Pattern of haematologic abnormalities in incident dialysis patients and the effect of using locally derived haematologic reference ranges.

Background: The aim of the study was to compare the prevalence of haematologic abnormalities seen in incident haemodialysis patients using standard laboratory reference ranges with reference ranges derived locally. Study Design and Method: This was a retrospective study of 97 patients with renal failure who received haemodialysis at a single dialysis unit in Lagos, Nigeria. All patients were 18 years of age or older, had renal failure requiring dialysis, and had not previously dialyzed. Patients with a history of haemoglobinoapthy or other red cell disorders, recent history of overt blood loss or blood transfusion and pregnancy were excluded. Results: Fifty six (57.7%) of the patients were males; and 55 (56.7%) had chronic kidney disease. There were no significant differences in baseline characteristics between males and females, however, patients with CKD had significantly higher mean systolic and diastolic blood pressures, mean serum creatinines and lower mean haemoglobin concentrations. Overall, anaemia was the most common haematologic abnormality (97.9%), followed by leukocytosis (34.0%). Leukopenia, thrombocytosis and thrombocytopenia were less common (3.1%, 7.2% and 10.3% respectively). The use of locally derived reference ranges was associated with significantly higher frequencies of occurrence of majority of the haematologic abnormalities studied. Conclusion: Haematological abnormalities occurred frequently in the study population. Use locally derived haematologic reference ranges was associated with significant differences in the frequency and pattern of some of the haematologic abnormalities. Further studies are needed to determine the clinical implications of these findings.

Crossed renal ectopia coexisting with nephrolithiasis in a young Nigerian man.

INTRODUCTION: Renal ectopia or ectopic kidney is a congenital anomaly in which one or both kidneys are located in an unusual position. It results from the kidney failing to ascend properly from its origin in the true pelvis. In some cases, one kidney may cross over (crossed renal ectopia) so that both kidneys are on the same side of the body. When a crossover occurs, the two kidneys may grow together and become fused (crossed fused renal ectopia). Renal ectopia is generally uncommon; its coexistence with nephrolithiasis is even rarer. Due to its variable presentations, it is usually discovered incidentally, especially when investigating patients for abdominal pain. Treatment may be conservative when renal function is preserved and no complication is associated. CASE REPORT: we highlight the unusual occurrence of renal ectopia with nephrolithiasis in a 34 year-old Nigerian businessman who presented to the renal clinic of our hospital with a three-month history of intermittent dull right flank pain radiating to the right groin. Physical examination revealed right lumbar tenderness without guarding. The rest of the examination was unremarkable. An abdominal ultrasound scan done revealed a linear calculus in the right renal collecting system but the left kidney was not visualised. An intravenous urogram (IVU) showed a crossed ectopic kidney with nephrolithiasis. The patient was treated conservatively and his kidney function has remained stable. CONCLUSION: This case report describes the relatively uncommon finding of crossed renal ectopia associated with nephrolithiasis.