Pattern of blood pressure and hypertension in adolescents in Port Harcourt, Nigeria.

BACKGROUND: The rate and prevalence of hypertension in children is increasing. Childhood hypertensionif untreated can lead to hypertension in adulthood with its consequent cardiovascular and renal complications. Early detection of paediatric hypertension may lead to improvement in cardiovascular health in adults. OBJECTIVE: This study aims to determine the blood pressure (BP) pattern and prevalence of hypertension in asymptomatic secondary school children and factors associated with hypertension in these adolescents. METHODS: A cross-sectional study of 820 adolescents selected from 12 secondary schools in Port Harcourt was conducted. BP was measured by the auscultatory method. The average of three readings was taken as the actual blood pressure. Hypertension was defined as systolic and/or diastolic blood pressures equal to or greater than the 95th percentile for age, sex and height. Data was analysed using SPSS version 17.0. RESULTS: Systolic and diastolic BP increased with age in all subjects. Male subjects had a higher systolic BP compared to females. Hypertension was seen in 26 (3.2%) subjects; 13 males and 13 females. The proportional prevalence was higher in the age group 15-17 years (3.9%); in those in social classes V (9.1%) and with family history of hypertension (3.6%), (p à 0.05 in all cases). It was however significantly higher in the obese subjects (p = 0.000). CONCLUSION: The prevalence of hypertension in adolescents in Port Harcourt is high and is strongly associated with obesity. We recommend blood pressure measurement as part of the school health programme in secondary schools.

Prevalence of microalbuminuria among secondary school children.

BACKGROUND: Microalbuminuria is an early sign of kidney and cardiovascular damage. Therefore, early detection in asymptomatic individuals may be helpful in preventing deterioration in renal function. METHODS: We carried out a cross-sectional study of 820 secondary school students aged 10 - 19 years from September to November 2008. The urine samples of 615 (75.0%) without overt proteinuria and haematuria were tested for microalbuminuria using the micral test strips. Values of greater than 20mg/L were considered positive. RESULTS: There were 299 (48.6%) males and 316 (51.4%) females, with a M:F ratio of 1:1.1. The prevalence of microalbuminuria as seen in 214 of the students was 33.2%. It was significantly higher in females (45.3%), obese subjects (35.4%), those with hypertension (70.6%), those with positive family history of hypertension (59.5%), and diabetes mellitus (46.4%). Microalbuminuria was found in 1 of the 2 subjects who had features of DM and in one subject with sickle cell anemia. CONCLUSION: The prevalence of microalbuminuria in Nigerian adolescents is high. We recommend routine screening for microalbuminuria in adolescents for early detection and prevention of renal damage.

Familial focal segmental glomerulosclerosis (FSGS) in a Nigerian family and exclusion of mutations in NPHS2,WT1 and APOL1.

BACKGROUND: Focal segmental glomerulosclerosis (FSGS) is a significant cause of end-stage renal disease. It is generally considered to be sporadic but familial cases have been reported in varied ethnic groups. Genetic mutations implicated in familial FSGS involving NPHS1, NPHS2, WTI and APOL1 have not been studied in African children living outside America. This is the first report of familial FSGS and genetic study from children living in Africa. CASE REPORT: We reported two siblings; a 4-year old male and a 15-year old female from a non-consanguineous family with renal biopsy-confirmed FSGS who presented with Nephrotic syndrome (NS). The male was steroid dependent NS and achieved long term remission after two courses of oral cyclophosphamide, while the elder sister is steroid resistant and has not achieved remission with cyclosporine. We performed mutational analysis on the family by sequencing both strands of all exons of NPHS2, WT1 and APOL1 using exon flanking primers. There was absence of common gene mutations in NPHS2, WT1 and APOL1 gene in any of the two children. CONCLUSION: We present for the first time mutational analysis of NPHS2, WT1 and APOL1 in a sibling with familial FSGS from Nigeria. There may be different and unidentified gene mutations responsible for FSGS in indigenous African children.

Microalbuminuria in children with human immunodeficiency virus (HIV) infection in Port Harcourt, Nigeria.

BACKGROUND: Microalbuminuria is an early manifestation of HIV associated nephropathy (HIVAN). This study was to determine the prevalence and risk factors for microalbuminuria in children with HIV infection in Port Harcourt, Nigeria. METHODS: Urine specimen of 50 children with HIV infection seen over a 4 months period (October 2007-February 2008) was assayed for albumin and creatinine to determine urinary albumin to creatinine ratio (ACR). Microalbuminuria was defined as urinary albumin to creatinine ratio (ACR) of greater than 2.5-25 mg/mmol. The glomerular filtration rate (GFR) was calculated using the Schwartz formula. RESULTS: There were 28 (56%) males and 22 (44%) females with a male to female ratio of 1.3:1. They aged 1 month to 18 years with a mean age of 4.07 +/- 3.61 years. Microalbuminuria occurred in 6 (12%) patients; 3 males and 3 females, mean age of 5.5 +/- 4.6 years. Five (83.3%) of the patients with microalbuminuria had clinical AIDS and CD4+ cell count less than 200 cells/microL. All the patients with microalbuminuria were not receiving highly active antiretroviral therapy (HAART) at the time of study. One (16.7%) patient had overt HIV-associated nephropathy (HIVAN) with ACR greater than 2.5 mg/mmol, elevated serum creatinine 400 micrommo/L, urea of 20 mmol/L and a GFR of 69 ml/min/1.73m2. CONCLUSION: The prevalence of microalbuminuria in Nigerian children with HIV infection is high, and it occurs mainly in older children with clinical AIDS who are not on HARRT.