Current trends in the management of acute kidney injury in children

Acute Kidney Injury (AKI) previously known as acute renal failure (ARF) is a common problem in the paediatric emergency wards with infections likesepsis and malaria being the commonest causes in Nigeria. It has been known by various nomenclatures with a lack of standardised definition. This has made comparison of data very difficult. In the last decade, attempts have been made to standardize the definition by developing a classification criterion termed “RIFLE”. This is in turn undergoing variousmodifications with the most recent classification system developed by the Kidney Disease: Improving Global Outcomes (KDIGO). Despite these interesting developments, the basis of these classifications which is the use of serum creatinine measurements is fraught with its own limitations.This has led to discovery of various urinary and serum biomarkers like the cystatin C and neutrophil gelatinase associated lipocalin (NGAL) which appear to have very promising advantages over the well known creatinine measurements. Management of AKI continues to be anticipatory with appropriate fluid therapy and adequate treatment of infections. The benefits of furosemide and dopamine in management are still a constant source of debate. Treatment of life threatening complications like hyperkalaemia and hypertension as well as maintaining the kidney through the period of non-function can lead to remarkable recovery of renal homeostatic function.Keywords: acute kidney injury, paediatrics, managemen

Symmetrical peripheral gangrene in a child following severe malaria with concomitant sepsis

Symmetrical peripheral gangrene (SPG) is a well- documented but rare clinical syndrome characterized by symmetrical distal ischemic damage leading to gangrene of two or more sites in the absence of large vessel obstruction or vasculitis. The aetiological factors responsible for SPG are vast and it could follow many common diseases such as malaria. This is a report of a 9month old child who developed symmetric peripheral gangrene following severe malaria (severe anaemia) and sepsis. Gangrene involved the 2nd to the 5thdigits and 3rd and 4thdigits of the left and right hands and all the toes. Autoamputation of the affected digits followed several weeks after discharge and was limited to the distal interphalangeal joints. There is the need for a high index of suspicion, early detection and prompt management of patients with disorders associated with SPG in order to limit the risk of permanent disability in otherwise treatable diseases

Cryptococcal Meningitis, A Rare Opportunistic Infection In An HIV Infected Nigerian Boy: A Case Report

Cryptococcal meningitis (CM) is an uncommon opportunistic infection in HIV infected children. Few childhood cases have been reported in literature. This is the second case report in a Nigerian child and the first at our hospital. A 13 year old boy presented with fever, cough, neck pain, convulsions and altered sensorium. He was assessed clinically and results of laboratory investigations supported a diagnosis of CM. He was diagnosed HIV positive at the same time with a history of blood transfusions in a private hospital. Unfortunately, appropriate intravenous anti-fungal to be used for treatment were not available and child died within a week of diagnosis. The pandemicity of HIV requires that a high index of suspicion be maintained to detect invasive fungal infections like CM. Efforts should also be made to ensure availability of appropriate antifungal, such as amphotericin B, for prompt treatment of affected persons. There is similarly the need to reinforce the campaign on screening of blood and blood products to prevent HIV transmission. Key words: Cryptococcal meningitis, Nigerian child, HIV/AID