Major urogenital malformations in Nigerian children

Background:There is scanty data on the pattern of childhoodurogenital malformations in many resource-poorcountries, including Nigeria.Objective:To describe the pattern of occurrence of majorurogenital malformations in children presenting in atertiary health care centre in sub Saharan Africa.Design:Retrospective case review.Patients:All children with major urogenital malformationspresented at the Department of Paediatrics of theUniversity College Hospital, Ibadan, a large tertiaryhealth care institution in South West Nigeria. In theperiod from July 1985 to December 1995.Main results:A total number of 125 cases of major urogenitalmalformations were seen during the study period.The commonest of these malformations were posterior urethral valves (40.0%), hypospedias(18.4%), ambiguous external genitalia (12.8%) andectopia vesicae (11.2%).Prenatal diagnosis was rare and most patientspresented late. Mortality during first admission was14.4% (18/125), mostly accounted for by cases ofposterior urethral valves.Conclusion: Posterior urethral valves accounted for the majority of major urogenital malformations seen in the setting studied. The high mortality probably reflected the severity of the lesions and late presentation of patients (which was related to the rarity of prenatal diagnosis). Increased awareness of these lesions among physicians practising in developing countries and greater use of ultrasonography in the third trimester of pregnancy may improve the prognosis by early detection and management

Influence of disease remission on renal dimensions in childhood nephrotic syndrome in Ibadan, South West Nigeria

Background: The hallmark of Nephrotic syndrome is massive proteinuria, with associated enlarged kidneys. However the association between remission status and size of the kidneys in patients with nephrotic syndrome is not known. This study is aimed at determining the dimensions of the kidneys of children with nephrotic syndrome and to compare kidney dimensions in patients with nephrotic syndrome who were in remission compared with the dimensions in patients who were not in remission.Subjects and Methods: This is a case-control study, where fiftythree children with diagnosis of Nephrotic syndrome and fiftyseven age matched healthy controls were analysed. The kidneys of both cases and controls were scanned using the B- mode ultrasound and the kidneys Bipolar, anteroposterior and transverse dimensions and volume were determined.Results: The mean renal longitudinal, anteroposterior, transverse dimensions and volume were higher in cases compared to the controls, bilaterally (p <0.001). The mean difference in values of the measured parameters between the cases in remission and those yet to attain remission was not significant. The bipolar dimension of the left kidney showed positive correlation with duration of disease (r= 0.290, p=0.035). The study was also able to demonstrate high incidence of nephromegaly, in 52.8%, 62.3% and 67.9% respectively for the right kidney, left kidney and combined.Conclusion: Despite a comparative global enlargement in the kidney dimensions in children with nephrotic syndrome compared with controls and the general population, the remission status does not seem to be a significant factor.Keywords: Nephrotic syndrome, renal dimensions, ultrasonography, nephromegaly, paediatric

Is the Art of Renal Biopsy on the Decline in Nigeria?

Background: Renal biopsy remains the means by which definitive parenchymal kidney disease diagnoses are made. With the renal biopsy, the activity, progression and prognosis of renal parenchymal diseases can be studied with objectivity. We investigated the trend of renal histopathology request in a tertiary hospital in Nigeria over 31 years.Objective: To determine the trend of renal biopsy requests in one of the biggest tertiary hospitals in Nigeria over a 31-year period (1981- 2011).Methods: We retrospectively analysed all the renal biopsies submitted to the Department of Pathology, University College Hospital (UCH) Ibadan, South-West Nigeria over a 30 year period (1981-2011). Trend of requests of all the biopsies submitted from the Surgery, Paediatrics and Medicine departments was analysed using a test for linear  trend. Gender and age groups trends were also studied.Results: A significant reduction in the rates of renal biopsy request over the 31-year period (p=0.001) was noted which is attributed to diminution in requests from the Medicine and Paediatrics Departments (p<0.001), while the rates of requests from Surgery Department remain fairly uniform over this period (p=0.05). Decrease in biopsy requests significantly cuts across the ages in both genders. Conclusion: Lack of adequately trained manpower, poor health insurance scheme and lack of facilities may be contributory in renal biopsy requests decline. Adequate efforts should be made towards reviving this important investigative modality in Nigerian tertiary hospitals.Keywords: Kidney, Biopsy, Histology, Trend test, UCH Ibadan

Asymptomatic bacteriuria in sickle cell disease: a cross-sectional study

BACKGROUND: It is known that there is significant morbidity associated with urinary tract infection and with renal dysfunction in sickle cell disease (SCD). However, it is not known if there are potential adverse outcomes associated with asymptomatic bacteriuria (ASB) infections in sickle cell disease if left untreated. This study was undertaken to determine the prevalence of ASB, in a cohort of patients with SCD. METHODS: This is a cross-sectional study of patients in the Jamaican Sickle Cell Cohort. Aseptically collected mid-stream urine (MSU) samples were obtained from 266 patients for urinalysis, culture and sensitivity analysis. Proteinuria was measured by urine dipsticks. Individuals with abnormal urine culture results had repeat urine culture. Serum creatinine was measured and steady state haematology and uric acid concentrations were obtained from clinical records. This was completed at a primary care health clinic dedicated to sickle cell diseases in Kingston, Jamaica. There were 133 males and 133 females in the sample studied. The mean age (mean ± sd) of participants was 26.6 ± 2.5 years. The main outcome measures were the culture of ≥ 10(5 )colony forming units of a urinary tract pathogen per milliliter of urine from a MSU specimen on a single occasion (probable ASB) or on consecutive occasions (confirmed ASB). RESULTS: Of the 266 urines collected, 234 were sterile and 29 had significant bacteriuria yielding a prevalence of probable ASB of 10.9% (29/266). Fourteen patients had confirmed ASB (prevalence 5.3%) of which 13 had pyuria. Controlling for genotype, females were 14.7 times more likely to have confirmed ASB compared to males (95%CI 1.8 to 121.0). The number of recorded visits for symptomatic UTI was increased by a factor of 2.5 (95% CI 1.4 to 4.5, p < 0.005) but serum creatinine, uric acid and haematology values were not different in patients with confirmed ASB compared with those with sterile urine. There was no association with history of gram negative sepsis. CONCLUSION: ASB is a significant problem in individuals with SCD and may be the source of pathogens in UTI. However, further research is needed to determine the clinical significance of ASB in SCD

Neonatal hypernatremia: A report of two cases in Ibadan, Nigeria

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Evaluation of the Nitrite Test in Screening for Urinary Tract Infection in Febrile Children with Sickle Cell Anaemia

Background: Urinary tract infection (UTI) is a significant cause of morbidity in children and individuals with sickle cell anaemia (SCA) have been reported to be at increased risk. It will be useful to have a simple means of screening such children for UTI with a view to instituting prompt treatment. Objectives: The objective of the study was to evaluate the usefulness of the nitrite test in detecting UTI in febrile SCA children. Methods: This prospective study was carried out in the department of Paediatrics, University College Hospital, Ibadan. The study group consisted of 171 children aged one to 15 years with SCA presenting with fever (temperature e” 37.5oC). Midstream urine specimen was collected from each patient and subjected to nitrite test, microscopy, culture and sensitivity. Results: There was significant bacteriuria in 37 (21.6 percent) children. A positive test for nitrite was obtained in the urine of eight patients, seven of whom had bacteriuria. The nitrite test in detecting bacteriuria had a specificity of 99.2 percent, a sensitivity of 18.9 percent, a positive predictive value of 87.5 percent and a negative predictive value of 81.6 percent. A positive nitrite test was significantly associated with bacteriuria, while a negative test was also significantly associated with an absence of bacteriuria. Conclusion: The nitrite test is useful as a screening test for UTI in SCA children. However, in sick children, urine microscopy and culture should still be done in spite of a negative test. Nigerian Journal of Paediatrics Vol.31(1) 2004: 10-1

Acquisition, maintenance and adaptation of invasion inhibitory antibodies against Plasmodium falciparum invasion ligands involved in immune evasion

Erythrocyte-binding antigens (EBAs) and P. falciparum reticulocyte-binding homologue proteins (PfRhs) are two important protein families that can vary in expression and utilization by P. falciparum to evade inhibitory antibodies. We evaluated antibodies at repeated time-points among individuals living in an endemic region in Nigeria over almost one year against these vaccine candidates. Antibody levels against EBA140, EBA175, EBA181, PfRh2, PfRh4, and MSP2, were measured by ELISA. We also used parasites with disrupted EBA140, EBA175 and EBA181 genes to show that all these were targets of invasion inhibitory antibodies. However, antigenic targets of inhibitory antibodies were not stable and changed substantially over time in most individuals, independent of age. Antibodies levels measured by ELISA also varied within and between individuals over time and the antibodies against EBA181, PfRh2 and MSP2 declined more rapidly in younger individuals (≤15 years) compared with older (>15). The breadth of high antibody responses over time was more influenced by age than by the frequency of infection. High antibody levels were associated with a more stable invasion inhibitory response, which could indicate that during the long process of formation of immunity, many changes not only in levels but also in functional responses are needed. This is an important finding in understanding natural immunity against malaria, which is essential for making an efficacious vaccine