Unilateral renal agenesis associated with ovarian cysts in a 19 year old woman in Orlu, South-East Nigeria

Background: Anomalies linked with unilateral renal agenesis are not completely known.Aim: We report here a rare occurrence of ovarian cysts associated with unilateral renal agenesis in Orlu, Nigeria.Methods: A 19 year-old woman was being evaluated for acute pyelonephritis.Findings: We noted that this patient had acute pyelonephritis on a background of right renal agenesis that was associated with bilateral ovarian cysts. Ovarian cyst in the index patient was an incidental finding whereas acute pyelonephritis, perhaps, was a complication of unilateral renal agenesis.Conclusion: This case report highlights the need for consideration of possibility of ovarian cysts during evaluation of unilateral renal agenesis as many abnormalities of the ovaries, uterus and vagina are associated with renal agenesis and may impact negatively on fertility.Keywords: Unilateral renal agenesis, ovarian cysts, pyelonephritis, urogenital abnormalities, Orlu, Nigeri

Human immunodeficiency virus infection presenting as a fatal case of Guillain-Barré syndrome on a background of diabetes mellitus

Background: Guillain-Barré syndrome (GBS), a post-infective acute polyneuropathy, which occurs rarely among Africans, has been associated with HIV infection and less commonly with diabetes mellitus. Aim: The article documents a case of GBS occurring on the setting of HIV infection on a background of diabetes mellitus. Findings: A 47 years old man presented with features of inability to walk, “pins and needles” sensation in the lower limbs, progressive lower limb weakness of 3 days duration and later on admission involving the upper limbs and, finally respiratory distress leading to his death on the 3rd day of hospital admission. He had an antecedent history of a diarrheal illness 3 weeks prior to his admission, and was treated at a private hospital without any complication. He was observed to have concomitant HIV infection and diabetes mellitus. He was not previously known to have any of these diseases and initially diagnosed as having acute diabetic neuropathy. Conclusion: GBS can occur in the setting of HIV infection on a background of DM and may be associated with a poor prognosis. There is a need to have a high index of suspicion in making a diagnosis of GBS in diabetic patients when it occurs concomitantly with HIV infection.Key words: HIV, Guillain-Barré Syndrome, diabetes mellitus, paralysis, presenting, progressive weaknes

Evaluating the impact of type 2 diabetes mellitus on cardiovascular risk in persons with metabolic syndrome using the UKPDS risk engine

O Stephen Ogedengbe,1 Ignatius U Ezeani,2 Ijezie I Chukwuonye,3 Ndukaife Anyabolu,4,5 Ikemefuna I Ozor,6 Aihanuwa Eregie1 1Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, 2Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Federal Medical Center, Umuahia, 3Division of Nephrology, Department of Internal Medicine, Federal Medical Center, Umuahia, 4Division of Nephrology, Department of Internal Medicine, Imo State University Teaching Hospital, Orlu, 5Division of Nephrology, Department of Internal Medicine, Federal Medical Centre, Owerri, 6Division of Neurosurgery, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, NigeriaBackground: The aim of this study is to evaluate the impact of coexistence of metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) on the estimated cardiovascular risk as calculated using the United Kingdom Prospective Diabetic Study risk engine (UKPDS-RE) and also to determine the impact of the coexistence of MS and T2DM on the 10-year risk of developing coronary heart disease and stroke.Methodology: This is a cross-sectional study in which convenience sampling technique was used to recruit 124 consecutive persons with T2DM and 96 controls using a questionnaire administered technique. The World Health Organization (WHO) criterion was used to define MS and the UKPDS-RE was used to identify persons with increased risk for stroke and those with increased risk for coronary heart disease. The data obtained were analyzed using SPSS version 16. Statistical comparisons were made with chi-square for comparison of proportions. A P-value of less than 0.05 was taken as statistically significant.Results: Fifteen subjects were identified as having an increased 10-year risk for stroke and ten as having an increased risk for a coronary event. The odds of a T2DM subject with MS having an increased risk for stroke compared with a T2DM subject without MS was 0.9579≈1 while the odds of a T2DM subject with MS developing an increased risk for a coronary event compared with a T2DM subject without MS was =3.451≈3.Conclusion: MS was more common in subjects with T2DM compared with controls (irrespective of the diagnostic criteria used) and MS appears to increase the risk of a coronary event in subjects with T2DM by threefold. Also from this study, MS did not appear to cause an additional increase in the risk of stroke in subjects with T2DM.Keywords: diabetes mellitus, metabolic syndrome, coronary heart disease, cardiovascular disease, UKPDS risk engin

Prevalence of chronic kidney disease in Nigeria: systematic review of population-based studies

Innocent Ijezie Chukwuonye,1 Okechukwu Samuel Ogah,2 Ernest Ndukaife Anyabolu,3 Kenneth Arinze Ohagwu,1 Ogbonna Collins Nwabuko,4 Uwa Onwuchekwa,5 Miracle Erinma Chukwuonye,6 Emmanuel Chukwuebuka Obi,1 Efosa Oviasu7 1Division of Nephrology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Abia State, 2Division of Cardiology, Department of Internal Medicine, University College Hospital Ibadan, Oyo State 3Division of Nephrology, Department of Internal Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka, Anambra State, 4Department of Haematology, Federal Medical Centre, Umuahia, 5Division of Nephrology, Department of Internal Medicine, Abia State University Teaching Hospital, Aba, 6Department of Family Medicine, Federal Medical Centre, Umuahia, 7Division of Nephrology, Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria Background: The aim of this study was to identify and discuss published population-based studies carried out in Nigeria that have information on the prevalence of chronic kidney disease (CKD) and have also used the Kidney Disease Outcomes Quality Initiative (KDOQI) practice guidelines in defining CKD, with emphasis on the performance of three estimating equations for glomerular filtration rate (GFR) – Modification of Diet in Renal Disease (MDRD), Cockcroft–Gault, and CKD epidemiology collaboration (CKD-EPI) creatinine equation. Materials and methods: A systematic literature search was carried out in Google, MEDLINE, PubMed, and AJOL database, with the aim of identifying relevant population-based studies with information on the prevalence of CKD in a location in Nigeria. Results: Seven cross-sectional population-based studies were identified. Two of the studies used the Cockcroft–Gault and observed a prevalence of 24.4% and 26%. Four of the studies used the MDRD and the prevalences observed were 12.3%, 14.2%, 2.5%, and 13.4%. One of the studies used the CKD-EPI equation and the prevalence was 11.4%. The male to female ratios of CKD prevalence in six studies were 1:1.9, 0.8:1, 1:1.6, 1:2, 1:1.8, 1:1.4, and the observed risk factors in the studies were old age, obesity, diabetes mellitus, hypertension, family history of hypertension, family history of renal disease, low-income occupation, use of traditional medication, low hemoglobin, and abdominal obesity. Conclusion: The prevalence of CKD was high but variable in Nigeria, influenced by the equation used to estimate the GFR. MDRD and CKD-EPI results are agreeable. There is a need for more population-based studies, with emphasis on repeating the GFR estimation after 3 months in subjects with GFR <60 mL/min/1.7 m2. Keywords: CKD, Cockcroft–Gault, Modification of Diet in Renal Disease, CKD epidemiology collaboration creatinine equatio