Childhood acute glomerulonephritis in Ibadan Nigeria

Background: Acute glomerulonephritis (AGN) is an important cause of mortality and morbidity in children in developing countries while its incidence has declined in the developed world. This study was to document its present impact in our setting.Aim: To evaluate the sociodemographic features and clinical outcomes in children hospitalized for AGN in the Paediatric Nephrology Unit of the University College Hospital, Ibadan.Subjects and Methods: This was a descriptive analytical study of children aged 2 to 14 years admitted with AGN between 2007 and 2019. Their sociodemographic data, clinical features, complications and outcome were analysed.Results: AGN accounted for 116 (8.9%) of new renal cases admitted over the period. Seventy-four (63.8%) were male, mean age (SD) was 8.2 (3.3) years and peak age incidence between 5 and 9 years. Average annual hospital incidence rose from 4-5 new cases to 8-9 new cases/annum with an upsurge to 17 cases in 2019. Highest yearly monthly incidence was between June and December. Forty -five out of 50 (90%) evaluated subjects were in the middle/ low socioeconomic classes. Stage 2 hypertension occurred in 30/50 (60%) with hypertensive crises in 24%. RPGN occurred in 6/50 (12%) of cases accounting for 5 of the 8 dialysed patients and 4 of the 5 deaths. The case fatality rate was 4.3%.Conclusion: The study showed a progressive increase in the hospital incidence of AGN.RPGN was a major risk factor for death in children with AGN and therefore requires a high index of suspicion and an appropriate early intervention

Steroid response in primary childhood nephrotic syndrome in a tropical african environment.

BACKGROUND: Earlier studies on childhood nephrotic syndrome (NS) in tropical Africa showed steroid resistance in the majority. More recent studies show a variable picture, necessitating a re-evaluation. This study was aimed at determining the current pattern of steroid response in childhood NS, in an environment known to be dominated by steroid resistance. PATIENTS AND METHODS: This prospective study of consecutive children who received steroid therapy for primary NS was carried out at the University College Hospital, Ibadan, Nigeria between 2006 and 2013. The outcomes of interest were steroid sensitivity and death. The recruited patients received a 4-6 weeks' course of prednisolone at 60 mg/m2/day followed by alternate day doses of 40 mg/m2 up to total steroid therapy duration of 6 months in steroid sensitive patients. Statistical analysis was carried out using STATA version 12.0. P value <0.05 was considered significant. RESULTS: Of 109 children that received steroids for at least 8 weeks, whose mean (SD) age was 7.9 (3.7) years, 69 (63.3%) were steroid sensitive. Those aged ≥6 years responded as well as those aged <6 years (P = 0.78). Boys were more likely to be steroid-sensitive than girls, 65.2% versus 34.8% (P = 0.039). There was zero mortality among the patients studied. CONCLUSION: This study has shown a better steroid sensitivity of 63.3% in children with primary NS compared with the previously reported 36.8-42.9% in patients with highly selective proteinuria. This improved steroid response and zero mortality show a remarkable departure from the past.

Prevalence and determinants of depression among patients with hypertension: A cross-sectional comparison study in Ghana and Nigeria.

BACKGROUND: Despite evidence linking depression to poor blood pressure (BP) control and increased hypertension-related morbidity and mortality, there is paucity of data about depression among patients with hypertension in sub-Saharan Africa. We assessed factors associated with depression among patients with hypertension in Ghana and Nigeria. SUBJECTS AND METHODS: Patients with hypertension were recruited from four hospitals: In Ghana, Korle Bu Teaching Hospital (n = 120), and in Nigeria, the University of Port Harcourt Teaching Hospital, the Lagos State General Hospital, and the University College Hospital Ibadan (n = 237). Demographic, socioeconomic, psychosocial, and clinical factors which predicted depression among the study cohort were assessed by logistic regression. Depression and beliefs about medications were assessed with the Patient Health Questionnaire (PHQ-9) and the Beliefs about Medication Questionnaire, respectively. Depression was regarded as PHQ-9 score >4. RESULTS: The mean ages of the Ghanaian and Nigerian cohort were 57.0 ± 13.7 years (58.3% female) and 56.4 ± 12.9 years (57.0% female), respectively. Prevalence of depression was 41.7% and 26.6% among the Ghanaian and Nigerian cohorts, respectively. Significant predictors of depression in the Nigerian cohort were age in years [OR 0.97 (0.95-0.99)], concern about medications [OR 1.15 (1.03-1.30)], and poor BP control [OR 2.06 (1.09-3.88)]. Young age was the only independent predictor of depression in the Nigerian cohort. In the Ghanaian cohort, none of the factors significantly predicted depression. CONCLUSION: Prevalence of depression is high among patients with hypertension in Ghana and Nigeria. Screening and treatment of depression among patients with hypertension in Ghana and Nigeria may have important implications for improving outcomes.

A CASE REPORT OF SUSPECTED ANGIOEDEMA IN A CHILD AFTER ADMINISTRATION OF MEBENDAZOLE, COTRIMOXAZOLE AND LEAF EXTRACTS.

Adverse drug reactions in children are an important public health problem. Children are at a higher risk of developing adverse drug reactions as they seldom express their own drug therapy experiences. Factors that have been implicated include polypharmacy especially with anti-infective and non-steroidal anti-inflammatory drugs; also concomitant use of traditional medicines which is prevalent in some cultures. Cutaneous drug allergy is a common manifestation of adverse drug reactions.

Kidney disease in hospitalised HIV positive children in Ibadan, south west Nigeria.

BACKGROUND: There is a paucity of data on the clinicopathologic pattern of kidney disease in human immunodeficiency virus (HIV) seropositive children from sub-Saharan Africa and non from south west Nigeria. OBJECTIVE: To determine the clinical pattern and outcome of kidney disease among HIV positive children hospitalised at a tertiary hospital South West Nigeria METHODOLOGY: A retrospective study of all HIV positive children who were hospitalised and managed for kidney diseases over a period of 78 months at the University College Hospital Ibadan, South West Nigeria. Patients were followed up over the duration of hospital admission. RESULTS: Ten children (six males and four females) aged 4-15 (10.4 +/- 3.2) years were identified. Four presented in acute kidney injury, (AKI) three with nephrotic syndrome (NS) and two in chronic kidney failure (CKF). One patient had left renal artery stenosis. Renal biopsy performed in three children showed focal segmental glomerulosclerosis in two patients and membranous nephropathy in the third. Management included antiretroviral therapy, angiotensin converting enzyme inhibitors and acute haemodialysis. Mortality was 40%. CONCLUSION: AKI, NS and CKF were the predominant clinical patterns of kidney disease in hospitalised HIV positive children and the mortality is high.

Nephrotic syndrome complicating cyanotic congenital heart disease: a report of two cases.

BACKGROUND: Renal complications are said to be common in cyanotic congenital heart disease (CCHD), but have not been documented frequently in Nigerian children. Nephrotic syndrome (NS) is an uncommon complication of CCHD. OBJECTIVES: To report two cases of NS complicating CCHD who presented within months of each other, in order to draw attention to the problem. METHODS: The details of the clinical presentation, course and outcome of two children with CCHD, presenting with features of NS within months of each other, were reviewed. The patients were fully assessed clinically and were further investigated with chest X-ray, ECG ad echocardiography. RESULTS: A 12-year old girl with Fallot's tetralogy underwent a Blalock-Taussig shunt at the age of 2 years, but subsequently defaulted from follow-up. She reappeared 10 years later with features of NS. Echocardiography revealed impaired myocardial function. Despite initial clinical improvement following three plasma exchanges and Enalapril therapy, she suddenly died on the 15th day of admission. The second patient was a 7-year old boy with tricuspid atresia, diagnosed at the age of 10 months, and similarly defaulted, reappearing six years later with features of NS. Oedema regressed with similar treatment, but his renal function deteriorated. He was stable enough to be discharged after six weeks on admission. CONCLUSION: Proteinuria is likely to be more common in Nigerian children with CCHD than has been previously appreciated. Early intervention in patients with CCHD is desirable in order to prevent development of complications which worsen the prognosis. Patients with CCHD should be screened regularly for proteinuria in order to detect and address renal complications early.