Impairment of renal sodium excretion in tropical residents--phenomenological analysis.

There is evidence of impaired renal sodium excretion in salt-sensitive African Blacks. A decreased rate of renal sodium chloride (NaCl) excretion, low plasma renin activity and a tendency to elevated blood pressure are the hallmarks of salt sensitivity. Recent evidence indicates that increased proximal and distal tubular fluid reabsorption in some tropical residents may explain the impaired sodium excretion in these people. In this study of a cohort population, we speculated that subjects selected from that population might be salt-sensitive. We therefore measured the sodium balance in 10 normotensive male subjects over 10 consecutive days, after they had ingested a normal or a high amount of sodium, as NaCl (salt) in their diet. We quantified their renal sodium excretion rate by phenomenological analysis of their sodium balance data. We also measured plasma renin activity for 7 consecutive days in a separate group of 6 male and 4 female subjects in order to assess the state of their renin/angiotensin system. We selected all our subjects from a cohort population of 269 subjects randomly selected from a community known to have a high prevalence of primary hypertension. Our data on two separate groups of subjects from the same cohort population revealed delayed renal sodium excretion with t1/2 of about 5 days, compared to published data for normal individuals with t1/2 of less than 24 h. Also, plasma renin activity levels were low. Hence, our subjects are salt-sensitive. Quantification of their renal impairment is important for various reasons: it heightens one's appreciation of the problem of salt retention in African Blacks who are salt-sensitive and it also underlines the importance of the need for further research into the benefits of dietary salt restriction for reducing cardiovascular mortality in African populations, as has been done in some Western countries.

Hemodialysis in the treatment of acute renal failure in tropical Africa: a 20-year review at the Korle Bu Teaching Hospital, Accra.

From 1972 to 1992, 170 patients with acute renal failure (87 M, 83 F; mean age 32.51 +/- SE 0.945) underwent hemodialysis at the renal unit of the Korle Bu Teaching Hospital, Accra. Vascular access was established initially by arteriovenous shunt (133 cases), femoral venous cannulation (10 cases), and subclavian vein cannulation (27 cases). The overall mortality for acute renal failure (ARF) was 31.8% (54/170). The mortality for obstetric cases was 43.7% (14/32); for surgical cases, 33.3% (6/18); medical cases, 28.3% (13/32); and gynecologic (posthysterectomy) cases, 28.3% (2/7). The most important causes of death in ARF were pulmonary edema (42%), sepsis (20%), and cardiac tamponade (10.4%). Hemodialysis is now established as a form of treatment for ARF and a overall survival rate of 68.2% justifies the development of our program. With improvement of economies of developing countries and health insurance schemes, this form of treatment should be available in all developing countries.

Blackwater fever and acute renal failure in expatriates in Africa.

From September 1976 to July, 1993, 7 patients---5 Europeans, 1 Filipino national, and 1 Korean---were admitted to the Renal Unit of Korle Bu Teaching Hospital in Ghana with acute renal failure due to severe malaria and intravascular hemolysis. All these patients had been in the Tropics 3 to 8 weeks and none were no malarial prophylaxis. All needed dialysis because of severe uremic symptoms. Four patients survived and 3 died. It is recommended that nationals from nonmalarial countries be counselled on the extreme importance of malarial prophylaxis when visiting Tropical areas where malaria is endemic.

Anuric acute renal failure due to bilateral accidental ureteric ligation during abdominal hysterectomy.

OBJECTIVE: To determine the incidence of accidental ureteric ligation causing acute anuric renal failure (AARF) at the KorleBu Teaching Hospital, Accra, Between August 1984 and December 1991. METHOD: The records and operative data of all cases managed with acute anuric renal failure at the hospital during the period were reviewed. RESULT: The 7 patients with AARF presented with mean pre-referral anuria of 3.2 days. Total abdominal hysterectomy (4 for fibroids, 2 for carcinoma of uterus and 1 for post partum hemorrhage) was the cause of ureteric ligation. The 7 patients mean age 38.5 years were anemic (mean HB 4.1 g/dl) and uremic (mean blood urea 40.51 mmol/l) on admission. Abdominal ultrasonography was useful for diagnosis of obstructive uropathy. Hemodialysis was required in all cases prior to laparotomy and ureteroneocystostomy. The ureters were usually ligated at the distal 3 cm. Five survived ureteroneocystostomy and 2 died before laparatomy from septicemia and/or pulmonary edema. CONCLUSION: Abdominal hysterectomy is a major cause of anuric acute renal failure and early recognition and treatment prevents death.

Presentation and clinical course of end stage renal failure in Ghana - a preliminary prospective study

Thirty-four patients with end stage renal failure seen over a 1-year period were included in this study. All patients presented with severe hypertension; moderate anaemia and raised blood urea and creatinine levels; findings which in the tropical setting usually suggested the diagnosis of end stage renal failure

Acquired nephrogenic diabetes insipidus complicating acute tubular necrosis with acute renal failure

Two cases of acquired nephrogenic diabetes insipidus following acute tubular necrosis with acute renal failure due to severe intravascular hemolysis are presented. One of the cases was associated with full defect of Glucose 6-Phosphate Dehydrogenase (G6PD) with mild falciparum malaria parasitaemia. Both cases had prolonged polyuria even when their electrolytes; urea and creatinine levels had normalised. Water deprivation tests showed inability to concentrate the urine in both cases. It was only when oral intake was reduced that urine volumes normalised. It is suggested that such cases be controlled with judicious fluid restriction rather than keeping up with fluid losses