents to renal biopsy during training, lack of trained nephropathologists/necessary diagnostic tools and high cost/out-of pocket payment by patients. Review of residency training curriculum in nephrology and improvement in funding of nephrology practice are imperative for optimization of the nephrology patient.Keywords: Renal biopsy, Knowledge, Attitude, Practice , Nephrologists, Nigeri

Type II diabetes Mellitus in a 15-year-old female with congenital hypothyroidism

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Lupus Nephritis in University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background: Paediatric-onset Systemic Lupus Erythromatosus (pSLE) is a severe autoimmune disease with multisystem involvement characterized by immune dysregulation and malfunctioning. Lupus Nephritis occurs in 60% to 80% of all pSLE patients, and increases the morbidity and mortality associated with this condition. Methodology: This was a single center review of children managed for Lupus Nephritis in the Paediatric Nephrology unit of the University of Port Harcourt Teaching Hospital from June2017 to February 2020. Diagnosis of SLE was made using the EULAR/ACR scoring system and staging of Lupus Nephritis was based on the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) 2018 Revised Grading of Lupus Nephritis. Results:  There were seven cases of SLE with Lupus Nephritis managed at the centre during the period. These included five females (71.4%) and two males (28.6%), giving a female to male ratio of 2.5: 1. The ages of the patients ranged from 4.5years to 17years, with a median age of 12years. Renal manifestations included generalized body swelling in 100%, hypertension in 71.4% and haematuria in 85.7%. Their ISN/RPS grades were grades IIIA, IIIC, and IVA Extra renal manifestations were fever in 85.7%, joint pain/swelling in 71.4%), haematological manifestations with thrombocytopenia in 71.4% and severe anaemia in 57.1%, skin involvements in 42.9%, and a case of neuropsychiatric involvement. Treatment received included blood transfusion, steroid therapy, Mycophenolatemofetil, antihypertensives, diuretics/antihypertensives, and haemodialysis. Outcome was poor, with a mortality rate of 4 (57.1%). Conclusion: Lupus nephritis is a severe disease and major cause of morbidity and mortality in children

Acute kidney injury in children with severe malaria

Background: Renal involvement in severe malaria has been reported as an important contributor to morbidity and mortality. Acute kidney injury (AKI) is a frequent and life threatening complication of falciparum malaria. This study was undertaken to determine the prevalence and risk factors of AKI in children with severe malaria in Port Harcourt.Materials and Methods: This was a retrospective study of patients with severe malaria and AKI conducted at the University of Port Harcourt Teaching hospital, Nigeria over a 5-year period (January 2007 to December 2012). We analysed information on biodata, clinical features, investigations, complications, treatment including specific treatment for renal failure and outcome. The estimated glomerular filtration rate (eGFR) was calculated using the modified Schwartz equation.Results: AKI occurred in 32 of 960 patients with severe malaria giving a prevalence of 3.3%. They were aged 8 months to 9 years with majority (84.4%) less than 60 months. There were more males with a male: female ratio of 1.3:1. Over 80% of the patients had oliguric AKI while 5 (15.6%) patients had non-oliguric AKI. Proteinuria ranging from 30 to 100mg/dl occurred in 19 (59.4%) patients. Twenty-six (81.3%) patients responded to conservative management of AKI while 6 patients (18.8%) received acute peritoneal dialysis for failed conservative treatment (2 patients) and uraemic encephalopathy (4 patients). The duration of oliguria in all patients ranged from 4 - 11 days. Two patients died from uraemic encephalopathy giving a mortality rate of 6.3%.Conclusion: AKI occurs in Nigerian children with malaria and majority respond well to conservative treatment.Keywords: Acute kidney injury(AKI), Severe malaria, Plasmodium falciparium, Children, Nigeri

pRIFLE and prevalence of acute kidney injury in under-five children with severe malaria: any change?

Background: Malaria is an endemic disease in sub- Saharan Africa caused by parasites of the genus Plasmodium. Plasmodium falciparum is responsible for most of its severe complications, including cerebral malaria, severe anaemia and acute kidney injury (AKI) formerly known as acute renal failure. AKI is more commonly diagnosed in children than in adults and studies report varying prevalence among different populations. The study set out to determine the prevalence of AKI in under-5 children with severe malaria in a tertiary hospital in South-South Nigeria.Materials and Methods: Children aged 6 - 60 months with a positive rapid diagnostic test (RDT) for malaria, who met the criteria for severe malaria were studied. Serum creatinine obtained from the subjects was used to calculate estimated creatinine clearance and AKI was stratified using the WHO and pRIFLEcriteria.Results: Eleven of 190 subjects studied met the WHO criteria for malarial AKI, giving a prevalence of 5.8%. Of these,90.1% were children between 48 to < 59 months. More males were affected, with a male: female ratio of 1.8:1.All the children with AKI were in pRIFLE stage'F'.Conclusion: The prevalence of malarial acute kidney injury in this study was low, males and children in the low socioeconomic class were most affected.Keywords: Malarial Acute Kidney Injury, Prevalence, Under -5 children, pRIFL

The role of urine neutrophil gelatinase associated lipocalin as an early marker of Aki in sick neonates admitted into the special care baby unit of University of Port Harcourt Teaching Hospital

Background: Neonatal acute kidney injury (NAKI) is relatively common, with increasing incidence globally. Infants with NAKI are at increased risk of long-term chronic kidney disease, or death. Although serum creatinine is still presently used as an index of renal function, it is an insensitive  and poor marker of renal injury. The use of serum creatinine leads to delay in the detection and intervention in the early periods of renal injury when appropriate management strategies can be instituted before irreversible renal damage occurs. Urine NGAL is presently the most expressed protein in the kidney following ischemia and has  been found to be a very sensitive and specific early marker of AKI before renal failure sets in. Early diagnosis of NAKI using urine NGAL will aid in earlier institution of measures which will  improve clinical outcome in patients with AKI. This study will establish the role of urine NGAL as an early marker of NAKI in our setting. Materials and methods: Two hundred and thirty ill neonates greater than 34weeks gestational age admitted into the special care baby unit of UPTH were consecutively recruited into the study. Serum for creatinine estimation was obtained on the third and fifth day of life respectively. Neonatal acute kidney injury (NAKI) was defined as an increase in serum creatinine by >26umol/l within 48hours. Spot urine obtained in the first 48 hours of life was used for urine NGAL assessment. NAKI was defined as an increase in urine NGAL > 210ng/ml on the urine sample within the first 48hours of life. Results: Urine NGAL detected more neonates with NAKI in the first 48 hours of life, before there was a rise in serum creatinine between the 3rd and 5th day, giving an incidence of NAKI of 38.3% and 23.5% using urine NGAL and serum creatinine respectively. Area under the curve (AUC) =0.722; 95% confidence interval: 0.644 – 0.799; p value= 0.0001 Urine NGAL of > 210ng in the first 48 hours of life in at risk neonates had a relatively significant diagnostic performance with a sensitivity of 70% and specificity of 72%. Although the positive predictive value of urine NGAL was relatively low (43%), the negative predictive value was high (89%) which implies that a urine NGAL of <210ng/ml as early as the first 48hours of life significantly excludes the diagnosis of NAKI in at risk new-borns. Conclusion; Tertiary care facilities caring for critically ill new-borns such as those with severe birth asphyxia should routinely screen as early as the first 48hours of life using urine NGAL to exclude neonatal acute kidney injury

Prevalence of Microalbuminuria among secondary school children

Background: Microalbuminuria is an early sign of kidney and cardiovascular damage. Therefore, early detection in asymptomatic individuals may be helpful in preventing deterioration in renal function. Methods: We carried out a cross-sectional study of 820 secondary school students aged 10 19 years from September to November 2008. The urine samples of 615 (75.0%) without overt proteinuria and haematuria were tested for microalbuminuria using the micral test strips. Values of greater than 20mg/L were considered positive. Results: There were 299 (48.6%) males and 316 (51.4%) females, with a M:F ratio of 1:1.1. The prevalence of microalbuminuria as seen in 214 of the students was 33.2%. It was significantly higher in females (45.3%), obese subjects (35.4%), those with hypertension (70.6%), those with positive family history of hypertension (59.5%), and diabetes mellitus (46.4%). Microalbuminuria was found in 1 of the 2 subjects who had features of DM and in one subject with sickle cell anemia. Conclusion: The prevalence of microalbuminuria in Nigerian adolescents is high. We recommend routine screening for microalbuminuria in adolescents for early detection and prevention of renal damage

Renal Size of Apparently Healthy Primary School Children in Port Harcourt, Nigeria

Introduction:  The  assessment  of kidney size isavaluable parameter for both diagnostic and prognostic purposes . To evaluate the abnormalities of kidney sizes, it is important to know the normal limits in ourpopulation. Aim: To determine the mean renal sizes inrelation to age, sex, weightand height among apparently healthy school children which will aid in developing renal size normogram for use inclinical practice. Methods: This was a cross sectional study carried out among 455 children aged 6 to 12 years. The sonographic assessment of renal sizes (length, width, depth and volume) of each kidney was carried out using a portable real time ultrasound machine model  DP-1100  PLUS  MINDRAY fitted with 3.5MHz curvilinear probe. The age, weights and heights of the children were recorded and related to thekidney sizes.  volume was52.l ± 15.4cm and 52.2 ± 15.4 cm3on the right and left kidneys respectively.There was no significant difference in the length and volume between the right and left kidneys in the study population and no significant gender difference in the renal sizes of the study population. Therenal length increased from 77.6± 5.7mm at 6years to 85.7 ± 6.lmm at 12years of age while the renal volume increased from 45.6 ± 13.3cm3 at 6years to 60.6 ± 17.4cm3 at 12years. There was a significant positive correlation of renal size with age, weight and height. Conclusion: The renal length and volume significantly correlated with age, weight and height. This study has provided the renal sizes of normal school age children in Port Harcourt, Nigeria and regression equations for predicting renal length and volume in clinical practice. Keywords: Renal size, Ultrasound, Age, Weight, Height, School Children, Port Harcourt, Nigeria &nbsp