Microalbuminuria and left ventricular hypertrophy among newly diagnosed black African hypertensive patients: a cross sectional study from a tertiary hospital in Uganda.

BACKGROUND: Microalbuminuria is an early manifestation of kidney damage and independently predicts cardiovascular disease (CVD). Left ventricular hypertrophy (LVH) is also an early marker of cardiac manifestation of target organ damage among hypertensive patients. The prognostic significance of microalbuminuria and its correlation with left ventricular hypertrophy has not been extensively studied in African adult hypertensive populations. This study aimed at determining the prevalence of microalbuminuria, LVH in patients with microalbuminuria and the correlation between microalbuminuria and LVH among newly diagnosed black adult hypertensive patients attending a large outpatient hypertension clinic or admitted on the cardiology ward at Mulago national referral and teaching hospital and Uganda Heart Institute in Kampala, Uganda. METHODS: In this cross-sectional study, 256 newly diagnosed eligible black adult hypertensive patients attending the outpatient hypertension clinic or admitted on the cardiology ward at Mulago national referral and teaching hospital and the Uganda Heart Institute, Kampala Uganda were consecutively recruited over a period of 5 months. Data on socio-demographics, clinical and laboratory findings of the study participants was collected using a pre tested questionnaire. Two spot urine samples were collected to assess for microalbuminuria. Echocardiography (ECHO) was done to assess for the left ventricular mass index using the formula of Teicholz as evidence for early hypertensive heart disease. RESULTS: The mean age/standard deviation of the study participants was 54.3 ± 6.2 years with a female predominance (162, 63.3%). The prevalence of microalbuminuria among newly diagnosed hypertensive patients was 39.5%. The prevalence of LVH among patients with microalbuminuria was found to be 17%. There was a positive correlation between microalbuminuria and left ventricular hypertrophy among the newly diagnosed adult hypertensive patients at Mulago Hospital (r = 0.185, p = 0.003). CONCLUSIONS: This study demonstrates that microalbuminuria is highly prevalent among newly diagnosed black hypertensive patients and in the presence of LVH. There is also a positive correlation between microalbuminuria and LVH among newly diagnosed hypertensive patients. Since it is a less costly and readily available test, it can be used to predict presence of LVH especially in resource limited settings where ECHO services are not readily available.

Acute kidney injury among adult patients with sepsis in a low-income country: clinical patterns and short-term outcomes.

BACKGROUND: Acute kidney injury (AKI) is a common complication of sepsis. We determined the prevalence of AKI among adult patients with sepsis on the medical wards in a low-income country and described their clinical pattern and outcomes at discharge. METHODS: We conducted a cross-sectional study of sepsis-related AKI on the adult medical wards of Mulago National Referral Hospital between January and April 2013. All patients meeting the American College of Chest Physicians (ACP) sepsis criteria were recruited. Demographic, clinical, laboratory and ultrasonography data were recorded and all patients with AKI were followed up to a maximum of 2 weeks. Proportional analysis was carried out and odds ratios with 95% confidence intervals were calculated in the bivariate analysis. RESULTS: Of 387 patients recruited, 217 (55.6%) were male and the average age was 37 years (range18-90 years). The prevalence of sepsis-related AKI was 16.3%. Age >59 years (p = 0.023), a postural drop in systolic blood pressure of >9 mmHg (p = 0.015) and a white blood cell count >12,000 cells/mL (p = 0.003) were significantly associated with AKI. In-hospital mortality among patients with AKI was 21% (13/63). 59% (20/49) of patients who were discharged alive or were still on the wards after 2 weeks had persistent kidney injury. Acute Kidney Injury Network (AKIN) Stage 3 was significantly associated with persistence of kidney injury (p = 0.001). None of the patients requiring dialysis or ICU care received either because of limited access. CONCLUSIONS: The prevalence, morbidity and mortality due to AKI among sepsis patients in Uganda is very high and limited access to dialysis and ICU care is a major factor in poor outcomes for these patients.

Randomized trial of adjunctive interleukin-2 in adults with pulmonary tuberculosis.

Interleukin (IL)-2 has a central role in regulating T cell responses to Mycobacterium tuberculosis. Adjunctive immunotherapy with recombinant human IL-2 was studied in a randomized, placebo-controlled, double-blinded trial in 110 human immunodeficiency virus-seronegative adults in whom smear-positive, drug-susceptible pulmonary tuberculosis was newly diagnosed. Patients were randomly assigned to receive twice-daily injections of 225, 000 IU of IL-2 or placebo for the first 30 days of treatment in addition to standard chemotherapy. Subjects were followed for 1 year. The primary endpoint was the proportion of patients with sputum culture conversion after 1 and 2 months of treatment. After 1 month, the proportion of patients for whom sputum culture converted to negative was 17% for the IL-2 group compared with 30% in the control group (p = 0.14; chi2). After 2 months, 77% in the IL-2 group were culture negative compared with 85% of those receiving placebo (p = 0.29, chi2). Results were similar when patients with isoniazid monoresistance were included in the analysis. There were no differences in weight gain and no improvement in fever, cough, and chest pain between groups. One patient in each arm relapsed. IL-2 did not enhance bacillary clearance or improvement in symptoms in human immunodeficiency virus-seronegative adults with drug-susceptible tuberculosis.