ABSTRACT
BACKGROUND: Infections such as malaria, schistosomiasis, hepatitis B and HIV have been suggested as major causes of the nephrotic syndrome (NS) in African children. We retrospectively analysed the course of the NS in 32 children from Ghana and reviewed the literature on NS from 18 different African countries for the presence of 'the tropical nephrotic syndrome'. METHODS: Thirty-two children (22 boys, 10 girls, median age 12 years, range 1-18 years) with NS were treated from 2000-2003 at Battor Hospital, Ghana. Thirteen out of 32 children underwent a renal biopsy which was investigated by light, immune and electron microscopy. All 32 patients were initially treated with oral prednisone (PRED) therapy (29 with standard therapy for 8 weeks and three individually tailored), and steroid-resistant children received also intravenous methylprednisolone pulses (three children) or oral cyclophosphamide (two children). RESULTS: All patients fulfilled the clinical and laboratory criteria of a NS. The initial median serum creatinine was 65 micromol/l (range 44-133 micromol/l). Renal biopsy was performed in 13/32 children and revealed focal and segmental glomerulosclerosis (FSGS) in 10 patients, minimal change disease (MCNs) in two and no conclusive result in one patient. Glomerular immune complex deposition was absent in all biopsies. After treatment with PRED, oedema disappeared in 24/32 patients; however, proteinuria normalized in 16/32 patients only. The NS relapsed in 9/16 steroid-sensitive patients after cessation of PRED therapy, and two children were frequent relapsers. The steroid-resistant NS did not respond to an intensified immunosuppression in 5/16 children receiving methylprednisolone or cyclophosphamide. Five out of 32 children died, all were steroid resistant. CONCLUSIONS: There was no evidence for a dominating role of steroid-resistant 'tropical glomerulopathies' in children with a NS in Ghana. Similar to South Africa, focal and segmental glomerulosclerosis (FSGS) and minimal change disease were the most frequent findings on histology. Contrary to Nigeria, membrano-proliferative glomerulonephritis was not found in these patients. We conclude from this data and from the literature that the histological pattern of NS may vary between different African countries. Concerning therapy of NS under tropical conditions, we emphasize that despite the limited therapeutic facilities half of these patients may benefit from corticosteroids; however, steroid resistance and FSGS resulted in a high mortality.
Subject(s)
Nephrotic Syndrome/epidemiology , Adolescent , Biopsy , Child , Child, Preschool , Diagnosis, Differential , Female , Ghana/epidemiology , Glucocorticoids/therapeutic use , Humans , Incidence , Infant , Kidney Glomerulus/ultrastructure , Male , Microscopy, Electron , Nephrotic Syndrome/drug therapy , Nephrotic Syndrome/pathology , Prednisone/therapeutic use , Prognosis , Retrospective Studies , Severity of Illness IndexABSTRACT
An epidemiological cross sectional study of Schistosoma mansoni was conducted in two hyper endemic fishing villages of Rhino Camp and Obongi both in West Nile district in northern Uganda in 1991 and 1992. People with various water contacts were registered. A small group of civil servants and clergies with less water contact in the river Nile were studied for control of infection and morbidity. An overall prevalence of 81.5% of the 1367 people studied in both fishing villages of Rhino Camp and Obongi were excreting from 100 to > or = 500 Schistosoma mansoni eggs per gram (epg). 253 18.5% did not have Schistosoma mansoni eggs in their faeces. The influence of socioeconomic factors on infections in the study population was high among poorer illiterates who have frequent water contacts activities with River Nile. The sonomorphological abnormalities of periportal thickening (PT) due to Schistosoma mansoni were performed using ultrasound. 664 patients were found to have various stages of (PT stages 0, I, II and III). A total of 703 (51.4%) patients did not have any periportal thickening (PT 0) in their livers despite the fact that 450 (32.9%) of them had Schistosoma. mansoni eggs in their faeces. The gravities of schistosomiasis in the two villages were similar showing greater morbidity in the younger adults.
Subject(s)
Anthelmintics/therapeutic use , Praziquantel/therapeutic use , Schistosomiasis mansoni/drug therapy , Schistosomiasis mansoni/epidemiology , Adolescent , Adult , Child , Child, Preschool , Cross-Sectional Studies , Feces/parasitology , Humans , Infant , Infection Control/methods , Morbidity , Prevalence , Rivers , Socioeconomic Factors , Uganda/epidemiology , UltrasonographyABSTRACT
Abdominal ultrasonography, including assessment of the liver, spleen, pancreas, great abdominal vessels, and kidneys, was carried out in seven patients with lepromatous leprosy, six patients with tuberculoid leprosy, and 32 healthy Congolese controls. Abnormal ultrasound findings were predominantly detected in the livers of patients with lepromatous leprosy and included an inhomogeneous echo texture of the hepatic parenchyma in all cases. Furthermore, six patients revealed echo dense, partly irregular areas up to 1.5 cm x 3 cm in size distributed throughout the liver. These were associated with shadowing and were considered to contain calcium. No abnormal findings were encountered in controls or in patients with tuberculoid leprosy except for one patients with tuberculoid leprosy who had a rounded caudal liver edge. The sizes and volumes of liver, spleen, and kidneys were not different in the three groups
