Prevalence, clinical and laboratory characteristics of kidney disease in antiretroviral naïve HIV infected patients in South-South Nigeria

Background: Since the emergence of acquired immune deficiency syndrome (AIDS) about three decades ago, several renal disorders have been reported as common complications of the human immunodeficiency virus (HIV) infection. These renal disorders have resulted from diverse aetiologies. The aim of this study was to determine the prevalence, clinical and laboratory characteristics of antiretroviral naïve HIV-infected patients with impaired kidney disorder in South-South Nigeria.Methods: This was a cross-sectional study of antiretroviral naïve HIV-infected patients presenting at the University of BeninTeaching Hospital (UBTH), Benin City in South-South Nigeria for six months. The patients biodata, clinical,haematological and biochemical parameters were assessed. Their glomerular filtration rate using the six equation ofMDRD and protein excretion was calculated from protein-creatinine ratio. Data was analysed using statistical software program SPSS version 15.0.Results: Three hundred and eighty-three (383) patients with a mean age of 35.39 ± 8.78 years with a male/female ratio of 1:1 were studied. Of these 53.3% had evidence of kidney disorder. The main clinical features in patients with kidney disorder were evidence of fluid retention, urinary symptoms, pallor and encephalopathy. The mean systolic and diastolic blood pressure was 115.33 ± 17.17 and 72.33 ± 14.31 mmHg respectively. The mean estimated glomerular filtration rate (eGFR) was 52.5 ml/minute/1.73mm2. Patients with kidney disorder had worse proteinuria (p = 0.001), lower mean CD4 cell count, and packed cell volume (p = 0.019 and 0.001 respectively).Conclusion: Kidney disorder is a common complication in HIV-infected patients and they have clinical and laboratory anomalies. Screening of HIV/AIDS patients at point of diagnosis will facilitate early diagnosis of kidney disorders in them

Case Report - Analgesic nephropathy as a cause of end‑stage renal disease in a 55 year‑old Nigerian

Analgesic nephropathy is a subtle but significant cause of chronic renal failure. There is paucity of data on analgesic nephropathy in Nigeria. This case presentation is to highlight the need to have high index of suspicion in patients at risk of developing analgesic nephropathy. In March 2009 a 55‑year‑old businessman was referred to the renal unit on account of azotemia by the hematologist who had hitherto managed the patient as a case of refractory anemia. The patient had osteoarthritis for over 10 years and was managed with several analgesic drugs over the same period. He was found to have features suggestive of analgesic nephropathy and had end‑stage renal disease. He was commenced on appropriate therapy, and he had a live related kidney transplant six months later. Analgesic nephropathy is preventable and morbidity/mortality can be remarkably reduced with appropriate and prompt intervention

Prevalence and correlates of chronic kidney disease among civil servants in Bayelsa state, Nigeria

Introduction: Chronic kidney disease (CKD) has become a public health problem with rising incidence and prevalence world-wide. Despite the fact that Sub-Saharan Africa, including Nigeria appears to be badly hit by this epidemic, there is a paucity of data on CKD prevalence in these regions and where data exists, they are mostly hospital-based.Objectives: The present study was carried out to determine the prevalence and correlates of CKD in an urban civil service population in Bayelsa State, Nigeria.Materials and Methods: A total of 179 civil servants in the Bayelsa State secretariat were screened for CKD during the World Kidney Day on March 2012. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2 body surface area and/or proteinuria. Socio-demographic data was obtained using interviewer.administered semi-structured questionnaire while anthropometric measurements were taken. Blood pressure (BP), urinalysis, serum urea and creatinine were also assessed.Results: The prevalence of CKD in the study was 7.8%. Age >50 years was associated with CKD in univariate analysis but none of age, gender, body mass index, BP or hyperglycemia independently predicted it.Conclusion: The prevalence of CKD among Nigerian civil servants was fairly high and was associated with advancing age. Routine screening for CKD in this population is recommended.Key words: Bayelsa, civil servants, kidney disease, Nigeria, prevalenc

Congenital malaria in Urabá, Colombia

<p>Abstract</p> <p>Background</p> <p>Congenital malaria has been considered a rare event; however, recent reports have shown frequencies ranging from 3% to 54.2% among newborns of mothers who had suffered malaria during pregnancy. There are only a few references concerning the epidemiological impact of this entity in Latin-America and Colombia.</p> <p>Objective</p> <p>The aim of the study was to measure the prevalence of congenital malaria in an endemic Colombian region and to determine some of its characteristics.</p> <p>Methods</p> <p>A prospective, descriptive study was carried out in the mothers who suffered malaria during pregnancy and their newborns. Neonates were clinically evaluated at birth and screened for <it>Plasmodium spp</it>. infection by thick smear from the umbilical cord and peripheral blood, and followed-up weekly during the first 21 days of postnatal life through clinical examinations and thick smears.</p> <p>Results</p> <p>116 newborns were included in the study and 80 umbilical cord samples were obtained. Five cases of congenital infection were identified (four caused by <it>P. vivax </it>and one by <it>P. falciparum</it>), two in umbilical cord blood and three in newborn peripheral blood. One case was diagnosed at birth and the others during follow-up. Prevalence of congenital infection was 4.3%. One of the infected newborns was severely ill, while the others were asymptomatic and apparently healthy. The mothers of the newborns with congenital malaria had been diagnosed with malaria in the last trimester of pregnancy or during delivery, and also presented placental infection.</p> <p>Conclusions</p> <p>Congenital malaria may be a frequent event in newborns of mothers who have suffered malaria during pregnancy in Colombia. An association was found between congenital malaria and the diagnosis of malaria in the mother during the last trimester of pregnancy or during delivery, and the presence of placental infection.</p

Pregnancy in a 24 year old Nigerian woman with chronic kidney disease: Challenges and outcome

There is increasing incidence and prevalence of chronic kidney disease worldwide. The developing countries including Nigeria are facing greater challenges because of the prevailing poverty and high burden of infectious diseases. There are various prevalent co-morbid conditions that influence and are influenced by the status of the kidney function of the patient. These conditions pose some peculiar challenges and management of the challenges will determine the outcome. The aim of this report is to highlight the challenges of pregnancy in women with chronic kidney disease and possible outcome. We report a 24 years Nigerian woman diagnosed with chronic kidney disease who presented with 10 weeks gestation and deteriorating kidney function. Her management was associated with various challenges including non adherance to medications and not regular to follow up visits. She later developed ecclampsia and had intra uterine fetal death. She had various interventional measures including haemodialysis. She recovered kidney function appreciably but has defaulted follow up since discharge.KEY WORDS: pregnancy, CKD, challenges, outcome, hypertension, proteinuri

Anasarca in a 35 year old man- A diagnostic dilemma

Anasarca is generalized swelling of the body following accumulation of fluid in the extracellular compartments. It may result from multiple aetiology mainly of renal, hepatic or cardiovascular origin. The aim of this case report is to highlight the challenges encountered in making diagnosis in a patient with anarsaca. We report a case of a 34 year old transporter who presented with anasarca. He had clinical features and risk factors suggestive of renal, hepatic and cardiovascular disease. However investigations ruled out renal, hepatic or cardiovascular diseases as the aetiology of the anarsaca. The anarsarca was also noted to be unresponsive to diuretics. The diagnosis of the disease causing the anarsaca was therefore a dilemma

Renal disease in HIV infected patients at University of Benin Teaching Hospital in Nigeria

Background: HIV related renal disease is a common occurrence in patients with HIV infection. It is the third leading cause of end stage renal disease among African-American males between the ages of 20 and 64 years in USA. Renal function impairment has been reported at all stages of HIV infection. The aim of this study is to determine the relationship between severity of renal function impairment and CD4 cell count in HIV infected patients. Method: HIV patients presenting at University of Benin Teaching Hospital Benin, City Nigeria from 1st January to 30th June 2007 were randomly selected and screened for renal functional impairment (RFI). Those with RFI detected by glomerular filtration rate < 60ml/min/1.73m2 or urine protein creatinine ratio ³ 200 were stratified into mild, moderate and severe RFI. Forty patients from each stratum and forty HIV infected patients with normal renal functions were recruited as subjects and control respectively. Their clinical and laboratory parameters were evaluated. The data obtained were analysed using SPSS vs 15.0. Results: Of the HIV patients screened, 53.3% had renal functional impairment. of these, 40.2% had mild, 37.7% had moderate and 22.2% had severe impairment in their renal functions respectively Their mean age was 36.0±8.8 years. The CD4 cell count was found to be 309.75 ± 268.71/ul, 188.45 ± 173.12/ul, and 141.10±126.01/ul among subjects with mild, moderate and severe RFI respectively. The CD4 cell count in control group was 319.05 ± 248.41/ul. The difference was statistically significant. (p = <0.001). CD4 cell count had a significant positive correlation with GFR (r = 0.32, p = 0.042). However, there was a negative correlation between CD4 cell count and proteinuria but this was not statistically significant (r = 0.09, p = 0.173). Conclusion: Severity of RFI has a positive correlation with degree of immunosuppression in HIV infected patients