Five years experience of haemodialysis at the Lagos University Teaching Hospital--November 1981 to November 1986.

The Dialysis Centre at the Lagos University Teaching Hospital became operational in November 1981 and caters for acute haemodialysis, chronic maintenance haemodialysis and continuous arteriovenous haemofiltration. In the past 5 years, over 600 patients had presented out of whom 245 could be accommodated within the realities of available facilities and patients' financial status. Of the 245 patients, 25 were discharged against medical advice and five were transferred to hospitals abroad but did not survive. There were 117 patients in end-stage renal failure (ESRF), 75 males, 42 females, ratio M:F 1.8:1, age range 13-69 years, mean 37.5. There were 51 males and 47 females in acute renal failure (ARF), ratio 1.1:1, age range 13-76 years, mean age 32.3 (Table 1). All patients in ESRF had moderate to severe hypertension (diastolic pressure of greater than or equal to 120 mmHg or 22.1 kPa) and a creatinine clearance of less than or equal to 5 ml/min and about 75% had established cardiac decompensation. Full pertinent investigations were precluded or contra-indicated in most patients in ESRF because of late presentation. In only 13 patients was renal biopsy performed and the pathohistologies were end stage renal disease (8), chronic glomerulonephritis (4) and glomerulosclerosis (1). In ARF the cause of the renal damage was multifactorial in 66.7%, with sepsis being the direct cause of death in 60.0%. The commonest conditions were septicaemia (61.4%), nephrotoxin (17.2%), trauma (31.3%), septic abortion (33.3%) and toxaemia of pregnancy (29.0%) (Table 2). The dialysis associated complications which were encountered included shunt infection (7%), burst membrane (9%), suspected pyrogen reaction (5.6%) and femoral vein perforation (0.9%).(ABSTRACT TRUNCATED AT 250 WORDS)

Supra-normal creatinine clearance in black mild hypertensive patients in Nigeria.

Glomerular filtration rates, as assessed by creatinine clearances were studied in 35 mild hypertensive, 104 moderate hypertensive and 167 severe hypertensive patients. The ages ranged from 16 to 65 years and the duration of hypertension varied between 0.5 and five years. The cause of hypertension was presumed idiopathic in all but 13 severe hypertensives in whom renal biopsies were performed. The mean creatinine clearances in mild, moderate and severe hypertensives were 154.5 +/- 15.0, 83.0 +/- 26.0, 15.0 +/- 14.0 (male) and 147.0 +/- 20.0, 78.0 +/- 15.0 and 14.3 +/- 13.0 (female) respectively. A creatinine clearance of greater than 125 ml per minute was recorded in all patients with mild hypertension. This finding might be a feature of early structural and functional renal damage in mild hypertension.