Pediatric acute renal failure in southwestern Nigeria

Pediatric acute renal failure in southwestern Nigeria.BackgroundAcute renal failure (ARF) was investigated to determine the prevalence of ARF clinical types, etiology, comorbidities, and outcome in Nigerian children.MethodsConsecutive cases of ARF admitted from March, 1994 through February, 2003 were prospectively studied. Information were obtained concerning the following: age, gender, body surface area, early (within 48 hours of onset of ARF) or late (>48 hours of onset of ARF) presentation, admission duration, etiology, comorbidities, urine volume/day, dialysis need, reasons for considering dialysis, laboratory investigations, and outcome in each patient. Histopathologic reports of percutaneous renal and surgical biopsies, as well as autopsy specimens, were reviewed.ResultsThere were 78 boys and 45 girls (M:F, 1.73:1); mean age was 6.28 ± 4.0 years. A portion of patients presented early (46.3%), while 53.7% presented late. Oliguric (63.41%), anuric (20.33%), and nonoliguric (16.26%) ARF were the clinical types seen. Dialysis requirement was significantly higher in oliguric (P < 0.005) and anuric (P < 0.005) than nonoliguric ARF. Primary and secondary etiologies accounted for 29% and 71% of ARF cases, respectively. Renal Burkitt's lymphoma (47.2%), glomerulonephritis (27.8%), nephrotic syndrome (16.7%), hemolytic uremic syndrome (5.5%), and acute tubulointerstitial nephritis (2.8%) were primary etiologies. Plasmodium falciparum malaria (42.53%), septicemia (28.73%), hypovolemia (11.49%), and obstructive uropathy (8.05%) were major secondary etiologies. Financial constraints on the part of parents of patients, as well as inadequate and/or lack of dialysis equipment, were major inhibitions to effective management of the patients; in fact, 6 patients took voluntary discharge due to inability to afford the cost of treatment. Mortality risk factors were late presentation [odds ratio (OR) 3.5, P < 0.001], dialysis eligibility (OR 3.8, P < 0.001), nondialysis (OR 23.1, P = 0.00004), primary etiology (OR 2.6, P < 0.025), and presence of ≥2 comorbidities (OR 2.9, P < 0.025); overall mortality rate was 46.2%.ConclusionThese results show that many of the causes of ARF in our patients are preventable; it should be possible to reduce morbidity due to ARF through purposive preventive measures

Histopathological study and audit of the spleen in Nigerians

Studies on the spleen in Nigerians are rare. This study reviewed retrospectively the gross and histopathological findings in spleens received at the histopathology laboratory of the Obafemi Awolowo University Hospital (OAUTHC), Ile-Ife, Nigeria. 119 consecutive splenectomy specimens received within a period of 18 years were analysed with respect to age, sex, pathological diagnoses and indication for splenectomy. There were 76 males and 43 females with a mean age of 34.8 years (STD 19.6 years). Spleen weight, size, the presence of malarial parasite as well as fibrosis was not documented in many cases. The most frequent finding both grossly and microscopically was haemorrhagic necrosis from laceration of the spleen arising from trauma (62.7% of all cases). Road traffic accident (RTA) accounted for 86% of all trauma cases and was the predominant finding in both sexes up to the age of 50 years. Thereafter, haematological malignancy was the predominant finding in the spleen. Chronic lymphocytic leukaemia (CLL) was the most common haematological malignancy in the spleen. The indications for splenectomy correlated well with the histological findings (kappa=0.81). Pathological description of spleen specimens is inadequate. Trauma is the major reason for splenectomy. In elderly Nigerians, splenectomy specimen would likely show CLL

Signet ring lymphoma: The import of immunohistochemistry in resolving diagnostic dilemnas

Signet ring cell lymphomas are a rare subtype of non Hodgkin lymphoma characterised by malignant lymphoid cells with cytoplasmic inclusions that displace the nucleus and imparts a “signet ring” appearance.This poses a diagnostic challenge as it can be mistaken for an adenocarcinoma or any other epithelial malignancy.A 54yr old male presented with a 6month history of generalised lymphadenopathy. Examination of excision biopsy of the lymph nodes show effacement of architecture by sheets neoplastic cells with abundant cytoplasm distended by eosinophilic amorphous substances. Immunohistochemistry with a panel of three monoclonal antibodies [LCA, CD20, and CD3] confirmed these cells to be of lymphoid origin.Keywords: Non Hodgkin Lymphoma;Signet Ring,Immunohistochemistr

Childhood idiopathic steroid resistant nephrotic syndrome in Southwestern Nigeria

Clinical charts of 23 Nigerian children diagnosed with Idiopathic Steroid Resistant Nephrotic Syndrome (iSRNS) between January 2001 and December 2007 were retrospectively re-viewed to determine their clinicopathologic characteristics and outcome. iSRNS (54.8&#x0025;) was pri-mary in 19 patients (83&#x0025;) and secondary in four (17&#x0025;). The mean age at diagnosis was 8.3 &#177; 3.5 years (2.1-13 years). Histopathology revealed membranoproliferative glomerulonephritis (MPGN) in 43.5&#x0025;, focal and segmental glomerulosclerosis (FSGS) in 39.1&#x0025; and mesangial proliferative glo-merulonephritis in 8.7&#x0025; of the patients while minimal change disease (MCD) and membranous nephropathy accounted for 4.35&#x0025; each. Routine treatment protocol comprised pulse intravenous (i.v.) cylophosphamide infusion and i.v. dexamethasone &#897; lisinopril or spironolactone. Cumulative Com-plete Remission (CR) rate was 57.12&#x0025;. The overall median time to CR from start of steroid sparing agents in 12/21 treated patients was 4.5 weeks. CR was better achieved in MPGN than FSGS (P = 0.0186). Five patients had eight relapses with the overall median relapse-free duration being four months. Cumulative renal survival at 36 months was 41.8&#x0025;. The median follow-up duration was eight months. Our study revealed that there was a high prevalence of iSRNS and preponderance of non-MCD lesions, with MPGN and FSGS being the major morphologic lesions. The outcome with steroid and cyclophosphamide-based treatment for iSRNS was further enhanced with addition of either lisinopril or spironolactone

Lymphoreticular diseases in Nigerians

Background: The lymphoreticular system plays a major role in both the innate and adaptive immune responses. This study reviews retrospectively cases of lymphoreticular diseases seen at a tertiary institution in Nigeria. Materials and Methods: This is a retrospective study in which biopsies from the bone marrow, spleen, lymph nodes and extranodal lymphoid tissues reported within a period of 16 years were reviewed with respect to age, sex and pathological diagnosis. Statistical analysis was performed for differences in proportion using Chi square by SPSS version 12. Results: Nine hundred and forty four cases comprising 559 biopsies from lymph nodes and extranodal lymphoid tissues, 272 bone marrow biopsies and 113 spleen biopsies were studied. Non Hodgkin&apos;s lymphoma (NHL) and tuberculosis were the most common lesions in lymph nodes and extranodal lymphoid tissues. The axillary and cervical nodes accounted for most cases of metastasis. Breast cancer accounted for the majority of metastasis to lymph nodes. The most common pathological changes in bone marrow were NHL and reactive hyperplasia. Patients with chronic lymphocytic leukaemia (CLL) had the highest mean age, which was significantly higher than in those with NHL (p=.001, 95% confidence interval -27.91 to -7.76). The most common finding in the spleen was splenic rupture and haemoperitoneum from road traffic accident. Conclusion: NHL and tuberculosis should be high on the list of differential diagnosis of lymphadenopathy in Nigerians. Whereas trauma from RTA was the major reason for splenectomy in Nigerians, in the elderly splenic biopsy would likely show CLL

Histopathological study and audit of the spleen in Nigerians

Studies on the spleen in Nigerians are rare. This study reviewed retrospectively the gross and histopathological findings in spleens received at the histopathology laboratory of the Obafemi Awolowo University Hospital (OAUTHC), Ile-Ife, Nigeria. 119 consecutive splenectomy specimens received within a period of 18 years were analysed with respect to age, sex, pathological diagnoses and indication for splenectomy. There were 76 males and 43 females with a mean age of 34.8 years (STD 19.6 years). Spleen weight, size, the presence of malarial parasite as well as fibrosis was not documented in many cases. The most frequent finding both grossly and microscopically was haemorrhagic necrosis from laceration of the spleen arising from trauma (62.7% of all cases). Road traffic accident (RTA) accounted for 86% of all trauma cases and was the predominant finding in both sexes up to the age of 50 years. Thereafter, haematological malignancy was the predominant finding in the spleen. Chronic lymphocytic leukaemia (CLL) was the most common haematological malignancy in the spleen. The indications for splenectomy correlated well with the histological findings (kappa=0.81). Pathological description of spleen specimens is inadequate. Trauma is the major reason for splenectomy. In elderly Nigerians, splenectomy specimen would likely show CLL

Histological Pattern of Cervical Malignancies in Southwestern Nigeria

Background: Malignant diseases of the uterine cervix are typically common among women in the developing countries of the world where they cause a lot of reproductive ill-health and mortality at the prime of age. Objectives:The aim of this study is to present the histological pattern of cervical malignancies as they present at Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) Ile-Ife between 1990 and 1999 Materials and Methods: The data for the study was collected retrospectively from the surgical daybooks of the histopathology department of the OAUTHC Ile-Ife from January 1990 to December 1999. All cervical biopsies and hysterectomy specimens from which a histopathological diagnosis of malignant tumour of the cervix was made form the subject for this study. Results: The results revealed 192 cases (45.5%) of cervical malignancies out of the 422 cervical surgical biopsies over the period of study. The age range of the patients was 20 to 89 years with a peak age incidence of 40 49 years. Histopathological study revealed squamous cell carcinoma in 85.4% with a preponderance of Large cell nonkeratinising squamous cell carcinoma in 41.1%, keratinising squamous cell carcinoma 32.3% while micro invasive carcinoma and small cell non keratinising tumours are seen in 1.0% and 9.9% respectively. Adenocarcinoma, adeno- squamous carcinoma, metastatic carcinoma and sarcomas occur in 8.3%, 3.6%, 1.6% and 1.0% respectively. Conclusion:Squamous cell carcinoma constitutes the main histological type with a high preponderance of large cell non-keratinising squamous cell carcinoma Key Words: Histological, Pattern, cervical, malignancies, Nigeria. [Trop J Obstet Gynaecol, 2004;21:118-121