Malnutrition Inflammation Complex Syndrome in Pre-dialysis Chronic Kidney Disease Patients in a Nigerian Tertiary Hospital.

BACKGROUND: Malnutrition Inflammatory Complex Syndrome (MICS) is a non-traditional cardiovascular risk factor that is associated with poor overall outcomes in chronic kidney disease (CKD). However, it has not been well studied among Nigerian CKD population despite its potential for response to therapeutic intervention. OBJECTIVES: To determine the prevalence and severity of MICS and some of its associated factors among pre-dialysis CKD patients. METHODS: This was a cross-sectional study that involved 51 predialysis CKD patients and 51 healthy controls. MICS was assessed using malnutrition inflammation scores (MIS) among the participants. MIS of > 6 was used as the criterion for diagnosis of MICS. RESULTS: The mean ages of the CKD and control groups were 50.96 ± 11.42 years and 48.31±9.83 years, respectively. The prevalence of MICS was significantly higher in the CKD group compared to the control group (54.90% vs 7.8%; P =<0.001). MICS was mild and moderate to severe in 64.3% and 35.7% of the predialysis CKD participants, respectively. Among all the study participants, lower educational level, low estimated glomerular filtration rate, (P<0.001), dyslipidemia (P =<0.001), anaemia (P=<0.001) and hypertension (P=0.033) were significantly associated with MICS. There was significant negative correlation between the MIS and estimated glomerular filtration (r = -0.73, P <0.001), and haematocrit (r = -0.335, p =0.016). CONCLUSION: MICS was common in pre-dialysis CKD population. It was significantly associated with hypertension, dyslipidemia, educational level, anaemia and estimated glomerular filtration rate in pre-dialysis CKD patients. Early diagnosis and treatment may reduce poor cardiovascular outcomes in them.

CONTEXTE: Le syndrome du complexe inflammatoire de la malnutrition (MICS) est un facteur de risque cardiovasculaire non traditionnel qui est associé à de mauvais résultats globaux dans la maladie rénale chronique (MRC). Cependant, il n'a pas été bien étudié parmi la population nigériane atteinte de MRC, malgré son potentiel d'intervention thérapeutique. OBJECTIFS: Déterminer la prévalence et la gravité de la MICS et certains de ses facteurs associés chez les patients atteints d'IRC en pré-dialyse. MÉTHODES: Il s'agissait d'une étude transversale portant sur 51 patients atteints d'IRC en prédialyse et 51 témoins sains. Le MICS a été évalué en utilisant les scores d'inflammation de malnutrition (MIS) parmi les participants. Un indice de malnutrition supérieur ou égal à 6 a été utilisé comme critère de diagnostic de la MICS. RÉSULTATS: L'âge moyen des groupes de personnes atteintes de NC et de témoins était de 50,96 ± 11,42 ans et de 48,31±9,83 ans, respectivement. La prévalence des MICS était significativement plus élevée dans le groupe IRC que dans le groupe témoin (54,90 % contre 7,8 % ; P =<0,001). La MICS était légère et modérée à sévère chez 64,3% et 35,7 % des participants à l'IRC avant dialyse, respectivement. Parmi l'ensemble des participants à l'étude, un niveau d'éducation plus faible, un faible débit de filtration glomérulaire estimé. (P<0,001), la dyslipidémie (P =<0,001), l'anémie (P=<0,001) et l'hypertension (P=0,033) étaient significativement associés au MICS. Il y avait une corrélation négative significative entre le MICS et la filtration glomérulaire estimée (r = -0,73, P <0,001), et l'hématocrite (r=-0,335, p =0,016). CONCLUSION: Le MICS était fréquent dans la population IRC pré-dialyse. Il était significativement associé à l'hypertension, la dyslipidémie, le niveau d'éducation, l'anémie et le taux de filtration glomérulaire estimé chez les patients IRC pré-dialysés. Un diagnostic et un traitement précoces pourraient réduire les mauvais résultats cardiovasculaires chez ces patients. Mots clés: Le syndrome du complexe inflammatoire de la malnutrition, Pré-dialyse, maladies rénal chronique, Titre courant proposé : Le MICS chez les patients IRC pré-dialysés.

Histopathological findings in nephrectomy specimens--A review of 42 cases.

OBJECTIVE: This study aims at determining the histopathological findings in nephrectomy specimens in the University of Maiduguri Teaching Hospital. METHODS: A retrospective study of all cases of nephrectomies in UMTH between January 1993 and December 2003. RESULTS: There were 42 cases of unilateral nephrectomies, 26 (61.9%) males and 16 (38.1.9%) females giving a ratio of 1.6:1. Of these, 23 (54.8%) were benign and 19(45.2%) malignant. Chromic interstitial/pyelonephritis was the commonest indication for nephrectomy and this accounted for 28.6% of all cases. Nephroblastoma, the second commonest, accounted for 23.8% of all cases and is the major malignant indication for nephrectomies. Renal cell carcinoma and hydronephrosis accounted for 7(16.7%) cases each; polycystic kidney, transitional cell carcinoma and non-Hodgkin's lymphoma. CONCLUSION: There is need to emphasise the importance of early diagnosis and proper treatment of urinary tract infections, since chronic interstitial/pyelonephritis is the commonest indication for nephrectomy in our environment. This will go long way in reducing the rate nephrectomies on our patients.

Practice pattern of hemodialysis vascular access in Maiduguri, Nigeria.

BACKGROUND: Despite available evidence based recommendations and guidelines there are differences in the preferred type of vascular access in use in different localities and geographical regions. This one center study on the practice pattern of vascular access was carried out in Maiduguri, Nigeria covering a period of the first 5 years of renal care in the area. METHOD: We analysed the dialysis and hospital records of consecutive patients that received hemodialysis in the renal center during the period between January 2000 and December 2004. Data comprised patients' demographics, vascular access used, complications encountered during the treatment period. Clinical and laboratory features of the patients were also recorded and analysed. RESULTS: The study involved one hundred and seventy-nine patients (M:F=2:1) who suffered kidney failure whose cause was clinically determined to be mainly due to chronic glomerulonephritis, hypertension, obstructive nephropathy and interstitial nephritis. Majority presented as late referrals to the nephrologist. Overall 9% of the study population used AVFs while 91% used catheters inserted into the femoral or internal jugular veins. CONCLUSION: The use of catheters for vascular access was the practice in the majority of the patients and this is possibly related to the poor survival of the patients on hemodialysis. Socioeconomic circumstances of the patients in turn largely influenced the rate of AVF use.

Effect of HIV infection on the clinical spectrum of leprosy in Maiduguri.

The clinical features associated with different classes of leprosy patients co-infected with HIV in Maiduguri was studied and the classification of leprosy was done clinically and bacteriologically using Ridley-Jopling classification and bacteriological index respectively. The cases were classified as paucibacillary (Tuberculoid--TT and Borderline Tuberculoid--BTT) and multibacillary (Borderline Borderline--BB, Borderline Lepromatous BL and Lepromatous Leprosy--LL) leprosy. Eleven (10.5%) of 105 leprosy cases were HIV-seropositive comprising of 7 males and 4 females. Age range was 15 and 62 years. Among the HIV seropositive patients, those with paucibacillary (PB) leprosy were 6 (TT-1, BT-5) while multibacillary (MB) leprosy 5 (BB-1, BL-2, LL-2). The predominant clinical features were clawing of fingers (64%), ulcerations (64%), hand muscle atrophy (55%) and clawing of toes (45%). Some clinical features of paucibacillary leprosy such as sensory and hair losses (as is also seen in HIV negative patients) occurred in increased frequency in HIV positive patients belonging to the multibacillary class. The HIV infected leprosy patients are more likely to manifest advanced stages of the disease than the HIV seronegative patients.