Incidence and predictors of acute kidney injury in children with severe malaria

    Background Acute kidney injury (AKI) is an underrecognized complication of severe malaria and an independent risk factor for mortality among children. Objective To determine the incidence and factors predictive of AKI as defined by the pediatric risk, injury, failure, loss, and end-stage (pRIFLE) criteria in children with severe malaria and to assess in-hospital mortality rates in malarial AKI (MAKI). Methods This was a prospective cohort study in 170 children aged 0.5 to 14 years with confirmed Plasmodium falciparum on peripheral blood smears and clinical and/or laboratory features of severe malaria. Serum creatinine was determined using the Jaffe method and glomerular filtration rate (eGFR) was estimated using the Schwartz equation. The primary outcome was the incidence of AKI as defined by the pRIFLE criteria. Secondary outcomes included in-hospital mortality comparison between AKI and non-AKI groups, as well as factors predictive of AKI. Results The incidence of MAKI was 61.2% (104/170) and was comparable between males (66.7%) and females (70.6%). Mean eGFR was lower among children with AKI than those without [42.00 (SD 22) vs. 98.7 (SD 3.9) mL/min/1.73m2, respectively; P=0.005]. Children with MAKI were categorized as having risk (47/104; 45.2%), injury (33/104; 31.7%), or failure (24/104; 23.1%). Mortality rates in AKI and non-AKI subjects were comparable (4.8% vs. 4.6%; P=0.888). Predictors of MAKI were hemoglobinuria [adjusted OR (aOR) 3.948; 95%CI 1.138 to 8.030], deep acidotic breathing (aOR 2.991; 95%CI 3.549 to 66.898), and longer hospital stay (aOR 2.042; 95%CI 3.617 to 12.156). Children with MAKI were more likely to have a longer hospital stay by a mean of 2.5 days. Conclusion AKI is a common complication in children with severe malaria. MAKI has a low mortality rate comparable to those with severe malaria but without AKI.  Hemoglobinuria, deep acidotic breathing, and longer hospital stay were predictive of MAKI.

Prevalence of chronic kidney disease and risk factors in North-Central Nigeria: a population-based survey

Background

Chronic kidney disease (CKD) is a growing challenge in low- and middle-income countries, particularly in sub-Saharan Africa. There is insufficient population-based data on CKD in Nigeria that is required to estimate its true burden, and to design prevention and management strategies. The study aims to determine the prevalence of CKD and its risk factors in Nigeria.

Methods

We studied 8 urban communities in Kwara State, North-Central zone of Nigeria. Blood pressure, fasting blood sugar, urinalysis, weight, height, waist circumference and hip circumference were obtained. Albuminuria and kidney length were measured by ultrasound while estimated glomerular filtration rate (eGFR) was derived from serum creatinine, using chronic disease epidemiology collaboration (CKD-EPI) equation. Associations of risk factors with CKD were determined by multivariate logistic regression and expressed as adjusted odds ratio (aOR) with corresponding 95% confidence intervals.

Results

One thousand three hundred and fifty-three adults ≥18 years (44% males) with mean age of 44.3 ± 14.4 years, were screened. Mean kidney lengths were: right, 93.5 ± 7.0 cm and left, 93.4 ± 7.5 cm. The age-adjusted prevalence of hypertension was 24%; diabetes 4%; obesity 8.7%; albuminuria of > 30 mg/L 7%; and dipstick proteinuria 13%. The age-adjusted prevalence of CKD by estimated GFR < 60 ml/min/1.73m² and/or Proteinuria was 12%. Diabetes (aOR 6.41, 95%CI = 3.50–11.73, P = 0.001), obesity (aOR 1.50, 95%CI = 1.10–2.05, P = 0.011), proteinuria (aOR 2.07, 95%CI = 1.05–4.08, P = 0.035); female sex (aOR 1.67, 95%CI = 1.47–1.89, P = 0.001); and age (aOR 1.89, 95%CI = 1.13–3.17, P = 0.015) were the identified predictors of CKD.

Conclusions

CKD and its risk factors are prevalent among middle-aged urban populations in North-Central Nigeria. It is common among women, fueled by diabetes, ageing, obesity, and albuminuria. These data add to existing regional studies of burden of CKD that may serve as template for a national prevention framework for CKD in Nigeria. One of the limitations of the study is that the participants were voluntary community dwellers and as such not representative for the community. The sample may thus have been subjected to selection bias possibly resulting in overestimation of CKD risk factors.

Cutaneous disorders of adolescence among Nigerian secondary school students

Introduction

A community-based, age-specific survey of skin disorders is usually necessary to characterize the true burden of skin disease among a given population and help to tailor health care personnel training and delivery towards the prevalent disorders in resource poor settings.

Methods

This was a descriptive cross-sectional study among adolescents attending secondary schools in Ilorin, Kwara State, Nigeria. A thousand and three hundred students were recruited from public and private secondary schools through a multi-staged stratified random sampling method. Information was obtained via a semi-structured questionnaire and all students underwent a physical examination. Data was analysed using SPSS version 20. Information generated was presented with tables and figures.

Results

The prevalence of skin disease in the study was 66.5%. More females, mid-adolescents, students in senior class and those attending public schools had skin disorders. The most prevalent skin disease were: acne vulgaris, pityriasis versicolor, tinea capitis, pityriasis capitis and traction alopecia.

Conclusion

Skin conditions are highly prevalent among the adolescent population. Infective and inflammatory skin conditions appear to be more prevalent than other classes. Most times, only a few skin disorders account for the bulk of dermatoses affecting this age group. Adolescent skin healthcare should be subsidized because of the high prevalence of skin disorders in this age group.

Left Ventricular Outflow Tract Thrombus in a Child with Dilated Cardiomyopathy: An Atypical Location

Dilated cardiomyopathy (DCM) may be associated with formation of intracardiac thrombi which may embolize and result in life-threatening complications. We present a 19-month-old female child with DCM who presented with a right hemispheric cerebrovascular accident. Urgent echocardiography revealed poor left ventricular systolic function and a thrombus attached to the interventricular septum along the left ventricular outflow tract. There was resolution of the thrombus following the use of warfarin.

Correlation between dipstick urinalysis and urine sediment microscopy in detecting haematuria among children with sickle cell anaemia in steady state in Ilorin, Nigeria

Introduction

Haematuria is one of the clinical manifestations of sickle cell nephropathy. Although dipstick urinalysis detects haemoglobin and by extension haematuria; it does not confirm haematuria. Urine sediment microscopy confirms haematuria and constitutes a non-invasive “renal biopsy”. The need to correlate dipstick urinalysis and urine sediment microscopy findings becomes important because of the cheapness, quickness and simplicity of the former procedure.

Methods

Dipstick urinalysis and urine sediment microscopy were carried (both on first contact and a month after) among consecutive steady state sickle cell anaemia children attending sickle cell clinic at the University of Ilorin Teaching Hospital between October 2004 and July 2005.

Results

A total of 75 sickle cell anemia children aged between 1-17 years met the inclusion criteria. Haematuria was found in 12 children (16.0%) and persistent haematuria in 10 children 13.3%. Age and gender did not have significant relationship with haematuria both at first contact (p values 0.087 and 0.654 respectively) and at follow-up (p values 0.075 and 0.630 respectively). Eumorphic haematuria was confirmed in all the children with persistent haematuria with Pearson correlation +0.623 and significant p value of 0.000.

Conclusion

The study has revealed a direct significant correlation for haematuria detected on dipstick urinalysis and at urine sediment microscopy. It may therefore be inferred that dipstick urinalysis is an easy and readily available tool for the screening of haematuria among children with sickle cell anaemia and should therefore be done routinely at the sickle cell clinics.

Sickle cell Nephropathy in children seen in an African Hospital - Case Report

AIMS AND OBJECTIVES

To determine and report the occurrence of overt renal presentations in children with sickle cell disease seen over the last 14 years (1995-2009) at the Emergency Paediatric Unit and Paediatric Ward and followed up at the Paediatric Nephrology clinic of University of Ilorin Teaching Hospital, Ilorin (UITH).

PATIENTS AND METHODS

The five cases with overt renal presentations seen during the period were reported and analyzed for age, sex, and renal manifestations.

RESULTS

The age range of the children was 9-15years with a mean of 11years. Four of the five patients were females, with one male. Three of the four females presented with features suggestive of nephrotic syndrome (NS) while the other one had gross haematuria which resolved within 24 hours. The only male had enuresis. The NS in one of the patients progressed to end stage renal disease requiring renal replacement therapy.

CONCLUSION

Children with sickle cell disease should be screened for renal complications especially from the late first decade of life. This will help in the early detection of renal disorder that could lead to chronic kidney disease. It is also suspected that the severe forms of SCN such as NS may have a predilection for the female gender. A more extensive study is needed to test the veracity of this observation.

Predicting the clinical outcome of severe falciparum malaria in african children: findings from a large randomized trial

Four predictors were independently associated with an increased risk of death: acidosis, cerebral manifestations of malaria, elevated blood urea nitrogen, or signs of chronic illness. The standard base deficit was found to be the single most relevant predictor of death.

Background. Data from the largest randomized, controlled trial for the treatment of children hospitalized with severe malaria were used to identify such predictors of a poor outcome from severe malaria.

Methods. African children (<15 years) with severe malaria participated in a randomized comparison of parenteral artesunate and parenteral quinine in 9 African countries. Detailed clinical assessment was performed on admission. Parasite densities were assessed in a reference laboratory. Predictors of death were examined using a multivariate logistic regression model.

Results. Twenty indicators of disease severity were assessed, out of which 5 (base deficit, impaired consciousness, convulsions, elevated blood urea, and underlying chronic illness) were associated independently with death. Tachypnea, respiratory distress, deep breathing, shock, prostration, low pH, hyperparasitemia, severe anemia, and jaundice were statistically significant indicators of death in the univariate analysis but not in the multivariate model. Age, glucose levels, axillary temperature, parasite density, heart rate, blood pressure, and blackwater fever were not related to death in univariate models.

Conclusions. Acidosis, cerebral involvement, renal impairment, and chronic illness are key independent predictors for a poor outcome in African children with severe malaria. Mortality is markedly increased in cerebral malaria combined with acidosis.

Clinical Trial Registration. ISRCTN50258054.

Bladder stone in a three-year-old Nigerian child with posterior urethral valve: a case report

BACKGROUND

Stone in the bladder is an uncommon presentation in the tropics, especially in children. Its rarity makes the index of suspicion to be low. Patients presenting with it may be mistaken for urinary tract infection (UTI) because of the presence of frequency and dysuria.

OBJECTIVE

To present a rare cause of urinary bladder stone in a child in the tropics.

METHODS

The patient, a three-year-old boy, presented with recurrent episodes of dysuria and stragury for a duration of about one year. Work up included clinical evaluation and laboratory assessments, results of which informed surgical intervention.

RESULTS

The child had been treated repeatedly for urinary tract infection. He was acutely ill with suprapubic tenderness dysuria and poor urinary stream. He was hypertensive. Micturating cystourethrography showed posterior urethral valves and a bladder stone. He had vesicolithotomy and valvotomy with improvement of his blood pressure.

CONCLUSION

The coexistence of bladder stone with PUV coupled with delayed diagnosis may be a predisposing factor to hypertension in children. Conventional surgical treatment gives good results.

Urinary tract infections in children with primary nephrotic syndrome and acute glomerulonephritis

BACKGROUND

The occurrence of urinary tract infection (UTI) in children with nephrotic syndrome (NS) has been widely reported by various workers, but not much has been documented about its occurrence among children with acute glomerulonephritis (AGN). Hence, the level of susceptibility to UTI by both diseases has not been compared.

OBJECTIVE

To determine and compare the prevalence of UTI in children newly diagnosed of AGN or NS.

METHODS

Urinary microscopy, culture and sensitivity of all children admitted with a diagnosis of NS and AGN between 1996-2004 were reviewed. Children with NS who had a relapse or were commenced on steroids, cytotoxic agents or antibiotics before admission were excluded from the study.

RESULTS

A total of 35 and 32 children diagnosed of AGN and NS respectively met the study criteria. Urinary tract infection occurred in three (9%) children with AGN and one (3%) of the children with NS. The organisms isolated among the AGN patients included Coliforms, Klebsiella, and Staphylococcus aureus while Coliform was isolated in the only NS patient with UTI.

CONCLUSION

There is a low prevalence of UTI in children newly diagnosed of AGN and NS.

Poisoning due to yam flour consumption in five families in Ilorin, Central Nigeria

BACKGROUND

Food poisoning is known to occur sporadically from time to time due to poor hygienic preparation. Its occurrence rarely assumes epidemic proportion.

OBJECTIVE

To report the ccurrence of food poisoning due to yam flour consumption among five families and to create public awareness about the condition.

CASE REPORT

Food poisoning due to yam flour consumption which occurred almost in quick succession between February and July 2005 among five family clusters in Ilorin is reported. They presented variedly with diarrhoea, vomiting, abdominal pain, convulsion and loss of consciousness. They all recovered within 48 hours of admission. Even though we could not carry out toxicological tests, yam flour consumption was highly implicated as the cause. Investigations indicated that the use of certain lethal preservatives for the processing of the yam flour might be responsible.

CONCLUSION

Poisoning from consumption of yam flour should be a differential diagnosis of acute seizure disorder or the occurrence of vomiting, diarrhoea and abdominal pain in the tropics. We recommend education on proper processing of all food products in view of the public health implication of doing otherwise.

Knowledge, attitude and perception of adults on childhood hypertension in a rural community in Nigeria

BACKGROUND

Childhood hypertension is less common and not readily recognised compared to adult hypertension. It is being missed because of lack of routine blood pressure measurements in some health facilities in the developing countries. This setback is likely to affect the knowledge, attitude and perception of parents and caregivers to the disease.

OBJECTIVE

To assess the knowledge, attitude and perception of childhood hypertension by adult respondents in a rural community in Nigeria.

METHOD

The study was carried out with the aid of pre-tested questionnaires, which sought information on wide ranging issues bothering on knowledge, attitude and perception of childhood hypertension.

RESULTS

Fifty-four 54/62 (89%) knew that hypertension implied high blood pressure. Fifty-eight 58/61(95%) also indicated that hypertension is detected by measuring the blood pressure. However 37/60 (62%) respondents did not think that childhood hypertension exist, while 53/59 (90%) respondents were not aware of any child diagnosed with hypertension. All our 62 respondents claimed to have seen 9 children with hypertension compared to 81 adults some of whom were related to them.

CONCLUSIONS

We conclude that there is still a low awareness about the existence of childhood hypertension by the rural populace. While this problem is not a priority health problem in the community, an increased awareness of it is crucial the successful management of any child that develops it. Periodic community survey for childhood hypertension and mandatory routine blood pressure measurement in all children presenting for consultation is suggested.

Bacterial pathogens and outcome determinants of childhood pyogenic meningitis in Ilorin, Nigeria

Empirical antimicrobial therapy remainsjustifiable in childhood pyogenic meningitis (CPM), but the continuing efficacy in a particular setting requires periodic microbiological surveillance. It was this need that informed the present five-year retrospective study of consecutive admissions for CPM at the Emergency Paediatric Unit (EPU) of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Of the 71 cerebro-spinal fluid [CSF] analyses, 41 (57.6%) were Gram-smear positive (GSP). Gram-positive cocci (GPC) were identified in 23 (56.1%) smears, while 14 (34.2.%) had Gram-negative bacilli (GNB). Only three (7.3%) had Gram-negative diplococci (GND). Despite corroborative biochemical findings, the remaining 30 (42.3%), including two with tuberculous meningitis proved smear-negative. GPC cases had a mean age of 4.49 +/- 5.3yrs, GNB, 3.06 +/- 4.8yrs and GND, 4.47 +/- 4.9yrs. CSF isolates were made in 28 (39.4%) cases. Streptococcus pneumoniae accounted for a predominant 22 (78.6%) (P = 0.00), Haemophilus influenzae for 2 (7.1%), and Neisseria meningitidis for only 1 (3.5%) case. Whereas Strept. pneumoniae and H. influenzae isolates were uniformly sensitive to each of sultamicillin, cefuroxime, ceftriaxone and ceftazidime, 7.7% of Strept. pneumoniae were resistant to crystalline penicillin, 6.7% to ampicillin, and 69.2% to chloramphenicol; one of the two H. influenzae isolates was chloramphenicol-resistant. Amongst the 30 (42.3%) fatal cases, the length of stay was significantly shorter in GNB-positive cases (P = 0.045). Mortality was significantly higher amongst cases with purulent/turbid CSF at admission (P = 0.03), and in those with CSF protein of >150mg/dl (P = 0.02) and glucose <1mg/dl (P = 0.047). The present aetiological preponderance of GPC and Strept. pneumoniae in our study population, the high case-fatality, and the emerging resistance profile suggest the need for exploring additional control options including vaccination. We emphasize the need for periodic auditing of local antimicrobial policies in CPM.

Serum electrolyte, urea and creatinine in clinically stable Nigerian newborn

Serum electrolytes urea and creatinine of 80 clinically stable normal newborn comprising 60 preterm and 20 term appropriate for gestational age babies were prospectively studied. A negative correlation between the serum sodium, potassium, urea, creatinine and the gestational age was found. A statistical significant difference in the mean values of serum urea and creatinine in both preterm and term babies was obtained but there was no statistical significant difference in the mean value of serum sodium and potassium.