Diabetic Nephropathy in Childhood: Predictive Tools and Preventive Strategies

Diabetic nephropathy is the commonest microvascular complication in both types 1 and 2 diabetes mellitus. Disease pathogenesis is based on a multifactorial interaction between metabolic and hemodynamic factors. In response to hyperglycemia, which disrupts the body’s metabolic milieu, a cascade of complex molecular events occur leading to glomerular hypertrophy, tubular inflammation, mesangial expansion, oxidative stress, and renal fibrosis. Beyond the conventional microalbuminuria, which can predict disease onset, novel biomarkers are now proving more reliable as predictive tools. While several reports show that glomerular and tubular biomarkers are more sensitive than microalbuminuria, tubular markers specifically constitute earlier predictors of the disease. Similarly, biomarkers of inflammation and oxidative stress have been demonstrated as dependable diagnostic tools. As an important cause of mortality from end-stage renal disease (ESRD), diabetic nephropathy constitutes an important challenge in diabetic care. Interestingly, strict glycemic control assessed by glycated hemoglobin (Hb A1 c) estimates, and antihypertensive therapy with angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARB) ± calcium-channel blockers form the main strategies for preventing its onset and slowing down its progression. Other strategies include uric acid antagonist, and renin and endothelin inhibitors. This book chapter discusses these predictive tools and possible preventive strategies

Factors associated with low rate of exclusive breastfeeding among mothers in Enugu, Nigeria

Background: Exclusive breastfeeding has proven to be beneficial both maternal and child health hence its adopted as a policy for infant feeding in most countries especially developing nations. Its practice has remained low despite the high levels of awareness of exclusive breastfeeding. The study set out to find out the possible reasons that have limited the translation of knowledge of exclusive breastfeeding to action by nursing mothers in an urban city in Nigeria.Methods: A self-administered structured questionnaire was used to collect data from 304 mothers attending immunization clinics of the Institute of maternal and child health in Enugu, Southeast Nigeria.Results: Awareness of exclusive breastfeeding was 98% with an exclusive breastfeeding rate of 26%. The commonest non-human milk given to infant was water- given in the first week of life. Post-natal support from lactation experts and family, beliefs about the sufficiency of human milk and subsequent refusal of complementary foods were major challenges to successful exclusive breastfeeding. Maternal age and education did not determine exclusive breastfeeding.Conclusions: Exclusive breastfeeding rates have remained low in Nigeria. Lack of family support and the belief that human milk is not sufficient food for the less-than-six-months-old infant were major challenges to exclusive breastfeeding

The effectiveness of locally-prepared peritoneal dialysate in the management of children with acute kidney injury in a south-east Nigerian tertiary hospital

Background: Peritoneal dialysis (PD) is the preferred mode of renal replacement therapy (RRT) in children with acute kidney injury (AKI). The gold standard remains the use of commercially-prepared PD fluid. In resource-poor nations, its availability and affordability remain a challenge.Aim: This study aims to report the effectiveness of locally-prepared PD fluid in the management of AKI in a south-east Nigerian tertiary hospital.Subjects and Methods: This was a retrospective study conducted at the paediatric ward of the University of Nigeria Teaching hospital, Enugu. The case records of 36 children seen over three years, diagnosed with AKI and requiring PD were reviewed. The retrieved information comprised biodata, aetiology of AKI, indications for PD, pre-and post-dialysis estimated glomerular filtration rate (eGFR) and patient outcomes.Results: The children (20 males and 16 females) were aged 3 to 36 months with a mean age of 9.92 ± 6.29 months. The common aetiologies of AKI were septicemia (30.6%), hemolytic uremic syndrome (19.4%), and toxic nephropathy (16.7%). The frequent indications for PD were uremic encephalopathy (58.3%) and severe metabolic acidosis (38.8%). The pre-and post-dialysis mean urine flow rate was 0.16 + 0.13 and 2.77 + 0.56 ml/kg/hour respectively. The eGFR before PD, at discontinuation, and a week later was 6.06 + 2.87, 24.44 + 15.71 and 59.07 + 22.22 mls/min/1.73m2 respectively.Conclusion: PD with locally-prepared dialysate is safe, effective and a life-saving alternative in the management of AKI in childrenKeywords: Peritoneal dialysis; renal replacement therapy; acute kidney injury; children; dialysate; developing country

School health services in Enugu East, Nigeria: perspectives from a resourcepoor setting

School health services (SHS) have widespread impact on the health of a large number of children with implications on access to primary health care especially in developing countries. The aim of this study was to assess health services in primary schools in Enugu East Nigeria. Thirty-three head teachers of primary schools in Enugu east Nigeria and officials of Ministry of Education were interviewed using a questionnaire adapted from school health evaluation scale. Four private schools had health personnel. Only six private schools had a health room. Two public schools had a functional first aid box. There were no health records available in any of the schools. School lunch was given by only one private school. Of a maximum of 45, public and private schools had a mean score of 10.3 and 12.7 respectively on the school health evaluation scale (P=0.01). Three schools only attained the minimum acceptable score of 19. Health services are at a minimal level in primary schools in Enugu East Nigeria. A state school health policy should be developed through inter-sectoral collaboration of the relevant stakeholders to use the platform provided by schools to ensure access to primary health care and also act as bridge for more formal medical care for school children

Bio-electric impedance analysis of body composition and glycaemic control in children and adolescents with type 1 diabetes in south-east, Nigeria

Background: Metabolic derangements in diabetes grossly affect components of body composition particularly the fat mass. Adequate glycaemic control is key to the reduction of risks of associated complications.Objectives: To determine the pattern of glycaemic control and body composition in children and adolescents with type 1 diabetes mellitus (T1DM).Methodology: This was a cross sectional descriptive study conducted in three centres in South-East Nigeria. Subjects were T1DM patients attending diabetic clinics at the hospitals who were consecutively recruited while controls were normal school children.Body composition was determined using bio-electrical impedance analysis method. Data was collected using a semi -structured proforma designed for the study and was subsequently analysed using SPSS version 22.0. The level of statistical significance was set at p< 0.05.Results: A total of 108 children and adolescents comprising 54 diabetic patients and 54 controls (age and sex matched) were studied. The mean age of the subjects was 16.3 ± 3.5 years.Majority of the patients had high HbA1c, with a mean and range values of 11.3 ± 2.4 and 7.0 – 13.0%, respectively. The body composition parameters among subjects including the body mass index, skeletal muscle percentage, visceral fat percentage and resting metabolic rate were lower than that of the controls.Conclusion: A majority of the subjects had poor glycaemic control with overall lower measured body composition parameters. There is need to improve glycaemic control and maintain normal body composition in children and adolescents with T1DM in order to minimize the risks of diabetic complications in them.Keywords: Body composition; Glycaemic control; Children; Adolescent