Subject(s)
Acute Kidney Injury/etiology , Infections/complications , Child , Child, Preschool , Female , Ghana , Hemolysis , Humans , Infant , MaleABSTRACT
The incidence of serum antinuclear antibodies and serum antibodies to single stranded (ss) and double stranded (ds) DNA was investigated following acute malaria in 58 Caucasians visiting tropical countries but resident in Britain and in 24 Ghanaians resident in Ghana. In Caucasians this infection was associated with a significant increase in the incidence of speckled antinuclear antibodies (38% compared to 3% in controls; P less than 0.001) and a significant rise in antibody levels against ssDNA (14% compared to 5%; P less than 0.05), but no rise in antibodies against dsDNA. Acute malaria in Ghanaians was associated with an incidence of 25% of antinuclear antibodies and 4% of antibodies to ssDNA; these were similar to those found in healthy Ghanaians who are chronically exposed to malaria. Antibodies against dsDNA were not detected. The incidence of antinuclear antibodies and levels of anti-ssDNA antibodies was higher in the Ghanaian healthy population than in normal Caucasians. These observations indicate that malaria is associated with the development of antinuclear and anti-ssDNA antibodies. Ghanaian patients with a tropical splenomegaly syndrome or with a nephrotic syndrome, both of which conditions are suspected of having a malarial aetiology, had serum levels of anti-ssDNA higher than healthy controls. This observation adds further circumstantial evidence to the role of malaria in causing anti-DNA antibodies.
Subject(s)
Antibodies, Antinuclear/analysis , DNA, Single-Stranded/immunology , Malaria/immunology , Adult , DNA/immunology , Humans , Immunoglobulin G/analysis , Nephrotic Syndrome/immunology , Splenomegaly/immunologyABSTRACT
One thousand two hundred and thirty-five haemodialyses have been performed on 92 patients with renal failure. The mean number of dialyses per patient was 13.42 and the survival rate was 60.9%. One hundred and six arteriovenous shunts (98 of arm, 7 of ankle, and one of groin) were created. Three arteriovenous fistulae of arm were created in 2 patients with chronic renal failure. All the operations were performed under local or regional block anaesthesia. The mean shunt complications were clotting (27.4%), bleeding (17.9%) and infection (13.2%). The complications associated with the fistulae were non-function, heart failure, infection, aneurysmal dilatation and bleeding. One death from heart failure was attributable to arteriovenous fistula. It is recommended that patients with renal failure requiring haemodialysis in developing countries should have shunts or fistulae created under regional anaesthesia to avoid the problems of general anaesthesia in uraemic patients.
Subject(s)
Acute Kidney Injury/therapy , Arteriovenous Shunt, Surgical/methods , Developing Countries , Kidney Failure, Chronic/therapy , Renal Dialysis , Adult , Aged , Ankle , Arm , Arteriovenous Shunt, Surgical/adverse effects , Female , Ghana , Groin , Humans , Male , Middle Aged , WristABSTRACT
Clinical and pathological features of the nephrotic syndrome were studied in 36 adults and 25 children in Ghana. No evidence was found to implicate Plasmodium malariae as a cause and in the majority of patients the aetiology was not identified. Minimal change glomerulonephritis responsive to steroids was demonstrated in 14/25 children and 5/36 adults which was surprising as this lesion has been reported only rarely from tropical Africa. The other major histological lesions were focal segmental glomerulosclerosis (12/61), diffuse proliferative glomerulonephritis (11/61) and membranous glomerulonephritis (9/61).
Subject(s)
Nephrotic Syndrome/pathology , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Glomerulonephritis/pathology , Glomerulosclerosis, Focal Segmental/pathology , Humans , Kidney/pathology , Male , Middle Aged , Nephrotic Syndrome/drug therapy , Nephrotic Syndrome/etiology , Prednisolone/therapeutic useABSTRACT
Between 1972 and 1975, 55 adult patients with acute renal failure were admitted to the renal unit of Korle Bu Hospital. Fourteen patients died, giving an overall death rate of 25%. Massive intravascular haemolysis after a short febrile illness was the commonest cause of acute renal failure. Clinically these patients presented with blackwater fever but in only one could Plasmodium falciparum malaria be confidently diagnosed. In half the patients various bacterial and viral infections (especially typhoid) could be incriminated as causing this blackwater fever syndrome. The incidence of glucose-6-phosphate dehydrogenase deficiency was 22.5%, but we could not confirm the impression of a greater predisposition to acute renal failure in patients with this enzyme defect.
Subject(s)
Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Adolescent , Adult , Aged , Female , Ghana , Glucosephosphate Dehydrogenase Deficiency/complications , Hemoglobinometry , Hemoglobinopathies/complications , Hemolysis , Humans , Male , Middle Aged , Peritoneal Dialysis , Renal Dialysis , Typhoid Fever/complications , Urinary Tract Infections/complicationsABSTRACT
Over a two-year period, out of 40 adult Ghanaians admitted to the renal unit of Korle Bu Hospital with acute renal failure, 6 (15%) had typhoid fever. During this period approximately 500 cases of typhoid were admitted to this Hospital. Prominent features in these cases were a blackwater fever syndrome and leucocytosis. These features in a patient with typhoid should suggest the possibility of complicating acute renal failure. Three patients showed a deficiency of glucose-6-phosphate dehydrogenase (G-6-P.D.) in their red blood cells. It is suggested that typhoid is likely to be an important cause of acute renal failure in areas where it is endemic and G-6-P.D. deficiency common.
