Factors contributing to primary caregiver delay in presenting children with chronic kidney disease for medical care in Ghana

Background: Conforming to the 2016 World Kidney Day focus on raising awareness of the early detection of kidney diseases in children, we report on factors that contribute to primary caregiver delay in presenting their children with chronic kidney disease (CKD) for medical care in Kumasi, Ghana. Aim: The objective of the study was to explore and describe the factors that contribute to primary caregiver delay in presenting children with CKD for medical care in Kumasi, Ghana. Setting: The study was conducted in the Paediatric Renal Unit in Kumasi, Ghana. Methods: A qualitative study was conducted in January 2017. Semi-structured interviews were used to collect data from a convenience sample of 10 primary caregivers whose children were admitted for CKD, but were not too ill. The primary caregivers had to respond to the research question: What factors contribute to your delay in presenting your child with CKD for medical care? Thematic data analysis and the ecological model of Schneider (2017) were used to organise the findings. Results: Four themes and related subthemes, including intrapersonal-related factors, interpersonal-related factors, community-related factors and infrastructural factors were identified as those that contribute to delay in presenting children with CKD for medical care. Conclusion: The findings show that primary prevention strategies for CKD in children should not only focus on personal-related factors but also cut across all levels of the socio-ecological model in order for them to be effective

Hypertension in pregnancy: a future risk for chronic kidney disease in South Africa

Background. Hypertension in pregnancy is a risk factor for end-stage chronic kidney disease (ESKD) and is particularly common in South Africa (SA). There are no data for the risk of developing chronic kidney disease (CKD).Objectives. To conduct a study of all female patients who presented to the renal replacement programme at Groote Schuur Hospital, Cape Town, SA.Methods. This was a retrospective study of female patients with ESKD who were presented to renal replacement meetings between 2007 and 2017. For each patient who was assessed, there was a comprehensive letter detailing patient demographics, as well as psychosocial and medical history, which served as the source data. Patients with a history of hypertension in pregnancy were identified as the case group and those without the condition were the control group. Patient demographics, causes of CKD, kidney function and outcome of the meeting were documented.Results. Of the 415 female patients with ESKD, 70 (16.9%) had a history of hypertension in pregnancy. The ethnic breakdown was as follows: 132 (42.44%) black, 172 (55.3%) mixed ancestry and 7 (2.25%) white. Compared with the control group, the patients were younger, with a median age of 33 v. 41 years (p<0.001), higher serum creatinine 1 045 v. 751 µmol/L (p=0.017) and lower estimated glomerular filtration rate (eGFR) 4.0 v. 5.1 mL/min (p=0.029). Patients were more likely to abuse methamphetamine (5.7 v. 1.7%; p=0.049), and less likely to be diabetic (1.4 v. 20.9%; p<0.001) or HIV-positive (2.9 v. 12.5%; p=0.019). There were no ethnic differences between patients and controls. Underlying causes of renal disease showed significant differences, as patients were more likely to have hypertensive nephropathy (57.1 v. 22.9%; p<0.0001), and less likely to have diabetic kidney disease (1.4 v. 20.4%; p<0.001), HIV-associated nephropathy (HIVAN) (1.4 v. 6.4%) or polycystic kidney disease (1.4 v. 7.0%). There was no difference in acceptance to the dialysis and transplant programme (53 v. 47%).Conclusions. This study suggests an important link between hypertension in pregnancy and ESKD. The patients were significantly younger, presented later and were more likely to have hypertensive nephropathy. Methamphetamine abuse appears to be a risk factor. The study suggests that all women with hypertensive disorders during pregnancy need further evaluation and follow-up postpartum

Study of the prevalence of sodium and potassium disturbances in the elderly

Background: Electrolyte disturbances establish a broad problem among old individuals. A medication adverse effect that in youngsters would deliver just a trifling change in the plasma sodium and potassium may cause a major serious effect in the older, mostly because of aging. This study was directed to assess the commonness of sodium and potassium disturbances in the old. Methods: A Cross-sectional study was completed among old patients who were regular visitors to Internal Medicine Department outpatient clinics of the Zagazig University from February 2018 to February 2019. This examination included 100 older patients. Results: Our examination revealed the predominance of hypokalemia was 17% and hyperkalemia was 25%. While hyponatremia was 32% and hypernatremia was 4%. Diuretics were the most affecting medication on potassium and sodium levels. No significant difference was found in age among potassium and sodium gatherings. Conclusion: In this study, we found that disturbances in the sodium and potassium are commonly found in the old and a few sorts of medications are assosciated with these disturbances however diuretics were the most commonly to be found. Different components, including polypharmacy , disabled organ work and numerous ailments, put them at a more serious danger of medication induced changes in electrolyte homeostasis. Specialists should know about this hazard and screen both medication records and sodium and potassium levels ,so as to counteract and deal with these disturbances that may some way or another further affect the health of these old and frail patients

Prevalence and pattern of chronic kidney disease-mineral bone disorders among hemodialysis patients in kano, northwest Nigeria

Introduction: Mineral and bone disorders (MBD) are among the important complications of chronic kidney disease (CKD) including end-stage renal disease. In addition to the higher rate of all-cause and cardiovascular-related mortality, MBD is also a cause of significant morbidity in CKD patients. Materials and Methods: This is a cross-sectional study of all consenting patients on hemodialysis at Aminu Kano Teaching Hospital, between December 2011 and June 2012. With the aid of an interviewer-administered questionnaire, the demographic profile and clinical features of the patients were obtained. After a general physical examination, blood sample was taken for the determination of calcium, phosphate, intact parathyroid hormone, 25 hydroxy (25[OH]) Vitamin D3, packed cell volume, serum creatinine, and potassium. Results: Forty-eight patients on maintenance hemodialysis were recruited for the study, 39 (81.3%) were male and 9 (18.8%) were female. The age range was 40­59 years, with a mean of 45.96 ± 13.7 years. Chronic glomerulonephritis was the predominant cause of CKD (25%). Hyperphosphatemia was noted in 19 (39.5%) of the patients, whereas 22 (46%) had hypocalcemia. In 26 (54.1%) of the patients, the calcium-phosphate product was >4.55 mmol2/L2. We found that 58% of the patients had CKD-MBD, of which 15 (31%) had secondary hyperparathyroidism, whereas 13 (27%) had features suggestive of adynamic bone disease. None of the patient had normal serum 25(OH) Vitamin D3(mean: 43.79 ± 21 ng/ml). Conclusion: CKD-MBD is common among patients on hemodialysis in our center. Screening for CKD-MBD and appropriate use of phosphate binder and Vitamin D when indicated are highly recommended