Abnormalities of Kidney Function in Acute Malarial and non-Malarial Infections.

INTRODUCTION: The tropical environment is endemic with malaria and non-malarial infections which are responsible for the high morbidity and mortality in these low- and middle-income countries. In particular, acute malarial infection can cause significant multi-organ dysfunction, including kidney involvement. Early detection of kidney dysfunction will help to improve the quality of care and reduce associated morbidity and mortality. This study aimed at identifying the spectrum of kidney dysfunction in patients with acute malaria and non-malarial infections. METHODS: This was a prospective observational study in which participants with acute malarial infection, acute non-malarial infection, and apparently healthy individuals were enrolled. For acute malarial infection, participants with thick blood smear parasite density of ≥1000 parasite/µl and falciparum species on thin smear were enrolled. Demographic, clinical, and laboratory parameters were measured. The renal abnormalities examined were urea, creatinine and eGFR, albuminuria, electrolytes, and presence of acute kidney injury (AKI). RESULTS: The following electrolyte abnormalities were observed in participants with acute falciparum infection: hyponatraemia (10.7%), hypernatraemia (4.0%), hypokalaemia (8.0%), and hyperkalaemia (13.3%). The mean serum urea in participants with acute malaria was 33.8±8.8mmol/l while participants with non-malarial febrile illnesses and healthy controls had 34.7±9.0mmol/l and 26.8±7.6mmol/l, respectively. The mean serum creatinine among participants with acute falciparum infection was 1.0±0.3mg/dl compared to those of participants with non-malarial infections and healthy controls which were 1.1±0.4mg/dl and 0.8±0.3mg/dl, respectively. The difference in the observed mean serum creatinine among the 3 groups was statistically significant (p=0.023). The mean urinary sodium among participants with non-malarial infection was highest at 23.03mmol/l. There was transient albuminuria in 6.7% of participants with acute malarial infection which resolved after recovery from the infection. CONCLUSION: A relatively high frequency of serum electrolyte abnormalities, albuminuria and urine microscopic abnormalities were observed among subjects with acute malaria compared to those without malaria infection.

INTRODUCTION: L'environnement tropical est endémique d'infections paludéennes et non paludéennes qui sont responsables d'une morbidité et d'une mortalité élevées dans ces pays à revenu faible et moyen. En particulier, l'infection palustre aiguë peut provoquer un dysfonctionnement significatif de plusieurs organes, y compris une atteinte rénale. La détection précoce du dysfonctionnement rénal permettra d'améliorer la qualité des soins et de réduire la morbidité et la mortalité associées. Cette étude visait à identifier le spectre du dysfonctionnement rénal chez les patients atteints d'une infection palustre aiguë ou d'une infection non palustre. MÉTHODES: Il s'agit d'une étude prospective d'observation à laquelle ont participé des personnes souffrant d'une infection palustre aiguë, d'une infection non palustre aiguë et des personnes apparemment en bonne santé. Pour l'infection palustre aiguë, les participants présentant une densité de parasites sur frottis sanguin épais de ≥1000 parasites/µl et des espèces de falciparum sur frottis mince ont été enrôlés. Les paramètres démographiques, cliniques et de laboratoire ont été mesurés. Les anomalies rénales examinées étaient l'urée, la créatinine et le DFGe, l'albuminurie, les électrolytes et la présence de lésions rénales aiguës (IRA). RÉSULTATS: Les anomalies électrolytiques suivantes ont été observées chez les participants atteints d'une infection aiguë à falciparum : hyponatrémie (10,7 %), hypernatrémie (4,0 %), hypokaliémie (8,0 %) et hyperkaliémie (13,3 %). L'urée sérique moyenne chez les participants atteints de paludisme aigu était de 33,8±8,8mmol/l alors que les participants atteints de maladies fébriles non palustres et les témoins sains avaient 34,7±9,0mmol/l et 26,8±7,6mmol/l, respectivement. La créatinine sérique moyenne chez les participants atteints d'une infection aiguë à falciparum était de 1,0±0,3mg/dl par rapport à celle des participants atteints d'infections non palustres et des témoins sains qui étaient de 1,1±0,4mg/dl et 0,8±0,3mg/dl, respectivement. La différence dans la créatinine sérique moyenne observée entre les 3 groupes était statistiquement significative (p=0.023). Le sodium urinaire moyen parmi les participants atteints d'une infection non palustre était le plus élevé à 23,03 mmol/l. Une albuminurie transitoire a été observée chez 6,7 % des participants atteints d'une infection palustre aiguë, qui s'est résorbée après la guérison de l'infection. CONCLUSION: Une fréquence relativement élevée d'anomalies des électrolytes sériques, d'albuminurie et d'anomalies microscopiques de l'urine a été observée chez les sujets atteints de paludisme aigu par rapport à ceux qui n'étaient pas infectés par le paludisme. Mots-clés: Anomalies de la fonction rénale, infection aiguë par le paludisme à falciparum, infections non palustres.

Comparative analysis of fibroblast growth Factor-23 as a correlate of cardiovascular disease among individuals with chronic kidney disease, hypertensives, and healthy controls.

Background: Chronic kidney disease (CKD) is a global growing public health epidemic with attending morbidity and huge financial cost. Cardiovascular disease (CVD), a major complication of CKD, contributes to its excessive mortality rate. The aetio-pathogenesis of the excess burden of CVD in CKD is a feature yet to be unravelled. Fibroblast growth factor-23 (FGF-23) has been implicated as a risk factor for CVD among patients with CKD. However, most of these studies were predominantly among the Caucasian population. Aim: This study aims to determine the correlation between FGF-23 and CVD among Nigerians with CKD. Patients and Methods: A cross-sectional comparative study composed of three groups: participants with CKD, hypertensives without CKD, and healthy individuals, represented as group 1, 2, and 3, respectively. Information obtained included demographic data and occurrence of risk factors for CVD. Cardiovascular risks were assessed by echocardiography and all the participants had kidney function tests done with plasma FGF-23. Results: The study sample size consisted of 135 participants. The mean (SD) age for participants with CKD and controls were 50.2 (12.7), 54.3 (15.5), and 40.2 (14.1) years, respectively. The median [interquartile range (IQR)] of plasma FGF-23 for participants with CKD 210 (139-304) RU/ml, and controls 124 (86-170) RU/ml, and 71 (38 - 89) RU/ml P < 0.001. Most participants with CKD had left ventricular hypertrophy (LVH) (80.0%), compared to the controls; 28.9% and 6.7% P < 0.001. Similarly, majority of participants with CKD had elevated plasma FGF-23 with LVH (85.7%) compared to controls 55.6% and 11.5%, whereas for aortic valve calcification with elevated plasma FGF-23 among CKD and controls were 53.6% (P = 0.29), 37.0% (P = 0.03), and 19.2% (P = 0.06), respectively. Conclusion: Individuals with CKD had frequencies of elevated plasma FGF-23, LVH, and cardiac valve calcification, which are surrogates of cardiovascular events.

Range-wide indicators of African great ape density distribution.

Species distributions are influenced by processes occurring at multiple spatial scales. It is therefore insufficient to model species distribution at a single geographic scale, as this does not provide the necessary understanding of determining factors. Instead, multiple approaches are needed, each differing in spatial extent, grain, and research objective. Here, we present the first attempt to model continent-wide great ape density distribution. We used site-level estimates of African great ape abundance to (1) identify socioeconomic and environmental factors that drive densities at the continental scale, and (2) predict range-wide great ape density. We collated great ape abundance estimates from 156 sites and defined 134 pseudo-absence sites to represent additional absence locations. The latter were based on locations of unsuitable environmental conditions for great apes, and on existing literature. We compiled seven socioeconomic and environmental covariate layers and fitted a generalized linear model to investigate their influence on great ape abundance. We used an Akaike-weighted average of full and subset models to predict the range-wide density distribution of African great apes for the year 2015. Great ape densities were lowest where there were high Human Footprint and Gross Domestic Product values; the highest predicted densities were in Central Africa, and the lowest in West Africa. Only 10.7% of the total predicted population was found in the International Union for Conservation of Nature Category I and II protected areas. For 16 out of 20 countries, our estimated abundances were largely in line with those from previous studies. For four countries, Central African Republic, Democratic Republic of the Congo, Liberia, and South Sudan, the estimated populations were excessively high. We propose further improvements to the model to overcome survey and predictor data limitations, which would enable a temporally dynamic approach for monitoring great apes across their range based on key indicators.

Clinical Utility of Urinary ß2-Microglobulin in Detection of Early Nephropathy in African Diabetes Mellitus Patients.

Background. Studies have indicated that diabetic tubulopathy may occur earlier than glomerulopathy, therefore providing a potential avenue for earlier diagnosis of diabetic nephropathy. Urinary beta-2-microglobulin (ß2m) was investigated in this study as a potential biomarker in the detection of early nephropathy in type 2 diabetics. Methods. One hundred and two diabetic subjects and 103 controls that met the inclusion criteria had data (sociodemographic, medical history, physical examination, and laboratory) collected. Urinary ß2m levels and urinary albumin concentration (UAC) were determined. Results. Elevated urinary ß2m was more frequent among the diabetics (52%, 95% CI: 42.1-61.8%) than among the controls (32%, 95% CI: 22.9-41.2%). The frequency of microalbuminuria was higher in the diabetics (35.3%, 95% CI: 25.9-44.7%) than in the controls (15.5%, 95% CI: 8.4-22.6%). There was a positive correlation between urinary ß2m and UAC (rho = 0.38, p < 0.001). Multivariate analysis showed BMI (OR: 1.23, 95% CI: 1.05-1.45), eGFR (OR: 0.97, 95% CI: 0.94-0.99), and presence of microalbuminuria (OR: 3.94, 95% CI: 1.32-11.77) as independent predictors of elevated urinary beta-2-microglobulin among the diabetics. Conclusion. Urinary ß2m may be useful, either as a single test or as a component of a panel of tests, in the early detection of diabetic nephropathy.

The knowledge, awareness, and acceptability of renal transplantation among patients with end-stage renal disease in Ibadan, Nigeria.

Renal transplantation is well established in the USA, Europe, India, and South Africa. However, it is still in its infancy in Nigeria. The objective of our study is to determine the knowledge, awareness, and acceptability of renal transplant among patients with end-stage renal disease (ESRD) and the factors which are responsible for the low level of transplantation in Ibadan, Nigeria. A 15-item pilot-tested questionnaire was administered to willing patients with ESRD seen at the medical outpatient clinic of the University Teaching Hospital, from January to December 2011. There was 81% participation rate of the respondents. Exactly 90.1% had formal education and 44% earned <50,000 naira per month. Seventy-nine percent of respondents was aware of renal transplantation, 70.4% would recommend it to others, and 66.7% accepted renal transplantation; 77.8% would maintain a close relationship with their donors. About 61.7% considered it very expensive, while 33.3% did not know the cost for transplantation. Of the reason for the low level of kidney transplantation in Nigeria, 39.5% had no idea and in 27.2% of the respondents, the fear of death by potential donors may be responsible. Eleven percent of responded that recipients had no money for kidney transplantation and another 11% thought the potential donors would like to be paid for donating their kidneys. Most of the respondents with ESRD were knowledgeable, aware of, and accepted renal transplantation as the next step to treat chronic renal failure. However, majority of these patients could not afford the cost for renal transplantation.

Naturally occurring radioactive materials (NORMs) generated from lignite-fired power plants in Kosovo.

The energy production in Kosovo depends primarily on lignite-fired power plants. During coal combustion, huge amounts of fly ash and bottom ash are generated, which may result in enriched natural radionuclides; therefore, these radionuclides need to be investigated to identify the possible processes that may lead to the radiological exposure of workers and the local population. Lignite samples and NORMs of fly ash and bottom ash generated in lignite-fired power plants in Kosovo are analyzed using a gamma-ray spectrometry method for the activity concentration of natural radionuclides. The average activity concentrations of (40)K, (226)Ra and (232)Th in lignite are found to be 36 ± 8 Bq kg(-1), 9 ± 1 Bq kg(-1) and 9 ± 3 Bq kg(-1), respectively. Indications on the occurrence and geochemical behavior of uranium in the lignite matrix are suggested. The activity concentrations of natural radionuclides in fly ash and bottom ash samples are found to be concentrated from 3 to 5 times that of the feeding lignite. The external gamma-ray absorbed dose rate and the activity concentration index are calculated to assess the radiological hazard arising from ash disposal and recycling in the cement industry.

Insulin resistance in Nigerians with essential hypertension.

BACKGROUND: Reports on the association between hypertension and insulin resistance have been inconsistent even though most studies show a definite association. It is also not certain if the association between insulin resistance and hypertension applies to all populations. OBJECTIVE: To determine the prevalence of insulin resistance in hypertensive Nigerians and to examine the association of insulin resistance with hypertension and some anthropometric indices. METHODS: Thirty five adults with essential hypertension and thirty five normotensives were studied. Anthropometric parameters, blood pressure, fasting glucose and insulin were measured. Homeostasis model assessment (HOMA) was used to determine insulin resistance (IR). RESULTS: The hypertensive subjects had significantly higher fasting insulin and HOMA-IR compared with normotensives (p = 0.02 and 0.04) respectively. There were significant correlations between HOMA-IR, BMI, waist and hip circumference in subjects with hypertension. At multiple linear regression, hypertension and body mass index were found to be the only significant predictors of insulin resistance. CONCLUSION: The hypertensives we studied had a higher occurrence of insulin resistance compared to the normotensives. This makes it necessary for persons with hypertensive to have regular screening for diabetes and other categories of glucose intolerance as the increased insulin increases their risk of developing type 2 diabetes mellitus.

Undiagnosed diabetes and prediabetes in hypertensive and normotensive adults at the university college hospital, Ibadan, Nigeria.

BACKGROUND: Essential hypertension is associated with an increased incidence of glucose intolerance (prediabetes and type 2 diabetes mellitus) but many persons with glucose intolerance remain undiagnosed for many years. AIMS: To determine the frequency of undiagnosed diabetes and prediabetes in a group of hypertensives and normotensives. METHODS: Anthropometry, blood pressure and standard oral glucose tolerance test (OGTT) were done in adult participants (hypertensive and normotensive controls) newly presenting to a General Outpatient Clinic of the University College Hospital, Ibadan. RESULTS: Using the OGTT, the frequency of undiagnosed diabetes was 10.4% and 4.3% in hypertensives and normotensives respectively (p = 0.031) but was 5.2% and 2.6% in hypertensives and normotensives respectively using fasting plasma glucose (FPG) alone (p=0.308).Using the OGTT, impaired glucose tolerance (IGT) was diagnosed in 32.2% of hypertensives compared to 14.8% of normotensives (p = 0.002) while impaired fasting glucose (IFG) was diagnosed in 5.2% of hypertensive and 2.6% of the normotensives (p = 0.288). After adjusting for hypertension, age, level of education, body mass index and waist circumference, hypertensives and persons with a higher waist circumference had statistically significantly increased odds of having glucose intolerance: hypertension (OR 2.915; 95% CI 1.526-5.556) and waist circumference (OR 1.050; 95% CI 1.010-1.090). CONCLUSION: Diabetes and prediabetes are commoner in hypertensive persons and such persons require close and frequent monitoring for the development of this disease. Screening with both fasting plasma glucose and post glucose load plasma glucose (OGTT) identifies more persons with glucose intolerance than fasting plasma glucose alone.

Visceral and subcutaneous adipose tissue from lean women respond differently to lipopolysaccharide-induced alteration of inflammation and glyceroneogenesis.

OBJECTIVE: Experimental endotoxaemia induces subcutaneous adipose tissue inflammation and systemic insulin resistance in lean subjects. Glyceroneogenesis, by limiting free fatty acids (FFA) release from adipocytes, controls FFA homoeostasis and systemic insulin sensitivity. The roles of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) in metabolic deregulation are intrinsically different. We compared the effect of lipopolysaccharide (LPS) on the inflammation profiles of SAT and VAT explants from lean women, as well as on glyceroneogenesis, to test whether these two fat depots have intrinsically different responses to this metabolic endotoxin. DESIGN: Abdominal SAT and VAT explants from eight lean women were treated in vitro with LPS. Their inflammatory status was evaluated by cytokine gene expression and secretion; glyceroneogenesis was evaluated by cytosolic phosphoenolpyruvate carboxykinase activity and FFA vs glycerol release. RESULTS: In the basal state, the cytokine status and expression of macrophage markers were lower in SAT than VAT. In the presence of 100 ng ml(-1) LPS, SAT exhibited a strong inflammatory response (increased interleukin-6 and tumor necrosis factor-α expression) and increased release of FFA due to inhibition of glyceroneogenesis, whereas VAT was only mildly affected. The effects of LPS on both tissues were blocked by the nuclear factor-κB (NF-κB) inhibitor, parthenolide. A significant effect of LPS on VAT occurred only at 1 µg ml(-1) LPS. CONCLUSION: SAT explants from lean women are more sensitive to LPS-induced NF-κB activation than are VAT explants, leading to a depot-specific dysfunction of FFA storage. As SAT is the major player in FFA homoeostasis, this SAT dysfunction could be associated with visceral fat hypertrophy and systemic lipid disorders.

Averting biodiversity collapse in tropical forest protected areas.

The rapid disruption of tropical forests probably imperils global biodiversity more than any other contemporary phenomenon. With deforestation advancing quickly, protected areas are increasingly becoming final refuges for threatened species and natural ecosystem processes. However, many protected areas in the tropics are themselves vulnerable to human encroachment and other environmental stresses. As pressures mount, it is vital to know whether existing reserves can sustain their biodiversity. A critical constraint in addressing this question has been that data describing a broad array of biodiversity groups have been unavailable for a sufficiently large and representative sample of reserves. Here we present a uniquely comprehensive data set on changes over the past 20 to 30 years in 31 functional groups of species and 21 potential drivers of environmental change, for 60 protected areas stratified across the world's major tropical regions. Our analysis reveals great variation in reserve 'health': about half of all reserves have been effective or performed passably, but the rest are experiencing an erosion of biodiversity that is often alarmingly widespread taxonomically and functionally. Habitat disruption, hunting and forest-product exploitation were the strongest predictors of declining reserve health. Crucially, environmental changes immediately outside reserves seemed nearly as important as those inside in determining their ecological fate, with changes inside reserves strongly mirroring those occurring around them. These findings suggest that tropical protected areas are often intimately linked ecologically to their surrounding habitats, and that a failure to stem broad-scale loss and degradation of such habitats could sharply increase the likelihood of serious biodiversity declines.

The epidemiology of end-stage renal disease in Nigeria: the way forward.

The incidence of CKD (Chronic kidney disease) in Nigeria has been shown by various studies to range between 1.6 and 12.4%. We have shown that the burden of renal disease in Nigeria is probably significantly higher than any previous study on end-stage renal disease (ESRD) has documented, as most studies are hospital-based and fail to include the many patients who do not have access to hospital care. The increased prevalence of ESRD among blacks in the United States and South Africa compared with other races also suggests that ESRD may be more prevalent in Africa than in the United States and other developed nations. Common causes of CKD in Nigerian adults are glomerulonephritis and hypertension, while common causes in children are glomerulonephritis and posterior urethral valves. In the United States, diabetes and hypertension are the commonest causes of CKD and glomerulonephritis plays a less important role. Access to renal replacement therapy (RRT) in Nigeria is limited, and mortality rates are very high, ranging between 40 and 50%. Important steps towards improving the situation are the development of prevention programmes and increased funding to ensure increased availability of RRT. To achieve this, health policies concerning CKD must be formulated, and the lack of a renal registry makes it difficult for this to be done. There is need for the development of a functional organizational structure for the reporting of CKD in Nigeria, the Nigerian Renal Registry.

Hepatitis B virus infection: implications in chronic kidney disease, dialysis and transplantation.

Hepatitis B virus (HBV) infection occurs worldwide but is most prevalent in Southeast Asia and sub-Saharan Africa with reported prevalence rates varying from 3 - 26 %. The higher prevalence of infection has been reported in patients with HBV and human immunodeficiency virus (HIV) co-infection. Hepatitis B virus not only affects the liver but has also been implicated in the pathogenesis of membranous, membranoproliferative and mesangial proliferative glomerulonephritides. Though controlling the spread of HBV infection in renal dialysis units has been one of the major triumphs in the management of end-stage renal disease, transmission of HBV can still occur through contamination of equipments and environmental surfaces and the use of multiple dose vials of drugs. Some reports have indicated that prior HBV infections have negative impact on graft and host survival following transplantation. Interferon can be used in the treatment of HBV-associated glomerulonephritides (HBV- GN) but is contraindicated in transplantation because of its immuno-modulatory effects. Despite the fact that patients with chronic kidney disease (CKD) have suboptimal response to HBV immunization, immunization is still beneficial to these patients. However, reports indicate that most patients with CKD were either not immunized or were given suboptimal doses. Control of HBV in the population by immunization can lead to a reduction in the prevalence of HBV- GN. In addition, immunization of patients with CKD will help in controlling HBV infection in dialysis settings and can lead to improved graft and host survival following transplantation.

Focal segmental glomerulosclerosis in malignant hypertension.

OBJECTIVE: Focal segmental glomerulosclerosis (FSG) may occur in primary malignant hypertension (MHT) either as a result of glomerular hyperfiltration or fibrinoid necrosis (FN), and may contribute to renal dysfunction. To determine the frequency of occurrence and distribution of FSG in primary MHT we studied renal biopsy specimens from 38 black Africans--30 postmortem and 8 needle-biopsy specimens. SUBJECTS: There were 31 male subjects and 7 female, with a mean age of 46 (+/- 7) years. RESULTS: Mean blood pressure (BP) was 206 +/- 15/137 +/- 9 mmHg, median 24-hour proteinuria (interquartile (IQ) range) was 5.1 g (3.3-6.5 g), median serum albumin 3.4 g (3.2-3.8 g) and median serum creatinine 540 mumol/l (425-752 mumol/l). Mucoid intimal proliferation was present in all the sections but FN was seen in 29 (76%). Glomerulosclerosis was present in all the sections, and was axially distributed in 7 (18%), segmentally in 22 (58%), and globally in 9 (24%). Median 24-hour proteinuria was 2.8 g (0.8-3.5 g IQ range), 5.6 g (1.7-8.1 g) and 3.4 g (2.6-4.0 g) respectively, and corresponding values of serum creatinine were 770 mumol/l (106-1,274 mumol/l IQ range), 522 mumol/l (248-991 mumol/l) and 1,230 mumol/l (920-1,558 mumol/l) respectively. CONCLUSION: The distribution of glomerulosclerosis did not appear to relate to proteinuria or serum creatinine, although cases with segmentally distributed glomerulosclerosis appeared to have the highest proteinuria, and those with global glomerulosclerosis appeared to have the highest serum creatinine levels. FSG therefore occurs prominently in primary MHT and may contribute to renal dysfunction.

Prevalence of hepatitis B and C viruses in pre-dialysis patients with chronic renal failure.

CRF affects people in their prime of life; they are often the Nation's workforces thereby leading to severe economic and social problems. Many patients with CRF who need dialysis, present for the first time in end stage renal failure. The commonest causes of CRF in Nigeria and other tropical countries have been reported to be hypertensive nephrosclerosis and chronic glomerulonephritis. Various studies in and outside Nigeria have documented an increased seroprevalence of anti-HCV and HBsAg in chronic renal failure patients on maintenance haemodialysis. Any association established between these viruses and CRF would suggest that the prevention and/or treatment of these viruses may likely lead to a reduction in the prevalence of CRF. Thus, forty-five (45) consecutive subjects with CRF and (45) age- and sex-matched control subjects who satisfied the eligibility criteria for the study were enrolled. Marker of HBV (HBsAg) was assayed using HUMAN Enzyme linked Immunosorbent Assay (ELISA) Test. Marker of HCV (anti-HCV) was determined using the HUMAN ELISA Test. The mean age of the subjects was 37 +/- 14 years (range 17 to 62 years) while the mean age of the control subjects was 38 +/- 14 years (range of 18 to 66 years). There were no statistically significant differences in the prevalence of HBsAg and anti-HCV in the CRF patients and controls P=0.74 and P=1.0 respectively. Although, the sample was small anti-HCV seropositive CRF patients were significantly younger than anti-HCV seropositive controls P<0.027. In conclusion, this study has shown that there were no significant differences in the prevalences of HBsAg and anti-HCV in the CRF patients and controls. A larger scale study may be more desirable in defining the role of these viruses in patients with chronic renal failure.

Short-term haemodialysis in pregnant patients with acute renal failure: a report of two cases.

Haemodialysis in pregnancy is not common although, successful dialysis in pregnancy have been reported. It has also been found to improve survival of both mother and child especially, in patients with chronic renal failure, with pre-term labor being a common occurrence. Out of the 2,995 patients that were dialyzed at the University College Hospital, Ibadan in the last 10 years, only 2 of the patients were pregnant and both of them had acute renal failure. We present here the two cases, which represents our experience at the University College Hospital, Ibadan, Nigeria.

Comparative effect of lisinopril and lacidipine on urinary albumin excretion in patients with type 11 diabetic nephropathy.

This study was carried out to assess whether with a similar degree of blood pressure reduction, Lisinopril compares favorably or otherwise with lacidipine in respect of effects on urinary albumin excretion and renal function as assessed by creatinine clearance, plasma creatinine, urea and electrolytes. Thirty hypertensive diabetic nephropathy patients with moderate hypertension were studied. After a 2-week washout period, they were allocated into two groups matched at baseline for age, sex, weight, blood pressure, and urinary albumin excretion rate as well as creatinine clearance. There were 8 males and 7 females in each group. One group received lisinopril (with furosemide if needed to control BP) and the other group received lacidipine. Staged increases in doses of antihypertensives were used until BP was controlled or maximum dose of 40 mg/day lisinopril or 8 mg/day lacidipine was reached. Furosemide was added to lisinopril if BP was not controlled at 40 mg/day. These medications were given for 12 weeks at the end of which measurements done at baseline were repeated. Comparison of baseline and end of study values of these parameters within the groups and between the two groups were made. Lisinopril group and lacidipine group achieved similar and highly significant reduction in blood pressure levels P < 0.001. There was reduction in urinary albumin excretion rate in both groups but this only reached statistical significance in the lisinopril group [480] [269] mg/day vs. 315 [202] mg/day P < 0.05] while for the lacidipine group it was not significant [491] [257] mg/day vs. 335 [182] mg/day P > 0.05]. However, comparison of albumin excretion rate between both groups at baseline and at end of the study did not show any significant difference, P > 0.1. With both drugs there is a tendency for creatinine clearance to increase and plasma creatinine to drop while plasma potassium tended to rise more with lisinopril than lacidipine but differences within and between both groups, did not reach statistical significance P > 0.05. In conclusion, blood pressure reduction was comparable in both drugs; both drugs reduced albuminuria but lisinopril appeared superior. Treatment with both drugs tended to increase creatinine clearance but both had no significant effects on blood sugar.

Rapidly progressive glomerulonephritis in adult Nigerians: a report of 4 cases.

The clinicopathological features of rapidly progressive glomerulonephritis (RPGN) were studied in 4 young adult Nigerians who presented with acute GN. There was a predilection for males with a male to female ratio of 3:1. Hypertension. nephrotic-range albuminuria, haematuria granular and cellular urinary casts, and a rapid progression to severe renal failure or death were the findings in all four patients. Renal biopsy revealed histological features compatible with findings in RPGN in all the patients, including the presence of crescents and epithelial cellular proliferation. The study shows that the early development of hypertension and deterioration of renal function in patients with features of acute glomerulonephritis should arouse suspicion of a rapidly progressive GN whose course could be altered by appropriate therapeutic measures, some of which are highlighted.

The influence of cuprophan and polysulfone membranes on dialyzer reusability and intradialytic complications.

The influence of cuprophan and polysulfone membranes on dialyzer reuse and intradialytic complications was examined in patients receiving chronic haemodialysis. Mean uses were 2.7 +/- 1.3 S.D. and 2.2 +/- 1.0 S.D. for cuprophan and polysulfone respectively (P < 0.001). 20.8% and 35.5% of cuprophan and polysulfone dialyzers respectively did not survive first use (X(2) = 17.4, P < 0.001), being unsuitable for further use. The most common number of uses obtainable was 3 for each type. 2.6% of cuprophan but none of the polysulfone dialyzers were usable over 5 times. Hypotension occurred in 12% and 29% of dialyses with cuprophan and polysulfone dialyzers (P < 0.001), and the difference persisted, but the frequency in each membrane group decreased, with reuse (P < 0.001). First use reactions occurred in 9.5% and 3.9% of dialyses with cuprophan and polysulfone respectively (P < 0.001), and the difference was not affected by reuse (P > 0.1), but the frequency decreased in each group (P < 0.001). Clotting of the dialyzer occurred in 2.2% and 1.9% of cases respectively (P > 0.5), diminished with reuse of cuprophan (P < 0.001), but not with polysulfone (P > 0.5). Cuprophan membrane was more reuseable and was associated with fewer episodes of hypotension, while polysulfone was associated with fewer episodes of first use reactions. Rational choice of membranes can be made during haemodialysis.