Diabetes Co-existing with Chronic Liver Disease : Clinical Features and Reponse to Therapy

Background and objectives : Diabetes mellitus (DM) and chronic liver disease (cirrhosis) may co-exist in the same individual. Diabetes may cause non-alcoholic steatohepatitis with necroinflammatory changes and granuloma formation leading to hepatic fibrosis. Cirrhosis of the liver from alcohol and hepatitis C infection; on the other hand; may give rise to insulin resistance or may result in progressive impairment of insulin secretion leading to DM. We studied the clinical features and response to therapy of diabetic patients with the two conditions to determine if there are differences in the clinical features and effects of the chronic liver disease (CLD) on the management of DM. Methods: This was a prospective study conducted at the Diabetes Clinic at the Jos University Teaching Hospital (JUTH) over a period of two years. Newly diagnosed diabetics with features of CLD (cirrhosis) were enrolled into the study after obtaining a consent. Age; sex; body mass index (BMI); family history of diabetes were recorded; as well as symptoms and signs of DM or CLD. Serum fasting blood glucose (FBS); prothrombin time ratio (PTR); and serum fasting lipids (serum lipoproteins and serum triglycerides) were measured. Urinalysis was done. The responses to therapy were classified as very rapid; rapid and gradual based on our previous unpublished observations that diabetic patients with CLD responded briskly to antidiabetes therapy. Result : 26 patients (19 men; and 7 women) were seen with both diseases agreed to participate in the study. This accounted for 8.6of the diabetic population attending the diabetes clinic. The mean age of the patients was 54.6 (9.2 ) years spanning a range of 34-75 years. Mean BMI was 21.6 (6) kg/m2. The mean serum albumin concentration was 25.5 (8.5) g/l; mean FBS was 15.5 (3.4) mmol/l and PTR was 1.6 (0.43). Urinalysis showed glycosuriain all patients with only one patient showing trace of ketonuria. Clinical features of DM and CLD were few each. There was a brisk response to insulin therapy so that one needs to be cautious with insulin administration.Conclusion : Diabetes in patients with CLD has similar but fewer features compared to patients with type 2 DM. CLD affects the response to therapy; particularly insulintherapy and calls for caution; as these patients may be sensitive to therapy

Familial polycystic kidney disease in Nigeria: A report of two cases

A case of familial polycystic kidney disease is reported. Although isolated cases of adult polycystic kidney disease have been reported in our environment; no case to our knowledge has been reported with a familial link. Polycystic kidney disease is said to be rare in Africans. Although it commonly terminates in chronic renal failure; it hardly features in the aetiopathogenesis of end stage renal disease requiring some form of renal replacement therapy in African series. This; some workers believe may be due to misdiagnosis and under reporting. This report is to show that it may not be as rare as suspected; and that the familial link shown in the advanced countries is also applicable here. Case 1 was diagnosed in the course of evaluation of her clinical disease. Case 2; an aunt of Case 1; was diagnosed following investigation of a casual complaint of a painless abdominal mass in the wake of her senior brother's death from haemorrhagic stroke