Poisoning with hair-dye containing paraphenylene diamine: ten years experience.

Hair-dye containing paraphenylene diamine (PPD) is widely used and this compound is known to be toxic, when ingested, to several organs including the kidney. In this study, we reviewed 150 cases presenting to Khartoum Teaching Hospital with PPD poisoning over a period of 10 years. The clinical features commonly involved the gastrointestinal tract, skin and eyes. Nearly all the patients had angioneurotic edema and some cases developed flaccid paraplegia or paraperesis. With regards to the renal involvement, we observed that 90 of the 150 study cases (60%) developed acute renal failure (ARF) requiring dialysis. The mean period on dialysis was 15 days (range 1-42 days). All patients recovered normal renal function. In order to exclude permanent glomerular damage following overdose of PPD, 20 patients were subjected to renal biopsy following recovery from ARF. None had evidence of glomerular injury. On the other hand, three patients who had chronic (skin) contact with the dye and one patient who recovered from ARF a year earlier showed evidence of focal segmental glomerulosclerosis on renal biopsy. We conclude that hair-dye containing PPD can cause severe side effects particularly after oral ingestion. Its use should be discouraged and public attention should be drawn in this regard.

Dialysis and transplantation in Sudan.

In this report we present the current status of the renal replacement therapy in Sudan. Sudan is a large country with 30 million inhabitants. Peritoneal Dialysis was started in 1968, while hemodialysis was started in 1973. At present, there are only 16 hemodialysis machines serving 56 patients in two centers in Sudan. There are also 15 peritoneal dialysis beds for 70 intermittent peritoneal dialysis patients in three centers. Continuous ambulatory peritoneal dialysis is not being practiced in Sudan. The first renal transplant was in 1974, and till now more than 30 transplants have been performed in two transplant centers. All the transplants have been from living donors. The scholars of Islam in Sudan oppose to donation from cadavers. There are 200 renal transplant patients being followed up in Sudan and the majority had their renal transplants abroad. We conclude that there is a tremendous shortage of renal services in Sudan. There are more efforts being made to improve these services.

Prevalence of hepatitis C virus infection in hemodialysis patients in Sudan.

To estimate the prevalence of positivity of hepatitis C virus (HCV) antibodies in the hemodialysis population in Sudan and the risk factors of this infection in them we studied 46 hemodialysis patients (34 males, 12 females) in the Khartoum Kidney Dialysis Center (KKDC) in December 1994. Also we studied 37 healthy staff members in that unit. The blood of both groups was screened for HCV antibodies using a second generation ELISA test and confirmed by two bead supplemental assays. In the patients group, 16 cases (34.9%) were confirmed seropositive for HCV. There was a history of jaundice in four them. The mean duration on dialysis was 3.28 years in the HCV seropositive group compared with 2.2 years in the HCV seronegative group (P < 0.05). The mean frequency of blood transfusion was 2.68 units of blood in the HCV seropositive group, while it was 3.16 units in the HCV seronegative group which was not significantly different. Only two patients had high liver enzymes in the HCV seropositive groups, while there were seven patients with high liver enzymes in the HCV seronegative group. There were two staff members (5.41%) with positive HCV antibodies, but none had a history of jaundice or elevated liver enzymes. Both staff members were not involved in the direct patients care. We conclude that the prevalence of HCV antibody positivity was high in the hemodialysis population in Sudan. Nosocomial transmission may be the factor of transmission since we found no correlation with the blood transfusions.

Predictors of upper gastrointestinal bleeding in patients with schistosomal periportal fibrosis.

A case-control study was conducted between 1985 and 1987 in the Gezira-Managil area of central Sudan to assess the major predictors of haematemesis. Eighty-four patients who had suffered at least one attack of oesophageal bleeding and had schistosomal periportal fibrosis demonstrated by ultrasonography were compared with 173 subjects without bleeding but with ultrasonographic evidence of periportal fibrosis. A splenic longitudinal dimension of more than 11 cm, periportal fibrosis worse than grade I and varices more than grade I were independently associated with a significant risk of variceal bleeding. Age, sex, presence of a palpable liver and portal vein diameter were not associated with a significant risk of bleeding after adjustment for potential confounding variables. Factors identified in this study could be helpful in the prophylactic management of patients with complicated schistosomiasis.

Congenital nephrotic syndrome in Sudan: histological and immunological features.

We report a 5-month-old Sudanese boy with a probable diagnosis of Congenital Nephrotic Syndrome. Our case had features which are neither typical of the Finnish type nor of other hereditary renal diseases. Histologically, the most striking changes were in the glomerular basement membranes which show patchy thinning, thick segments (with reduplication) and occasional low spikes. Tubules are well preserved, and no foam cells were seen. Electron microscopy showed extensive fusion of foot processes with podocyte microvilli. In parts the glomerular basement membrane shows irregular thickening and splitting, and incorporation of podocyte cytoplasm into the membrane. In other areas there is marked thinning of the basement membrane. Immunological features include a high level of IgA and IgG. To our knowledge such features have not been described before.

Paraphenylenediamine induced acute tubular necrosis following hair dye ingestion.

A case is reported of paraphenylenediamine toxicity following hair dye ingestion. Renal biopsy showed histology typical of acute tubular necrosis.