Renal Replacement Therapy in Children in the Developing World: Challenges and Outcome in a Tertiary Hospital in Southeast Nigeria

A 5-year observational, retrospective study was conducted to evaluate the indications, the availability, the accessibility, the sustainability, and the outcome of children managed for acute kidney injury (AKI) and end stage kidney disease (ESKD) who required renal replacement therapy RRT in Enugu, southeast Nigeria. A total of 64 patients aged 5 months to 16 years required RRT, of which only 25 underwent RRT, giving an RRT accessibility rate of 39.1%. Eleven (44%) patients required chronic dialysis program/ renal transplant, of which only 1 (9.1%) accessed and sustained chronic hemodialysis, giving a dialysis acceptance rate of 9.1%. Fifty (78%) of the patients belonged to the low socioeconomic class. Thirty-three (51.5%) could not access RRT because of financial constraints and discharge against medical advice (DAMA); 6 (9.4%) died on admission while sourcing for funds to access the therapy; 5 (7.8%) died while on RRT; 9 (14.1%) improved and were discharged for follow-up; 1 (1.6%) improved and was discharged to be on chronic dialysis program while awaiting renal transplantation outside the country/clinic follow-up, while the remaining 10 (15.6%) were unable to sustain chronic dialysis program or access renal transplantation and were lost to follow-up. We conclude that RRT remains unaffordable within the subregion

Impact of parity and gestational age of mothers with hypertension on birth weight, red blood cells and mode of delivery of their babies

Background: Maternal factors are determinants of birth outcome which includes birth weight, haematological indices and mode of delivery of their babies. Objectives: To determine the impact of parity and gestational age of hypertensive mothers on some neonatal variables. Methods: A hospital based cross-sectional study of measurement of neonatal variables (birth weight, red blood cells and mode of delivery) among hypertensive mothers and their controls was conducted over a period of six months. Data were analyzed using the Statistical Package for Social Sciences program (SPSS), version 20. Results: There were statistically significant differences in means between the neonates of the hypertensive group and non-hypertensive group for maternal age (t =1.61, p = 0.002), baby weight (t =2.87, p < 0.001), haemoglobin (Hb) (t =4.65, p = 0.010) and packed cell volume (PCV) (t =4.75, p = 0.009), but none for gravidity (t =1.95, p = 0.927) For all subjects, there was poor correlation between gestational age and variables; birth weight , haemoglobin (Hb), packed cell volume (PCV), nucleated red blood cell (nRBC) and parity. Likewise, parity poorly correlated with variables; age, birth weight, Hb, PCV, and nRBC. There was a statistically significant association between mode of delivery and hypertension (\u3c72 =53.082, p <0.001) but none with having a family history of hypertension (\u3c72 =1.13, p = 0.287). Conclusion: Parity and gestational age of mothers with hypertension have no impact on birth weight and red cells when compared with their non-hypertensive counterparts. However, mothers of babies delivered by elective and emergency caesarean section were about 2-3 times more likely to be hypertensive than those that delivered through spontaneous vertex delivery

Urinary screening for asymptomatic renal disorders in pre-school children in Enugu metropolis, South-east Nigeria: Useful or useless

To evaluate the usefulness of simple screening tests such as urinalysis and blood pressure measurement in the early detection of renal disorders in pre-School children, we used a multi-staged random sampling method to select subjects from registered nursery schools within Enugu metropolis in south-east Nigeria. We selected 630 children for this cohort study. There was a prevalence of 2.7%, 0% and 1.9% for asymptomatic proteinuria, hematuria and hypertension, respectively. There was no age, gender or social class preponderance (P = 0.44). Hypertension seemed to be limited to children close to the age group of five years (P <0.001). No correlations could be documented between asymptomatic proteinuria, hematuria or hypertension. The prevalence of persistent proteinuria was found to be 1.6% and the mean urinary protein excretion estimation (spot urine protein/creatinine) was 1.88 g/mg ± 0.53, with a mean glomerular filtration rate of 78.7 ± 12.6 mL/min/1.73 m 3 . Renal ultrasonography revealed abnormal findings in 30% of the children with persistent proteinuria. Asymptomatic persistent proteinuria with or without hematuria and hypertension could be a presumptive evidence of an underlying renal parenchymal disease and should be properly investigated and followed-up

Outcome of Late Presentation of Posterior Urethral Valves in a Resource-Limited Economy: Challenges in Management

Delayed presentation of patients with posterior urethral valve with complications like severe urosepsis, uremia, and anemia are seen in our setting. Renal replacement therapy which should have been offered to these patients is not readily available for children in our country. The aim of this study is to determine the pattern of late presentation and outcome of management of posterior urethral valve in a resource-limited setting. A descriptive retrospective study (1997–2009) was conducted. Data including pattern of presentation, duration of symptoms, complications, and outcome of initial management were analyzed. Twenty-one patients were seen. The median age was 3 years (2 days–13 years). The mean duration of symptoms before presentation was 2.6 years. Nineteen patients (91%) presented with urosepsis while 8 patients (36%) presented with significant renal insufficiency. Laboratory findings varied from-mild-to marked elevation in serum creatinine. Radiological findings confirmed the diagnosis of posterior urethral valve. We concluded that late presentation is common in our setting. This is associated with high morbidity and mortality rates. Efforts at improving awareness and early diagnosis among the health team should be made to stem the tide