Electrocardiographic evaluation of structural and electrical abnormalities in Nigerians with undiagnosed systemic hypertension

Essential hypertension has emerged as the commonest cardiovascular disorder in developing countries especially in Sub Saharan Africa. Blacks are known to suffer more severe hypertension and develop complications early. Some of the complications of hypertension can be detected early through non-invasive electrocardiography. The aim of this study is to evaluate the hypertension related abnormalities on the electrocardiograph of patients with untreated hypertension.Methodology: A detailed prospective analysis of the electrocardiographic tracing of all patients with untreated essential hypertension at first presentation over a six month period was undertaken. The patients were recruited from the medical outpatient clinic of the University of Port Harcourt Teaching Hospital.Result: A total of eighty three adult Nigerians aged 18years to 90 years who presented with untreated essential hypertension over the six months study period had their ECGs analyzed. There were thirty three males and fifty females (0.7:1); mean systolic blood pressure was 192.78+38.4mmHg and the mean diastolic blood pressure was 116.6+16.9mmHg. Sixty percent (60.22) had normal rhythm; and forty percent had various rhythm abnormalities; 77.6 had normal axis while 22.4 had left axis deviation; 45.8 had repolarisation abnormalities; 25.3 had evidence of left ventricular hypertrophy and 26.5 had various ventricular arrhythmias.Conclusion: Adult Nigerians presenting with hypertension for the first time have significant rhythm and structural abnormalities that should influence their clinical management and drug treatment choice. ECG is an important investigation and should be a mandatory evaluation for all newly presenting hypertensives

Spectrum of clinical presentations in human immunodeficiency virus (HIV) infected patients with renal disease

HIV infection is a multiorgan disease with the kidney not spared. A variety of renal syndromes with varying clinical presentations has been reported amongst HIV infected patients. This study aims to highlight the spectrum of clinical presentations in HIV infected patients with renal disease. HIV infected patients presenting at University of Benin Teaching Hospital (UBTH) Benin City were the study population. A total of 383 patients were studied. Their biodata; clinical presentations and laboratory investigations including serum urea; creatinine and albumin; urine protein and creatinine were assessed. Their glomerular filtration rate (GFR) and protein urine excretion were calculated using six equations of modification of diet in renal disease (MDRD) and protein: creatinine ratio respectively. Patients were stratified according to their renal functions into normal; mild; moderate and severe renal function impairment. The data was analysed using statistical software program SPSS Vs 15.0. 53.3of 383 patients screened had renal function impairment; 40.2mild; 37.7moderate and 22.28.3 years for mild; 9.9 and 36.3 8.3; 36.0 severe impairment. Mean age was 35.6 moderate and severe renal function impairment (RFI) respectively. Easy fatigability was the commonest symptoms occurring in 47.5; 30.0; 37.5and 22.5of control; mild RFI; moderate RFI and severe RFI subjects respectively (p = 0.568). Oliguria; facial and body swelling occurred more in patients with RFI especially in patients with severe renal impairment. The difference is statistically significant (p = 0.046; 0.041; and 0.033 respectively). Pallor was the commonest clinical sign occurring in 32.5; 50.0; 35.0and 62.5of control and patients with mild; moderate; and severe RFI respectively; the difference was not statistically significant (p = 0.459). Ascites; facial puffiness and pedal oedema were commoner in patients with RFI especially those with severe RFI. The differences were statistically significant. (p = 0.048; 0.019; and 0.008 respectively). In conclusion spectrum of clinical presentations in HIV patients with renal impairment are many but few are specific to these patients

Prevalence of Risk Factors for Chronic Kidney Disease in a Rural Adult Population in Rivers State

Background: The prevalence of chronic kidney disease (CKD) is on the increase globally with attendant heavy disease burden and high morbidity and mortality especially in the resource poor countries. Preventive measures are increasingly being explored. We undertook a survey to determine the prevalence of some risk factors of CKD and identify the at-risk individuals. Methods: Body mass index (BMI); dip-stick urine protein and urine glucose; random blood glucose and blood pressures were measured in adult subjects of Barako; a rural community in the Gokana Local Government area of Rivers state during a one-day Rotary eye camp exercise. Results: Out of the 154 subjects that responded; 152 satisfied the inclusion criteria and were studied. They had a mean age of 48.9 + 14.8(18-85) years and M:F ratio of 1:1.4. The mean body mass index (BMI) was 25.8 + 4.8 (11.1-40 .9) kg/m2. Forty-nine subjects (34.8) were pre-obese while 13.5were Obese. Proteinuria was seen in 29.7while none of the subjects had glycosuria. The mean random blood glucose was 6.6 +1.4(4.2-9.8) mmol/l. Four subjects (5) were previously diagnosed diabetics.The mean systolic blood pressure was 129.9 + 21.6(100-220) mmHg; mean diastolic blood pressure was 70.9 + 13.1(50-110) mmHg and the prevalence of hypertension was 27.9. BMI showed positive correlation with proteinuria (r = +0.2); while both systolic and diastolic blood pressures showed weak positive correlations with proteinuria (r = +0.02 and r = +0.06 respectively). Conclusions: The study shows; that the evaluated risk factors of CKD; obesity; hypertension; diabetes and proteinuria are common in this rural community of Rivers State

Occupational and environmental lead exposure in Port Harcourt, Nigeria: analysis of its association with renal function indices

Background: In spite of the high risk of lead exposure in Nigeria, there is a paucity of data on the occupational and environmental burden of lead exposure and its impact on human health especially its nephrotoxic effects. This study aims to assess the degree of occupational and environmental lead exposure in Port Harcourt Nigeria and the relationship between lead exposure and indices of renal function. Methods: A cross sectional comparative study of 190 adult subjects with occupational lead exposure and 80 matched controls. Blood lead was used as the biomarker of lead exposure. Serum urea, creatinine, uric acid, urine albumin and glomerular filtration rate were the renal function indices measured. Results: Occupationally lead exposed subjects had higher mean blood lead 50.37±24.58 ug/dl, than controls 41.40±26.85 ug/dl (p= 0.008). The mean values of serum urea, creatinine and uric acid were significantly higher in study subjects compared to controls 3.06±0.81 mmol/L vs. 2.7±0.84 mmol/L (p = 0.002), 87.2±14.30 umol/L vs. 80.68±14.70 umol/L (p = 0.001) and 271.93±71.18 umol/L vs. 231.1±62.70 umol/L (p = 0.000) respectively. Creatinine clearance was significantly lower in subjects compared to controls 98.86±21.26 ml/min/1.72m2 vs.108.18±25.16 ml/mi /1.72m2 (p = 0.002). Blood lead correlated positively only with blood urea [r = .031, r2 = .017, p = .031] and negatively [r = -.144, r2 = .021, p = .018] with serum phosphate. Conclusion: The level of environmental and occupational lead exposure in Port Harcourt, Nigeria is high, with occupational lead exposure increasing the risk of lead toxicity and renal function impairment