Haematological Indices and Iron Status in Pre-Dialysis Chronic Kidney Disease Patients.

BACKGROUND: Chronic kidney disease (CKD) is associated with haematological changes, the commonest being anaemia. The number and function of white blood cells (WBC) and platelets are equally affected. Iron deficiency is a common cause of anaemia in the CKD population and anaemia has been associated with reduced cardiac function, increased rates of hospitalization, morbidity and mortality. This study aimed to determine the haematological indices and iron status among pre-dialysis CKD patients. METHOD: A hospital-based cross-sectional study involving 95 predialysis CKD patients and 95 age- and sex-matched apparently healthy controls. Full blood count, peripheral blood film, serum ferritin, transferrin saturation, C-reactive protein (CRP), electrolytes, urea and creatinine, serum folate and vitamin B12 were done in all study participants. Comparisons were made between results obtained from participants in both groups. RESULT: The mean ages were 58.1 ± 14.9 years and 58.3 ± 15.0 years in the CKD group and controls, respectively. The male:female ratio was 1:0.9 in both groups. The prevalence of anaemia was 51.6% and 3% in patients with CKD and controls, respectively. There was no significant difference in the total WBC count, neutrophil and lymphocyte differentials, platelet count, serum vitamin B12 and folate in patients with CKD and controls. The prevalence of iron deficiency among patients with CKD was 32.6%, of which 62.5% were absolutely iron-deficient while 37.5% were functionally iron-deficient. The median ferritin and CRP were also higher in CKD. (p =0.001). CONCLUSION: Anaemia and iron deficiency are common in predialysis CKD patients. Early diagnosis and treatment are important to avoid the problems associated with them. MOTS-CLÉS: Maladie rénale chronique, Anémie, Carence en fer, Pré-dialyse.

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.

Factors associated with blood pressure control in predialysis chronic kidney disease patients: Short-term experience from a single center in Southern Nigeria.

BACKGROUND: Hypertension is a leading cause of kidney disease worldwide, and chronic kidney disease (CKD) is a known cause of secondary hypertension. Blood pressure (BP) control is a main-stay in the management of CKD because it retards the progression of established CKD. AIM: To determine BP control and its associated factors in predialysis CKD patients in a tertiary hospital setting. METHODOLOGY: CKD patients who attended the renal outpatient clinic during the period from December 2013 to June 2014 were recruited into the study. Demographic and clinical information were obtained from their case records. The average of the three most recent clinic BPs was calculated for each patient. Good BP control was taken as an average BP of <140/90 mmHg. RESULTS: One hundred and three patients (53 males and 50 females) met inclusion criteria for the study. The mean age of the patients was 40.6 ± 17.4 years. Estimated glomerular filtration rate was <60 ml/min in 49.5% of patients. Good BP control was seen in 57 (55.3%) patients. Poor BP control was associated with middle age, proteinuric CKD, and prescription of 3 or more BP medication. CONCLUSION: BP control in predialysis CKD patients still needs to be optimized. Special attention should be given to middle-aged patients who have proteinuric CKD and those on multiple BP drugs without optimal BP control.

Screening for kidney disease in an oil producing community in Nigeria: A pilot study.

Petroleum products have been associated with acute and chronic kidney disease. Nigeria is a major oil producing and exporting country. The aim of this study was to screen for kidney disease in an oil producing community in Nigeria. This was a cross-sectional study carried out in Ido, Asari-Toru Local Government Area of Rivers State. All subjects were resident in the town and those aged 18 years and above were eligible. Spot urine samples were collected for dipstick urinalysis, and venous blood was collected for estimation of serum electrolyte, urea, creatinine, and lipid profile. The estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft and Gault formula. A total of 99 participants were screened: 75% were females, over 50% aged above 50 years, and the majority had low socioeconomic status. The mean eGFR of the participants was 80.2 ± 33.3 mL/min/1.73 m 2 , 32.6% of the participants had eGFR <60 mL/min, and 2% had eGFR <30 mL/min. Furthermore, 36.5% of the participants had proteinuria and 29.8% had 1 + proteinuria. There was a significant negative correlation of eGFR with a family history of diabetes mellitus (-0.35, P = 0.016), elevated systolic hypertension (-0.29, P = 0.035), and elevated total cholesterol (-0.23, P = 0.045), but there was a positive correlation with body mass index (0.24, P = 0.018). We conclude that the prevalence of kidney disease was high in the screened population in a Nigerian oil producing community.

Prevalence and clinical and laboratory characteristics of kidney disease in anti-retroviral-naive human immunodeficiency virus-infected patients in South-South Nigeria.

Since the emergence of acquired immune deficiency syndrome (AIDS) about three decades ago, several renal disorders have been reported as common complications of human immunodeficiency virus (HIV) infection. These renal disorders result from diverse etiologies. The aim of this cross-sectional study was to determine the prevalence and clinical and laboratory characteristics of anti-retroviral-naοve HIV-infected patients with impaired kidney disorder in South-South Nigeria. This study was conducted on patients presenting at the University of Benin Teaching Hospital, Benin City in South-South Nigeria for six months. The patients' demographic data and clinical, hematological and biochemical parameters were assessed. Their glomerular filtration rate (GFR) was calculated and the protein excretion was assessed from the protein- creatinine ratio. Data were analyzed using statistical software program SPSS version 15.0. Three-hundred and eighty-three patients with a mean age of 35.39±8.78 years and a male: female ratio of 1:1 were studied; 53.3% had evidence of kidney disorder. The main clinical features in patients with kidney disorder were evidence of fluid retention, urinary symptoms, pallor and encephalopathy. The mean systolic and diastolic blood pressures were 115.33±17.17 and 72.33±14.31 mm Hg, respectively. The mean estimated GFR was 52.5 mL/min/1.73 m 2 . Patients with kidney disorder had higher proteinuria (P=0.001), lower mean CD4 cell count and packed cell volume (P=0.019 and 0.001, respectively). Kidney disorder is a common complication in HIV-infected patients, and they have clinical and laboratory anomalies. Screening of HIV/AIDS patients at the time of diagnosis will facilitate early diagnosis of kidney disorders in them.

Screening for risk factors of chronic kidney disease in a community in Niger Delta Nigeria.

BACKGROUND: Chronic kidney disease (CKD) is associated with many traditional and nontraditional risk factors. Screening for these risk factors has been associated with appropriate interventions and preventive measures in the management of CKD. The aims and objective of this study are to screen for risk factors of CKD in a Niger Delta community in Nigeria. SUBJECTS AND METHODS: This was a cross-sectional study. The study location was Ido, a Niger Delta community in Rivers State. All subjects aged 18 years and above who gave consent were recruited for the study. Their bio data, relevant medical history, clinical and laboratory parameters were documented. The obtained data were analyzed with SPSS versions 17.0. RESULTS: A total of 105 persons participated in the study. The age range was 18-86 years, 50.5% were above 50 years. Females were 75.0%, 66.7% had either primary or no education, 14.6% were retiree and 40.4% were traders. 14.1% were known hypertensive, and 39.4% had elevated blood pressure. 6.1% were known diabetic and 6.1% had random blood sugar of 200 mg/dl and above. 27.2% of subjects were obese. About 10.5% and 27.8% had a history of significant intake of tobacco and alcohol respectively. Total serum cholesterol was higher than 200 mg/dl in 51.5%. None of the participants had past or family history of kidney disease. CONCLUSION: The prevalence of risk factors for CKD in the Niger Delta community is high.

Prevalence and correlates of chronic kidney disease among civil servants in Bayelsa state, Nigeria.

INTRODUCTION: Chronic kidney disease (CKD) has become a public health problem with rising incidence and prevalence world-wide. Despite the fact that Sub-Saharan Africa, including Nigeria appears to be badly hit by this epidemic, there is a paucity of data on CKD prevalence in these regions and where data exists, they are mostly hospital-based. OBJECTIVES: The present study was carried out to determine the prevalence and correlates of CKD in an urban civil service population in Bayelsa State, Nigeria. MATERIALS AND METHODS: A total of 179 civil servants in the Bayelsa State secretariat were screened for CKD during the World Kidney Day on March 2012. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m 2 body surface area and/or proteinuria. Socio-demographic data was obtained using interviewer-administered semi-structured questionnaire while anthropometric measurements were taken. Blood pressure (BP), urinalysis, serum urea and creatinine were also assessed. RESULTS: The prevalence of CKD in the study was 7.8%. Age >50 years was associated with CKD in univariate analysis but none of age, gender, body mass index, BP or hyperglycemia independently predicted it. CONCLUSION: The prevalence of CKD among Nigerian civil servants was fairly high and was associated with advancing age. Routine screening for CKD in this population is recommended.

Choice of medical specialties amongst final year medical students in two universities in South-South, Nigeria.

UNLABELLED: Study aimed at determining the preferred medical specialties among final year medical students and the most important factor(s) influencing their choices. METHODS: A cross-sectional questionnaire-based survey was carried out among all final year medical students from the University of Benin (UNIBEN) and the Niger Delta University (NDU). The study was done in UNIBEN in July 2011 and subsequently in NDU in March 2012.Students were asked to choose the most preferred specialty out of a list of options and to select the most important factors influencing their choice. RESULTS: A total of one hundred and sixty seven (102 UNIBEN and 65 NDU) students completed the study. A hundred (59.9%) respondents preferred surgery-related specialties while forty nine (29.3%) preferred medicine-related specialty. Forty five (26.9%) students preferred surgery while thirty six (21.6%) preferred obstetrics and gynaecology. Internal medicine and paediatrics were preferred amongst 18(10.8%) and 10(6.0%) respondents respectively. Other specialties were chosen to a lesser degree. Personal interest in 95(56.9%) participants was the most important factor influencing choice of medical specialties. CONCLUSION: The study highlights a general preference for core clinical specialties and surgery-related specialties especially surgery and obstetrics and gynaecology, amongst final year medical students. Personal interest was the most important factor influencing career choice. These findings have important implications for Nigeria's medical education and health care policy making.

Frequency and risk factors of contrast-induced nephropathy after contrast procedures in a Nigerian tertiary centre.

Contrast-induced nephropathy (CIN) is a significant yet underestimated problem in clinical practice. The increasing use of contrast media in diagnostic and interventional procedures over the last 30 years has resulted in CIN becoming the third leading cause of hospital-acquired acute renal failure (ARF) in developed countries. Despite this, there is still a paucity of data on the incidence of CIN following intravenous contrast media especially in developing countries. The goals of this study were to determine the frequency and risk factors of CIN amongst patients receiving intravenous contrast in a tertiary health institution. This is a hospital-based prospective observational study. One hundred and eighty (180) consenting patients were recruited consecutively over a 6-month period. Venous blood and urine were collected for haematocrit, serum urea, electrolytes and creatinine estimation and urinalysis, before contrast exposure and up to 72 hours post-exposure. The frequency of CIN was 35.9% and one patient required haemodialysis. Baseline renal insufficiency, anaemia and age >55 years were significant risk factors for CIN and predictive of CIN in univariate but not multivariate analysis.

Analgesic nephropathy as a cause of end-stage renal disease in a 55 year-old Nigerian.

Analgesic nephropathy is a subtle but significant cause of chronic renal failure. There is paucity of data on analgesic nephropathy in Nigeria. This case presentation is to highlight the need to have high index of suspicion in patients at risk of developing analgesic nephropathy. In March 2009 a 55-year-old businessman was referred to the renal unit on account of azotemia by the hematologist who had hitherto managed the patient as a case of refractory anemia. The patient had osteoarthritis for over 10 years and was managed with several analgesic drugs over the same period. He was found to have features suggestive of analgesic nephropathy and had end-stage renal disease. He was commenced on appropriate therapy, and he had a live related kidney transplant six months later. Analgesic nephropathy is preventable and morbidity/mortality can be remarkably reduced with appropriate and prompt intervention.

Cardio-renal-anemia syndrome: a report of three cases.

Patients with chronic kidney diseases (CKDs) and cardiovascular diseases (CVDs) present with various degree of anemia. Anemia has been associated with poor outcome in patients with CKD and CVD. CVD is the commonest cause of morbidity and mortality in patients with CKD. CKD causes anemia and CVD, and this rapidly deteriorates when anemia is not corrected. This triad of CVD, CKD, and anemia has been termed cardio-renal-anemia syndrome. The objective of this study is to highlight the importance of cardio-renal-anemia syndrome, their relationship, and management. Three patients with various stages of CKD who presented with anemia and cardiovascular abnormalities are reported. The patients responded well to various interventional measures, with improvement in their clinical and laboratory parameters. Cardio-renal-anemia syndrome is an entity that should be identified. Early and appropriate intervention leads to better outcome.

Clinical diagnosis of intracerebral haemorrhage: validation of a simple scoring tool in West Africans.

OBJECTIVE: To validate the use of a simple stroke scoring tool in the clinical diagnosis of intracerebral haemorrhage (ICH). DESIGN: Prospective observational study . METHODS: 184 patients with acute stroke were consecutively evaluated within 24 hours of admission with a simple clinical tool- Benin Stroke Score (BSS), designed to diagnose ICH before cranial Computed tomography (CT) scans were done and the results were compared with CT findings as the gold standard. BSS is a simple 3-item tool with a minimum score of 0 and a maximum score of 3.5, that scores age, Glasgow Coma Scale (GCS) and pre-intervention admission diastolic blood pressure on an assigned score of either 0 or 1 and up to 1.5 for diastolic blood pressure. A model was devised and the accuracy was tested on a receiver operated characteristics (ROC) curve. Intra-rater and inter- rater reliability were tested with Pearson's correlation. BSS and CT were compared with kappa statistics. RESULTS: (1) BSS cut-off value of 2.5 and above was positive for ICH with sensitivity, specificity, positive and negative predictive values and likelihood ratio of 70.20%, 89.00%, 74.10%, 87.00% and 6.38 (AUC of ROC curve = 0.847, p < 0.001). (2) The inter-rater and intra-rater reliability coefficients of BSS were, r =0.90, 0.95 and 0.95 (p < 0.001, <0.001 and < 0.001) respectively. (3) BSS agreed with cranial CT findings in 60% of cases (p < 0.001). CONCLUSION: BSS is a simple 3-item tool with a reliable level of accuracy that could be used early after admission in the clinical diagnosis of ICH where neuroimaging is not available.

Renal disease in HIV infected patients at University of Benin Teaching Hospital in Nigeria.

BACKGROUND: HIV related renal disease is a common occurrence in patients with HIV infection. It is the third leading cause of end stage renal disease among African-American males between the ages of 20 and 64 years in USA. Renal function impairment has been reported at all stages of HIV infection. The aim of this study is to determine the relationship between severity of renal function impairment and CD4 cell count in HIV infected patients. METHOD: HIV patients presenting at University of Benin Teaching Hospital Benin, City Nigeria from 1(st) January to 30(th) June 2007 were randomly selected and screened for renal functional impairment (RFI). Those with RFI detected by glomerular filtration rate < 60 ml/min/1.73 m(2) or urine protein creatinine ratio 3 200 were stratified into mild, moderate and severe RFI. Forty patients from each stratum and forty HIV infected patients with normal renal functions were recruited as subjects and control respectively. Their clinical and laboratory parameters were evaluated. The data obtained were analysed using SPSS vs 15.0. RESULTS: Of the HIV patients screened, 53.3% had renal functional impairment. of these, 40.2% had mild, 37.7% had moderate and 22.2% had severe impairment in their renal functions respectively Their mean age was 36.0 ± 8.8 years. The CD4 cell count was found to be 309.75 ± 268.71/ul, 188.45 ± 173.12/ul, and 141.10 ± 126.01/ul among subjects with mild, moderate and severe RFI respectively. The CD4 cell count in control group was 319.05 ± 248.41/ul. The difference was statistically significant. (p = <0.001). CD4 cell count had a significant positive correlation with GFR (r = 0.32, p = 0.042). However, there was a negative correlation between CD4 cell count and proteinuria but this was not statistically significant (r = 0.09, p = 0.173). CONCLUSION: Severity of RFI has a positive correlation with degree of immunosuppression in HIV infected patients.

Dyslipidemias in type 2 diabetes mellitus patients in Nnewi South-East Nigeria.

BACKGROUND: Dyslipidemia has been noted to play an integral role in the pathogenesis and progression of micro and macrovascular complications in diabetes mellitus patients. The complications exemplified by renal vascular and cardiovascular disease cause the most morbidity and mortality in this group of patients. OBJECTIVE: This study is aimed at understanding the pattern of dyslipidemia among type 2 diabetic patients. MATERIALS AND METHODS: A total of 108 consenting adult type 2 diabetic patients seen in the medical unit of the Nnamdi Azikiwe University Teaching Hospital Nnewi were evaluated in this crosssectional study. Their fasting lipid profile, fasting blood glucose, weight, height and blood pressure were evaluated. RESULT: The prevalence of dyslipidemia (at least one abnormal lipid profile) was 90.7%. The 24.1% had single dyslipidemia while 66.6% had combined dyslipidemia. Reduced HDL constituted the highest single abnormality (62%) followed by hypertriglyceridemia (56.5%), hypercholesterolemia (53.7%) and high LDL in (44.4%). The duration of DM was not significantly associated with dyslipidemia (P > 0.05). CONCLUSION: Dyslipidemia is highly prevalent among type 2 diabetic patients in Nigeria with the majority of the patients having combined dyslipidemia. We recommend that aggressive treatment of lipidemia and hyperglycemia can be instituted to reduce the risk of macro and microvascular complications.

Prevalence of dyslipidemia among adult diabetic patients with overt diabetic nephropathy in Anambra state south-east Nigeria.

BACKGROUND: Dyslipidemia has been identified as a risk factor for the development and progression of diabetic renal disease. OBJECTIVE: This study was done to determine the prevalence of dyslipidemia among diabetic patients with overt nephropathy. MATERIALS AND METHODS: A total of 72 diabetic patients with overt diabetic nephropathy and 36 age- and sex-matched normoalbuminuric diabetic patients were studied. Their fasting lipid profile, fasting blood sugar, and renal function tests were evaluated. RESULTS: Total serum cholesterol and serum triglycerides were significantly higher in patients with overt diabetic nephropathy compared to the controls; 66.7% and 62.5% versus 36.1% and 30.6%, respectively ( P = 0.003 and 0.002, respectively). CONCLUSIONS: Diabetic patients with overt diabetic nephropathy have significant dyslipidemia and aggressive lipid lowering in these patients may retard their progression to end-stage renal disease.

Spectrum of Clinical Presentations in Human Immunodeficiency Virus (HIV) Infected Patients with Renal Disease.

HIV infection is a multiorgan disease with the kidney not spared. A variety of renal syndromes with varying clinical presentations has been reported amongst HIV infected patients. This study aims to highlight the spectrum of clinical presentations in HIV infected patients with renal disease. HIV infected patients presenting at University of Benin Teaching Hospital (UBTH) Benin City were the study population. A total of 383 patients were studied. Their biodata, clinical presentations and laboratory investigations including serum urea, creatinine and albumin, urine protein and creatinine were assessed. Their glomerular filtration rate (GFR) and protein urine excretion were calculated using six equations of modification of diet in renal disease (MDRD) and protein: creatinine ratio respectively. Patients were stratified according to their renal functions into normal, mild, moderate and severe renal function impairment. The data was analysed using statistical software program SPSS Vs 15.0. 53.3% of 383 patients screened had renal function impairment, 40.2% mild, 37.7% moderate and 22.2% severe impairment. Mean age was 35.6±8.3, 36.0±9.9 and 36.3±8.3 years for mild, moderate and severe renal function impairment (RFI) respectively. Easy fatigability was the commonest symptoms occurring in 47.5%, 30.0%, 37.5% and 22.5% of control, mild RFI, moderate RFI and severe RFI subjects respectively (p = 0.568). Oliguria, facial and body swelling occurred more in patients with RFI especially in patients with severe renal impairment. The difference is statistically significant (p = 0.046, 0.041, and 0.033 respectively). Pallor was the commonest clinical sign occurring in 32.5%, 50.0%, 35.0% and 62.5% of control and patients with mild, moderate, and severe RFI respectively; the difference was not statistically significant (p = 0.459). Ascites, facial puffiness and pedal oedema were commoner in patients with RFI especially those with severe RFI. The differences were statistically significant. (p = 0.048, 0.019, and 0.008 respectively). In conclusion spectrum of clinical presentations in HIV patients with renal impairment are many but few are specific to these patients.

Spectrum of clinical presentations in human immunodeficiency virus (HIV) infected patients with renal disease

HIV infection is a multiorgan disease with the kidney not spared. A variety of renal syndromes with varying clinical presentations has been reported amongst HIV infected patients. This study aims to highlight the spectrum of clinical presentations in HIV infected patients with renal disease. HIV infected patients presenting at University of Benin Teaching Hospital (UBTH) Benin City were the study population. A total of 383 patients were studied. Their biodata; clinical presentations and laboratory investigations including serum urea; creatinine and albumin; urine protein and creatinine were assessed. Their glomerular filtration rate (GFR) and protein urine excretion were calculated using six equations of modification of diet in renal disease (MDRD) and protein: creatinine ratio respectively. Patients were stratified according to their renal functions into normal; mild; moderate and severe renal function impairment. The data was analysed using statistical software program SPSS Vs 15.0. 53.3of 383 patients screened had renal function impairment; 40.2mild; 37.7moderate and 22.28.3 years for mild; 9.9 and 36.3 8.3; 36.0 severe impairment. Mean age was 35.6 moderate and severe renal function impairment (RFI) respectively. Easy fatigability was the commonest symptoms occurring in 47.5; 30.0; 37.5and 22.5of control; mild RFI; moderate RFI and severe RFI subjects respectively (p = 0.568). Oliguria; facial and body swelling occurred more in patients with RFI especially in patients with severe renal impairment. The difference is statistically significant (p = 0.046; 0.041; and 0.033 respectively). Pallor was the commonest clinical sign occurring in 32.5; 50.0; 35.0and 62.5of control and patients with mild; moderate; and severe RFI respectively; the difference was not statistically significant (p = 0.459). Ascites; facial puffiness and pedal oedema were commoner in patients with RFI especially those with severe RFI. The differences were statistically significant. (p = 0.048; 0.019; and 0.008 respectively). In conclusion spectrum of clinical presentations in HIV patients with renal impairment are many but few are specific to these patients

Multiple digital gangrene arising from traditional therapy: a case report.

BACKGROUND: Traditional medicine has being advocated as an alternative to Orthodox medicine in Nigeria despite, its reported adverse effects. OBJECTIVE: To report an unusual complication of traditional therapy. METHODS: A 20-year-old house-wife who was bitten by a crawling insect presented to a hospital with complaints of swollen body and pain in three digits. After clinical evaluation and investigations, she had both medical and surgical intervention. RESULTS: Two weeks following an insect bite, the patient noticed periorbital and bilateral leg swellings. She sought help from a traditional medicine practitioner who incised and tied the affected digits for three days. He repeated the cycle thrice. She had generalized oedema, massive proteinuria, hypoalbuminaemia, hypercholesterolaemia features consistent with a diagnosis of nephritic syndrome. There was gangrene of the left middle finger and both index toes. Oedema responded to diuretics, lisinopril and low salt diet. She had surgery for the gangrenous digits. CONCLUSION: Development of gangrene is an unusual finding in nephrotic syndrome. It occurred in this case as an aftermath of traditional medical intervention. This report reiterates the danger of this form of medical practice and the need for measures to protect the populace to be put in place.

Multiple digital grengrene arising from traditional therapy: a case report.

BACKGROUND: Traditional medicine has being advocated as an alternative to Orthodox medicine in Nigeria despite, its reported adverse effects. OBJECTIVE: To report an unusual complication of traditional therapy. METHODS: A 20-year-old house-wife who was bitten by a crawling insect presented to a hospital with complaints of swollen body and pain in three digits. After clinical evaluation and investigations, she had both medical and surgical intervention. RESULTS: Two weeks following an insect bite, the patient noticed periorbital and bilateral leg swellings. She sought help from a traditional medicine practitioner who incised and tied the affected digits for three days. He repeated the cycle thrice. She had generalized oedema, massive proteinuria, hypoalbuminaemia, hypercholesterolaemia features consistent with a diagnosis of nephritic syndrome. There was gangrene of the left middle finger and both index toes. Oedema responded to diuretics, lisinopril and low salt diet. She had surgery for the gangrenous digits. CONCLUSION: Development of gangrene is an unusual finding in nephrotic syndrome. It occurred in this case as an aftermath of traditional medical intervention. This report reiterates the danger of this form of medical practice and the need for measures to protect the populace to be put in place.

Acute renal impairment following use of intravenous contrast agent: A case report and reminder for increased awareness of the problem.

OBJECTIVE: Contrast-induced nephropathy is one of the adverse reactions to the use of radiocontrast media. Its incidence can be reduced if preventive measures are instituted. This report presents a case of acute renal impairment following use of radiocontrast media. PATIENT, METHOD AND RESULTS: We report a case of an elderly hypertensive diabetic who developed acute renal impairment within 24 hours of undergoing an intravenous urography. He was not a known asthmatic and had no previous history of allergy. His renal function improved subsequently with hydration, diuretics and strict input/output monitoring. He was discharged after 23 days in hospital and renal function returned to pre-morbid state 3 months after discharge. CONCLUSION: The report is a reminder of the possibility of nephropathy associated with the use of intravascular contrast media. There is need for extra care to be taken to identify risk factors in patients that are to undergo intravascular contrast studies and adequate attention paid to these.