Impact of COVID-19 on renal replacement therapy: perspective from a Nigerian renal transplant centre.

Introduction: COVID-19 has had a huge impact on the health system and the world at large. Patients with kidney failure are a select group which have been affected significantly by the scourge of the disease. In the COVID-19 era, renal replacement therapy (RRT) in the form of dialysis and kidney transplantation required modifications in many centres in order to maintain high quality care and reduce infection rates among this susceptible group of patients. The objectives were to describe some of the challenges experienced in one of the leading renal care centres in Nigeria during the height of the COVID-19 pandemic and analyse the impact of practice changes on select outcomes. Methods: a retrospective cross-sectional review of haemodialysis activities and kidney transplantation among chronic kidney disease patients was done over a 15-month period ranging from April, 2019 to June, 2021. Data was extracted from the electronic media record (EMR) and analysed using SPSS version 22. Results: there was an initial significant drop in the number of haemodialysis sessions and kidney transplant surgeries by 16.7% and 66% respectively in the first 2 months of COVID-19 in our centre following the national lockdown. The mean monthly kidney transplant rate was 9±3.29 before the COVID-19 and the national lockdown, this figure reduced to 3.0±0.1 during the lockdown. Activities however normalized at 6 months following the initial lockdowns have remarkable exceeded pre-COVID numbers as at early 2021. Conclusion: after the initial drop in numbers of patients for haemodialysis and renal transplantation, there was an increase in numbers in the following months. It was instructive to put several steps in place in order to continue to offer high level RRT in the COVID-19 pandemic. RRT can safely be practiced in the COVID-19 pandemic.

Congenital bilateral iliac vein anomalies in a Nigerian pediatric kidney transplant recipient: A case report and literature review.

The finding of bilateral congenital common iliac vein anomalies is indeed uncommon. This article presents the case of an 11-year-old boy with end-stage renal disease who had kidney transplantation (KT). At presentation, he was found to have a large superficial vein running from the left groin over the suprapubic area. The arterial pulsation of both lower limbs was preserved, and there was no pedal edema. Contrast-enhanced computed tomography scan revealed aplasia of the right common iliac vein, stenosis of the left common iliac vein, and marked dilatation of the left external and internal iliac veins. There were also varicosity of numerous pelvic veins and a collateral vein draining the right lower limb. This preoperative diagnosis was key to planning for surgery. On KT surgery, the renal allograft vein was anastomosed in an end-to-side fashion to the inferior vena cava and artery to the common iliac artery. The patient had a smooth postoperative recovery and continues to enjoy a normal renal function.

Résumé La découverte d'anomalies bilatérales congénitales de la veine iliaque commune est en effet rare. Cet article présente le cas d'un garçon de 11 ans avec insuffisance rénale terminale ayant subi une transplantation rénale (KT). Lors de la présentation, il a été découvert qu'il avait une grosse veine superficielle s'écoulant de l'aine gauche sur la zone sous-pubienne. La pulsation artérielle des deux membres inférieurs a été préservée et il n'y avait pas d'œdème pédale. La tomodensitométrie avec du contrast a révélé une aplasie de la veine iliaque commune droite, une sténose de la veine iliaque commune gauche et une dilatation marquée des veines iliaques externes et internes gauches. Il y avait aussi une varicosité de nombreuses veines pelviennes et une veine collatérale drainant la membre inférieure droite. Ce diagnostic préopératoire était essentiel à la planification de la chirurgie. Lors de la chirurgie KT, la veine d'allogreffe rénale a été anastomosée dans un mode à la veine cave inférieure et artère à l'artère iliaque commune. Le patient a eu une récupération postopératoire en douceur et continue de profiter d'une fonction rénale normale. Mots clés: Aplasie de la veine iliaque, Congénitale, Greffe de rein, Nigéria, Pédiatrique.