Takayasu's Arteritis Presenting Atypically in a Female Nigerian.

Takayasu's arteritis (TA) is an idiopathic form of large vessel granulomatous vasculitis that mainly affects the aorta and its major branches, most frequently in young women under 50 years. While traditionally, it is a disease found commonly in Asia continent, it has also been reported from different parts of the world, albeit with a few reports from Sub-Sahara Africa. The clinical presentations are variable and are commonly from systemic inflammation, vascular occlusive diseases and aneurysm. Asymptomatic cases of TA have been documented and are usually discovered incidentally on physical examination. Common vascular symptoms from different series include vascular claudication, reduced or absent pulse, carotid bruit, hypertension and headache. Facial mononeuropathy and retinal ischaemic changes are rare findings in TA. However, occlusive disease of ulnar artery has not been reported in TA despite our extensive literature search. Here, we present a 48-year-old woman, who was admitted via the medical emergency with community acquired pneumonia but was incidentally diagnosed with Takayasu arteritis with lower motor neuron facial nerve palsy, unilateral blindness, and ulnar artery occlusion. Multidisciplinary management was instituted and patient was discharged after resolution of community acquired pneumonia, vascular claudication, and chronic headache. TA often presents asymptomatically and sometimes with atypical features and thus we suggest high index of suspicion and detailed cardio-vascular examination in young individuals with unexplained chronic headache, facial nerve palsy and visual symptoms.

A Multicentre Study of Awareness and Practice of Vaccination Against Infectious Diseases Among Haemo-Dialysis Subjects in Nigeria.

BACKGROUND: Numerous studies indicate that immunization against vaccine-preventable infectious diseases lowers mortality among Chronic Kidney Disease/dialysis patients and improve their quality of life. However, their knowledge and practice of this appears to be poor in Nigeria and parts of Africa. OBJECTIVES: We set out to determine subjects' awareness of vaccination against preventable infectious diseases and its impact on their participation in vaccination programs. METHODS: A prospective, cross-sectional study. Data was collated using questionnaires, laboratory results and dialysis entries and analyzed using IBM SPSS Statistics19. RESULTS: One hundred and twenty-four participants (mean age, 48.26±14.45 years) undergoing maintenance haemodialysis were studied. Sixty-two subjects (50.4%), 15.3% and 16.9% had heard of Hepatitis B Virus, S. pneumoniae and H. influenza virus respectively. Thirty-four (54.6%) of the participants first heard of these infections from sources other than healthcare personnel. Of the three common infections, study participants only received formal counselling on Hepatitis B Virus (HBV) infection. Majority had never heard of S. pneumoniae or H. influenzae. Seven (5.7%) had completed their HBV immunisation schedule only. Better educated participants were more aware of necessary vaccination against Hepatitis B Virus (p=0.000) S. pneumoniae (p=0.005) and H. influenza virus (p = 0.003). A significantly higher proportion of participants who received health-personnel driven formal education commenced vaccination against Hepatitis B virus (p=0.000). CONCLUSION: Awareness and practice of vaccination against infectious diseases by haemodialysis patients was found to be poor. Defective system and practice of information dissemination by healthcare workers was remarkably contributory.

Study of association between sickle cell trait and renal dysfunction among young adults in South-west Nigeria.

BACKGROUND: Although sickle cell disease has become a recognized etiology of chronic kidney disease (CKD), the sickle cell trait (SCT) variant was until recently believed to be a benign carrier state with little or no effect on the health of affected individuals. However, recent studies now appear to suggest an association between SCT and CKD. OBJECTIVE: The objective of the study is to determine the association between SCT (hemoglobin AS) and renal dysfunction among young Nigerian adults. METHODOLOGY: This was a cross-sectional, descriptive study among apparently healthy undergraduates of Adeyemi College of Education, Ondo, southwest Nigeria. Their hemoglobin genotypes were determined using standard alkaline electrophoresis; their blood pressure, anthropometry, serum total cholesterol (TC), creatinine, and estimated glomerular filtration rate (eGFR) were determined. Data analyzed using Statistical Package for Social Sciences (SPSS) 20 were significant at P < 0.05. RESULTS: Six hundred and two subjects with HbAS (SCT, n = 465) and HbAA (non-SCT, n = 137) were studied. Their age range was 18-30 years with male-to-female ratio 1:3.8. There was no difference in the prevalence of renal dysfunction between SCT and non-SCT subjects (5.1% vs. 5.2%, P = 0.591). There was no increased risk of CKD among subjects with SCT (PR, 0.99 at 95% CI [0.417-2.348]). CONCLUSION: SCT was not associated with increased risk of renal dysfunction among young adults in Nigeria. Further studies are needed to clarify the controversy, especially in Nigeria, with a relatively higher prevalence of SCT.

The Prevalence and Pattern of Malnutrition in Pre-Dialytic Chronic Kidney Disease Patients at a Tertiary Care Facility in Nigeria.

BACKGROUND: Malnutrition is a common problem in chronic kidney disease contributing to adverse outcomes in terms of morbidity and mortality and overall poor quality of life. In our environment and indeed most other developing countries, the prevalence of malnutrition in the general population is high. The high cost and dearth of renal replacement therapy in developing countries underscores the need for identification of factors that if adequately addressed will lead to slowing down of the progression to End Stage Renal Disease. AIMS AND OBJECTIVES: To determine the prevalence and pattern of malnutrition in pre-dialytic CKD patients at a tertiary care renal unit in a developing country. METHODOLOGY: One hundred and two consecutive patients attending the nephrology clinic of a tertiary care facility along with apparently healthy age and sex-matched subjects were studied. Demographic data, social classification and aetiology of CKD were obtained from patients. Multiple tools were used for assessment of the nutritional status of patients in stages 2-5 CKD who are not yet on dialysis. Clinical examination, anthro-pometric measurements triceps skin fold (TSF), Body Mass Index (BMI), Mid-upper Arm Circumference (MUAC), biochemical assessment (serum albumin and serum cholesterol) and Subjective Global Assessment (SGA) were used as tools for nutritional assessment for patients and compared with controls. The proportion of patients that met the International Society of Renal Nutrition and Metabolism (ISRNM) criteria for malnutrition was also determined. RESULTS: The mean age of the CKD patients was 47±11 years with a male to female ratio of 1.2:1. Prevalence of malnutrition in the CKD patients using clinical assessment was 8.8% (control=none), Body Mass Index was 31.4% (control=7.8%), Triceps skin fold thickness 46.6% (control=14.7%), serum albumin 46.1% (control=5.9%), Mid-upper arm circumference was 30.4% (control=11.18%), serum cholesterol 11.8% (control=3.9%), Subjective Global Assessment, 5.9% (control = none) and International Study of Renal Nutrition and Metabolism criteria 31.4% (control=none). The Prevalence of malnutrition increased significantly across CKD stages 2 to 5 with the use of clinical assessment (p=0.001), SGA (p value =0.001), serum albumin (p value =0.001) and BMI (p value =0.012). CONCLUSION: Malnutrition is common in pre-dialytic CKD patients in Nigeria and possibly other developing countries. There is a need to identify those who may need nutritional intervention early as this will impact positively on the final outcome of the disease as well as reduce the number of patients progressing to ESRD.

Prevalence and Pattern of Chronic Kidney Disease and its Associated Risk Factors in a Rural Community in South Western Nigeria.

BACKGROUND: Chronic kidney disease (CKD) has now become a disease of public health importance. The increased prevalence in the population of patients with end stage renal disease (ESRD) is partly related to the failure of early detection of the pre-clinical stages of the disease and its associated risk factors. This study aimed to determine the prevalence of chronic kidney disease and its associated risk factors in Aiyepe community in Ogun state, south western Nigeria as well as determining the awareness level of the population about CKD. MATERIALS AND METHODS: It was a cross-sectional community-based study involving 456 participants recruited through cluster and simple random sampling techniques.Participants were screened for urinary albumin by dipstick and/or albumin creatinine ratio. Serum creatinine, fasting blood sugar and serum lipid profile were determined while glomerular filtration rate was estimated using Cockroft and Gault formula from serum creatinine. RESULTS: The mean age ± standard deviation (SD) of the study population was 48.09(±15.7) years, and the age range was 18-80 years. Hypertension was seen in 28.9% of studied participants while only 4.2% were diabetic. The mean waist-hip ratio (WHR) of the participants was 0.94(±0.55). The mean BMI of the participants was 26.62(±6.0) kg/m2 with a range of 15.04 to 48.68 kg/m2. The prevalence of overweight and obesity was found to be 24.4% and 30% respectively. The prevalence of proteinuria was 16.3% while 3.7% of the participants had history of haematuria. The prevalence of CKD was 27.6%. Age (OR-1.080, CI-95%, 1.059-1.102), female gender (OR-0.550, CI-95%, 0.320-0.945), BMI (OR-0.832, CI-95%, 0.785-0.882) and dyslipidaemia (OR-1.007, CI-95%, 0.978-1.037) were found to be predictive of CKD in this study. CONCLUSION: The prevalence of CKD and its associated risk factors is high in Aiyepe community in Ogun state, south western Nigeria. If this is true for other rural communities generally, it will pose huge challenges on the available healthcare resources.

Clustering of cardiovascular risk factors in semi-urban communities in south-western Nigeria.

BACKGROUND: In addition to poor socio-economic indices and a high prevalence of infectious diseases, there have been various reports of a rising prevalence of cardiovascular diseases, with associated morbidity and mortality in developing countries. These factors co-exist, resulting in a synergy, with serious complications, difficult-to-treat conditions and fatal outcomes. Hence this study was conducted to determine the clustering of cardiovascular disease risk factors and its pattern in semi-urban communities in south-western Nigeria. METHODS: This was a cross sectional study over seven months in 11 semi-urban communities in south-western Nigeria. RESULTS: The total number of participants was 1 285 but only 1 083, with 785 (65%) females, completed the data. Participants were 18 years and older, and 51.2% were over 60 years. The mean age was 55.12 ± 19.85 years. There were 2.6% current cigarette smokers, 22% drank alcohol and 12.2% added salt at the table, while 2% had been told by their doctors they had diabetes, and 23.6% had hypertension. The atherogenic index of plasma was at a high-risk level of 11.1%. Elevated total cholesterol and low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol levels were seen in 5.7, 3.7 and 65.1%, respectively. Prevalence of hypertension was 44.9%, diabetes was 5.2%, obesity with body mass index (BMI) > 30 kg/m2 was 5.7%, and abdominal circumference was 25.7%. Prevalence of clusters of two, three, and four or more risk factors was 23.1, 15.5 and 8.4%, respectively. Increasing age 2.94 (95% CI: 1.30-6.67), BMI 1.18 (95% CI: 1.02-1.37), fasting plasma glucose level 1.03 (95% CI: 1.00-1.05), albuminuria 1.03 (95% CI: 1.00-1.05), systolic blood pressure 1.07 (95% CI: 1.04-1.10), diastolic blood pressure 1.06 (95% CI: 1.00-1.11) and female gender 2.94 (95% CI: 1.30-6.67) showed increased odds of clustering of two or more cardiovascular risk factors. CONCLUSION: Clustering of cardiovascular risk factors is prevalent in these communities. Patterns of clustering vary. This calls for aggressive and targeted public health interventions to prevent or reduce the burden of cardiovascular disease, as the consequences could be detrimental to the country.

Bacterial contamination of hemodialysis water in three randomly selected centers in South Western Nigeria.

BACKGROUND: Hemodialysis (HD) is the most common method of renal replacement therapy for patients with either acute kidney injury in the failure stage or end stage kidney failure in Nigeria. The number of dialysis centers in Nigeria has risen exponentially from 10 centers two decades ago to more than 120 centers in 2015. The number of patients needing renal replacement therapy in the country in the form of HD has also risen close to a projected 2000/year. The outcome from HD in Nigeria is poor as a result of a myriad of interwoven factors such as complications of cardiovascular diseases and suboptimal dialysis dose primarily due to economic factors. These are often complicated by episodes of dialysis water related bacteremia, possibly as a result of the apparent lack of a standardized guideline or protocol for monitoring dialysis water treatment system which is the driving force of dialysis units. OBJECTIVES: This is a multicenter laboratory-based study designed to determine the microbiological quality of samples of HD water and dialysate in randomly selected dialysis units in three major government teaching hospitals in Nigeria. METHODOLOGY: Water samples were aseptically and serially collected from three HD units. The samples were taken from 6 points at each center coded A, B, and C over a 6-month period. RESULTS: The water system in the three dialysis centers were grossly contaminated with Gram-negative aerobic bacteria such as Pseudomonas species and Moraxella species at all the points in the three centers. CONCLUSION: Conventionally, water treatment is a major determinant of morbidity and mortality in HD units, and the microbial quality is a major factor involved. There is evidence of bacterial contamination in the dialysis units sampled in this study. There is thus the compelling need for periodic microbiological monitoring of water after each treatment step. A uniform national guideline as part of an effective quality assurance protocol in infection surveillance is also advocated for dialysis units in Nigeria.

Concomitant gentamicin-induced nephrotoxicity and bilateral ototoxicity.

Co-occurrence of aminoglycoside-induced ototoxicity and nephrotoxicity is rare, possibly as a result of divergent mechanisms of tissue damage despite similarities in the anatomy of the inner ear and the proximal renal tubular epithelium. We present the case of a 63-year-old hypertensive woman who developed nonoliguric acute exacerbation of chronic renal failure and sudden onset of sensorineural deafness after receiving daily injections of gentamicin. Coexisting ototoxicity and nephrotoxicity from aminoglycosides can occur, though rare. Adverse effects of aminoglycosides are better prevented by a careful exercise of discretion by prescribers.

Awareness, knowledge and perception of chronic kidney disease in a rural community of South-West Nigeria.

BACKGROUND: Awareness and education on kidney disease impact on its effective management and will reduce the significant economic and public health burden. Knowledge of CKD and risk factors increases the perception of being at high risk and increasing health seeking behavior. We conducted a cross-sectional descriptive study to assess the level of awareness, knowledge and conventional risk factors of CKD in the community to strategize on preventive modalities using the information gathered from this population. METHODS: We used a pretested structured questionnaire to draw information on sociodemography, knowledge and risk factors of CKD from 563 residents aged >18 years. RESULTS: A total of 454 residents completed this study, mainly farmers, with a mean age of 45.8 ± 19.0 years and male: female ratio of 0.8:1. Only 33.7% had heard of kidney disease with 59.3% from the media and 35.3% from health workers; the level of knowledge of CKD was good in 27.1%. The majority (67.0%) do not know the correct location of the kidneys. Only 10.6% could mention at least one function of the kidneys with only 24.5% agreeing that NSAIDs can cause kidney disease. A laboratory test for kidney function was known by 4.4%; 45.9% and 47.8% believe that CKD can be cured by spiritual means and herbal concoctions respectively. Only 11.1% agreed that CKD can be hereditary. Abdominal obesity and cigarette smoking were seen in 14.6% and 16.6% respectively. Hypertension was seen in 26.5% while 17.8% actually knew they were hypertensive. Diabetes mellitus was found in 3.4%. None of the patients with CKD who had diabetes or hypertension was aware of kidney disease. CONCLUSION: There are a misconception and low level of awareness and knowledge of CKD, including those with risk factors, in the community. Efforts should be made to create awareness and educate people on CKD and prevention of its risk factors.

A community study of the prevalence, risk factors and pattern of chronic kidney disease in Osun State, South West Nigeria.

BACKGROUND: Chronic kidney disease (CKD) is a global public health concern. Nigeria, like other African countries has paucity of hard data derived from community based studies. AIMS: We set out to determine the awareness, level of knowledge, prevalence of chronic kidney disease and its associated risk factors in Nigerian community. METHODS: We used a pre-tested structured questionnaire to draw information on sociodemography, knowledge and risk factors of CKD from 468 residents aged ≥ 18 years. Clinical examination, blood glucose, serum creatinine, urinalysis and urinary albumin: creatinine ratio (ACR) was carried out. Glomerular filtration rate (eGFR) was estimated using Modification for Diet in Renal Disease equation. CKD was defined as eGFR < 60 ml/min and/or macroalbuminuria (ACR ≥ 300 mg/g or dipstick proteinuria). RESULTS: A total of 454 residents, mainly farmers, with a mean age of 45.8 ± 19.0 years and M: F ratio of 0.8:1 completed the study. Only 33.7% had heard of kidney disease; the level of knowledge of CKD was adjudged good, fair and poor in 25.5%, 42.2% and 30.6% respectively. There was higher prevalence of CKD in those with poor knowledge (p=0.023). Smoking habit, habitual analgesic intake, alcohol and herbal concoction use was 7%, 20%, 19% and 75% respectively. The prevalence of hypertension was 30%, diabetes mellitus (3.7%), obesity by waist circumference (14.6%) and haematuria (3.1%). Estimated GFR < 60 ml/min was present in 12.3% while macroalbuminuria was present in 8.9%. The overall prevalence of CKD was 18.8%, with CKD stages 1, 2, 3 and 4 accounting for 2.4%, 4.1%, 11.8% and 0.5% respectively. Age (p=0.00; OR 1.09), female gender (p=0.006; OR 4.87), systolic blood pressure P<0.001; OR 1.04) and diabetes (p=0033; OR 15.76) were predictive of CKD. CONCLUSION: The prevalence of CKD and its risk factors are high in this rural community of South Western Nigeria. Majority had moderately impaired kidney function. This underscores the need for primary and secondary preventive programmes.

Kidney diseases in Africa: aetiological considerations, peculiarities and burden.

AIM: To review available literature on the burden of kidney diseases in Africa from the perspective of acute kidney injury and chronic kidney disease. It also aims to provide information on the status of renal replacement therapy activities, and the emerging roles of the double burden of communicable and non communicable diseases interfacing with the kidney in a continent with distinct environmental, socio-cultural, infrastructural and economical peculiarities. METHODS: A literature search was conducted on the aetiopathogenesis, management options of peculiar diseases causing both acute kidney injury and chronic kidney diseases and renal replacement therapies in Africa. The literature review used the electronic database; Medline, Pubmed and theAfrican Journal on line (AJOL). Information related to the topic over a 30-year period (1979-2009) was retrieved and reviewed. Search terms used were; acute renal failure in Africa, acute kidney injury in Africa, chronic renal failure/chronic kidney disease in Africa, heamodialysis, peritoneal dialysis and transplantation in Africa. RESULT: Nephrotoxins and infections are prevalent causes of acute kidney injury (AKI) in the continent. Chronic glomerulonephritis, hypertension and lately diabetes mellitus are still major peculiar aetiological factors of chronic kidney disease (CKD). A variety of renal syndromes which can be acute or chronic is associated with the Human immunodiefficency virus infection and its magnitude and consequences portend a grim reality in a continent that is least prepared to respond appropriately. Renal replacement therapy therapy is limited to less than five percent of those that need it especially in the sub-Saharan Africa. CONCLUSION: There is a huge burden of AKI and CKD in Africa from the perspective of their peculiar aetiological considerations. The status of renal replacement therapy activities is poor except in North and South Africa. The major challenges of kidney diseases in Africa include the high prevalence, delayed presentation, cost of treatment, general lack of preventive measures, lack of epidemiological studies and general lack of functional renal registries. There is thus a need for a strong advocacy for support for renal care in Africa.

End digit preference in blood pressure measurement in a hypertension specialty clinic in southwest Nigeria.

BACKGROUND: One of the observer errors associated with blood pressure (BP) measurement using a mercury sphygmomanometer is end digit preference (EDP) which refers to the occurrence of a particular end digit more frequently than would be expected by chance alone. Published reports, mainly from outside Africa, have shown a high prevalence ranging from 22 to 90% of end digit zero in BP readings taken by healthcare workers (HCWs). This study examined the prevalence of EDP and patients' and physicians' characteristics influencing the occurrence of EDP. METHODS: A retrospective review was undertaken of BP readings of 114 patients seen over a two-month period at our hypertension specialty clinic. RESULTS: Nurses and physicians displayed a high frequency of preference for end digit zero in systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. The preference for end digit zero was, however, higher for nurses than for physicians (SBP: 98.5 vs 51.2%, p < 0.001; DBP: 98.5 vs 64.3%, p < 0.001). Among the physicians, the consultant staff displayed the least preference for end digit zero compared to resident doctors. There was no statistically significant difference in gender, age, weight, height and BMI of those with BP readings with end digit zero compared with those with non-zero end digits. CONCLUSION: The high prevalence of EDP for zero argues for the training, retraining and certification of HCWs in BP measurement and the institution of a regular monitoring and feedback system on EDP in order to minimise this observer error.

Some emerging issues in medical admission pattern in the tropics.

BACKGROUND: There is a changing pattern in terms of medical admissions worldwide with an alarming increase in the prevalence of noncommunicable diseases, especially in the tropics over the last decade. The aim of this study was to describe the pattern of medical admission and highlight emerging issues of noncommunicable diseases in a Nigerian University Teaching Hospital. MATERIALS AND METHODS: A retrospective review of medical admission at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South Western Nigeria, over a 3 years period (January 2005 to December 2007). Data were retrieved from the medical records of all medical admission over the study period. RESULTS: During the study period, 1786 patients were admitted into the medical wards. This consisted of 1089 males (61.0%) and 697 females (39.0%). Their ages ranged from 14 to 96 years with mean ages of 51 ± 16.89 years. Subjects ≥60 years of age accounted for 27.3% and 29.8% of total males and female admissions which were the largest age group. Noncommunicable diseases were responsible for 47.99% of total medical admissions. The indications for admission in order of frequency include cerebrovascular accidents 239 (13.4%), diabetes mellitus 194 (10.9%), tuberculosis 151 (8.5%), and chronic kidney disease 116 (6.5%). Hypertension was the underlying risk factor in majority of patients with CVD and CKD. CONCLUSION: Noncommunicable disease accounted for a significant number of admissions over 3 year duration. The elderly accounted for a major age group admitted for medical diseases. Therefore, preventive strategies against noncommunicable disease and effective geriatric care are advocated.

Acute renal failure in the intensive care unit: aetiological and predisposing factors and outcome.

BACKGROUND: Acute renal failure (ARF) in the intensive care unit (ICU) complicates 20 to 35% of admissions worldwide. There is no information on the pattern of ARF in our ICU and factors that influence survival. OBJECTIVE: To determine the magnitude of acute renal failure, and outcome among patients at an ICU in Nigeria. METHODS: Adult patients requiring intensive care, and with ARF were recruited. Severity of ARF was assessed using the Liano prognostic scoring system and a modified version of APACHE II prognostic scores. Haemodialysis was offered when indicated. Management outcomes were noted while a relationship was sought between severity of ARF and outcome. RESULTS: Forty (19.6%) of the 204 patients managed during the period had ARF. These included 28 (70%) males and 12 (30%) females. Twelve (30%) of the patients had head injury while eight (20%) had major burns. Surgical sepsis accounted for seven (17.5%), while six (15%) patients had advanced metastatic carcinoma. Multiple fractures accounted for four (10%) while other causes accounted for the remaining 16 (40%). The mean serum creatinine and urea were 863.3+95umol per litre and 19.45(4.1) mmol per litre respectively. The Liano scores ranged from 33% to 99% , mean of 61 + or - 4.2%) while modified APACHE II score ranged from 5-19 (mean of 11 + or - 3.2). There was a significant correlation between the Liano scores and outcome (p<0.007) while the modified APACHE II score did not influence the outcome (P>0.05). Eighty percent of patients who had two or more organ failure died compared to 20% of the patients with less than two organ failure. Eight (20%) patients survived. Dialysis therapy significantly influenced outcome as 100% of the dialysed patients survived compared to 80% of those who were not. CONCLUSION: Acute renal failure presents a continuing challenge in the ICU setting with attendant of high morbidity and mortality. Dialysis significantly influences survival, hence, the service should be provided in every intensive care unit.

Acute renal failure (ARF) in developing countries: which factors actually influence survival.

Acute renal failure, a relatively common clinical condition, is still associated with a high mortality rate in both developed and developing countries despite the differences in the epidemiology, clinical characteristics and therapeutic modalities offered to affected patients. The various modalities of renal replacement therapy are still largely inaccessible, unaffordable and unavailable in most parts of sub-Saharan Africa, hence the need to judiciously utilise available resources. Consequently we studied patients with acute renal failure to critically appraise the factors that influence survival and determine the usefulness or otherwise of available renal replacement therapies (Acute HD and Acute PD). A total of 46 (34 (73.9%) males and 12 (26.1%) females) patients satisfied the inclusion criteria. Their ages ranged between 15 and 76 years (mean +/- SD; 38.2 +/-16.3 years). The commonest causes were gastro-enteritis (cholera) and septicaemia in 36.9% and 30.5% respectively. Twenty six (56.5%) of all the patients survived while the remaining 20 (43.5%) died. Twenty four (52.2%) patients had different complications of which pulmonary oedema was singularly found to significantly influence survival. Other factors that were found to significantly influence survival included availability of renal replacement therapy, the aetiology of ARF; gender; age of the patients and the duration of oliguria. We further compared the patients managed with haemodialysis with those managed with peritoneal dialysis and found no difference(s) in the age; duration of oliguria or hospitalisation; survival figures; effect of pulmonary oedema and the aetiology of ARF. However, the number of sessions for HD and the duration of PD significantly influenced survival. We conclude that ARF is still associated with a high mortality rate and prompt institution of available renal replacement therapy and aggressive management of complications would assist in reducing the trend.

Performance of laying pullets fed on cereal-free diets based on maize offal, cassava peel and reject cashew nut meal.

1. A 70-d experiment was conducted to determine the response of 26-week-old laying pullets to cereal-free diets based on maize offal, cassava peel and full-fat cashew nut meal (CNM) in comparison with a standard 550 g maize/kg reference diet. The 4 test diets all contained 315 g CNM/kg 232.5, 155.0, 77.5 and 0.0 g/kg of maize offal in combination with 77.5, 155.0, 232.5 and 315.0 g/kg of cassava peel, respectively. 2. Pullets fed on the 4 CNM-based diets consumed (P<0.05) less food than those fed on the reference diet; they also had lower (P<0.05) rates of lay, produced less (P<0.05) egg mass, had lower (P<0.05) food conversion efficiencies and their eggs had a lighter (P<0.05) yolk colour. Pullets fed some of the CNM-based diets also gained more (P<0.05) weight, the heaviest (P<0.05) being birds reared on the diet containing 315 g/kg cassava peel. Egg weight, shell thickness and albumen height from all eggs were similar. Pullets fed on the CNM-based diets had inferior (P<0.05) retention of dry matter and protein. 4. It was concluded that feeding full-fat CNM allowed for high dietary inclusion rates of cassava peel and maize offal and the resultant diets, which contained no maize, supported satisfactory performance of laying hens.