Aliyu Abdu

Peritoneal dialysis vs. haemodialysis in the management of paediatric acute kidney injury in Kano, Nigeria: a cost analysis

To determine the cost of the dialytic management of paediatric acute kidney injury in a low‐income country.

Neutrophil-to-lymphocyte, platelet-to-lymphocyte ratios and their association with atherogenic index of plasma in sickle cell nephropathy

Background/Objectives: Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios (NLR and PLR) were introduced as cheap and readily assessed biologic markers of subclinical inflammation. There are few studies that have evaluated NLR and PLR as prognostic markers of proteinuria in sickle cell anemia (SCA) patients. This study seeks to evaluate NLR and PLR in SCA patients with proteinuria, impaired kidney function and to ascertain whether there exist relationship between the leukocyte ratios and atherogenic index of plasma. Materials and Methods: The NLR, PLR, and atherogenic index were calculated from full blood count and lipid profile parameters determined from fasting blood specimens collected from 200 confirmed SCA patients and 100 control subjects with normal hemoglobin (Hb). Results: The NLR and PLR values were significantly higher (P < 0.001) in SCA patients compared with control subjects with normal Hb. Similarly, NLR and PLR values were significantly higher (P < 0.001) in SCA patients with proteinuria and those with impaired kidney function than without proteinuria and normal controls. A significantly positive association was observed between NLR and atherogenic index of plasma (AIP) in SCA patients with proteinuria (P < 0.05) and those with impaired kidney function (P < 0.02) while significant association was observed between PLR and AIP in SCA with impaired kidney function (P < 0.05). Conclusion: The leukocyte ratios may be useful as prognostic markers for the presence of proteinuria in SCA patients and impaired kidney function as well as cardiovascular risk event. The need to have reference cut-off values of NLR and PLR is hereby suggested to better identify those patients at risk in the management SCA patients.

Serum alpha-fetoprotein level is higher in hepatitis C than hepatitis B infected chronic liver disease patients

Background: The frequency of raised serum alpha-fetoprotein may vary in relation to hepatitis B or C infection in chronic liver disease (CLD). The study evaluated the frequency of hepatitis B and C in patients with chronic liver disease and correlated the levels of serum alpha-fetoprotein with hepatitis B and C infection in the patients. Materials and Methods: Eighty-six patients with CLD were recruited for the study. Fifty subjects, with no CLD were used as control. Hepatitis B surface Antigen (HBsAg) and hepatitis C antibody were determined using enzyme-linked immunosorbent assay (ELISA) technique (Human diagnostics, Germany and HCV Murex 40 Anhet laboratories, USA) while liver function tests were evaluated using express plus chemistry auto analyzer. Alpha-fetoprotein was assayed using ELECSYS 1010 auto analyser. Results: There were 60 males and 26 females, with a mean age of 46 + 6.5 years, while the controls were 25 males and 25 females with a mean age of 41 ± 2.5 years. Thirty-six subjects (41.7%) were seropositive for HBsAg while 24 (27.9%) were seropositive for Hepatitis C Virus (HCV) antibody. The mean alpha fetoprotein level was 359 ± 9.9 ng/mL while mean control value was 1.93 ± 0.24 ng/mL. Liver function test parameters were elevated compared with control subjects (P < 0.001). The increase in serum alpha-fetoprotein was higher (P < 0.001) in HCV than HBsAg positive patients. Conclusion: Serum alpha-fetoprotein level was highest in HCV compared to HBsAg positive and hepatitis negative patients with CLD.

Outcome and complications of permanent hemodialysis vascular access in Nigerians: A single centre experience

BACKGROUND It is widely accepted that autogenous arteriovenous fistula (AVF) carries less morbidity and mortality compared to all other forms of vascular accesses in maintenance hemodialysis patients. There is paucity of data on vascular access from sub-Saharan Africa. The aim of this study was to assess the outcome and complications of permanent vascular access in our center. MATERIALS AND METHODS The study is a prospective, hospital-based, longitudinal study. All consecutive patients on maintenance hemodialysis in Aminu Kano Teaching Hospital who were referred to the surgical unit of for creation of permanent hemodialysis vascular access were included in the study. The patients clinical and demographic data were documented. Data about vascular access types, outcomes, and complications were obtained over a 1-year period from the time of vascular access creation. RESULTS One hundred and seventy four patients were operated upon between January 2008 and December 2010 with a mean age of 46.4 years (range 18-76 years) and a male to female ratio of 1.5:1. Brescio--Cimino fistula was performed in 110 (63.2%) patients, brachiocephalic (Kauffmann) fistula in 51(29.3%), and synthetic graft in 1 (0.6%) patients respectively. Ten patients (5.7%) had brachio-brachial transposition arteriovenous fistula and 2 patients (1.1%) had transposition graft using harvested long saphenous vein. One-year patency rate was 63.2%. Complications encountered include AVF failure in 47(27.3%), steal syndrome in 2(1.1%), distal venous insufficiency in 2(1.1%), and false aneurysm in 6(3.5%) patients. CONCLUSION The outcome of permanent vascular access is favorable in our patient population with a one-year patency rate of 63.2%. The first choice of vascular access in our maintenance dialysis population should be AVF.

Prevalence of risk factors for chronic kidney disease among civil servants in Kano

Background: Data on the epidemiology of chronic kidney disease (CKD) from sub-Saharan Africa are still sparse. Preventive strategy through early detection and treatment has been advocated for CKD, especially in our environment where majority of patients present late and cannot afford the cost of renal replacement therapy which is not widely available. We investigated the prevalence of risk factors for CKD among the civil servants who volunteered after a public enlightenment campaign in Kano, northern Nigeria. Materials and Methods: We studied 225 apparently healthy civil servants who availed themselves of the opportunity to be screened for risk factors for CKD during the 2011 World Kidney Day activities. Relevant demographic and clinical data were obtained using a questionnaire. Weight, height, Body Mass Index (BMI), and blood pressure were measured. Spot urine samples were collected and tested for protein, sugar, and other parameters using a dipstick. Random blood sugar was measured with a glucometer. Results: The mean age of the study participants was 41.5 ± 9.68 years. Males constituted 83.6% of the respondents. Majority had a positive history of use of traditional medications, followed by the use of analgesic drugs, while very few (less than 5% each) admitted to alcohol ingestion or use of bleaching creams. While there was a significant family history of hypertension and diabetes, only about 3% had positive family history of kidney disease. Proteinuria was found to be present in 19.4%. Other risk factors found include hypertension (29.8%), obesity (11%), and diabetes mellitus (3.6%). Conclusion: Risk factors for CKD are common among civil servants in Kano. The most frequent CKD risk factors found among the study subjects were use of traditional medication, cigarette smoking, obesity, hypertension, and proteinuria.

The nutritional status of continuous ambulatory peritoneal dialysis patients at a Johannesburg hospital

Abstract Objectives: To assess the nutritional status of continuous ambulatory peritoneal dialysis (CAPD) patients in our hospital using different assessment tools, and to assess the correlation between nutritional status and other parameters such as solute clearance. Method: A cross-sectional study was performed on end-stage renal disease patients treated with CAPD at Charlotte Maxeke Academic Hospital, Johannesburg, South Africa. The nutritional status of each patient was assessed using subjective global assessment (SGA), anthropometric parameters including body mass index (BMI), mid-upper arm circumference (MUAC), triceps skin fold (TSF), arm muscle area (AMA) and arm fat area (AFA), and biochemical parameters including serum albumin and total cholesterol levels. Dialysis adequacy was assessed by solute clearance measurement. Results: The mean age of the patients was 37.9 ± 13.4 years, 54% were males and 74 % were black. The mean BMI was 24.8 ± 3.5 kg/m2, mean MUAC was 28.5 ± 3.9 cm, mean TSF 85.6 ± 41.5 cm, mean serum albumin was 37.1 ± 7.6 mg/dl, while mean serum cholesterol was 5.32 ± 1.7 mmol/l. Based on SGA scores, 42% were well nourished, 50% moderately undernourished, while 8% were severely malnourished. We noted significant correlation between the SGA score and anthropometric parameters (BMI, MUAC) and there was no significant correlation between the nutritional parameters and the solute clearance. Conclusion: Malnutrition is common among CAPD patients in our centre, without a significant correlation between the nutritional status and the solute clearance. There is thus a need for ongoing nutritional assessment and support among these patients.AbstractObjectives: To assess the nutritional status of continuous ambulatory peritoneal dialysis (CAPD) patients in our hospital using different assessment tools, and to assess the correlation between nutritional status and other parameters such as solute clearance.Method: A cross-sectional study was performed on end-stage renal disease patients treated with CAPD at Charlotte Maxeke Academic Hospital, Johannesburg, South Africa. The nutritional status of each patient was assessed using subjective global assessment (SGA), anthropometric parameters including body mass index (BMI), mid-upper arm circumference (MUAC), triceps skin fold (TSF), arm muscle area (AMA) and arm fat area (AFA), and biochemical parameters including serum albumin and total cholesterol levels. Dialysis adequacy was assessed by solute clearance measurement.Results: The mean age of the patients was 37.9 ± 13.4 years, 54% were males and 74 % were black. The mean BMI was 24.8 ± 3.5 kg/m2, mean MUAC was 28.5 ± 3.9 cm, mean TSF 85.6 ± 41.5 ...

Related Factors and Predictors of Cognitive Dysfunction in Chronic Kidney Disease on Maintenance Hemodialysis in Nigeria.

Background: Previous studies suggest a high frequency of cognitive impairment (CI) in persons with chronic kidney disease (CKD); however, factors associated with CI and predictors of CI in persons with CKD remain largely unclear. The aim of this study was to determine the factors associated with CI and predictors of CI in CKD patients on maintenance hemodialysis. Materials and Methods: The first stage of the study included recruitment of 100 apparently healthy participants aimed at determining the reference values. The second stage of the study included eighty CKD patients on maintenance hemodialysis. The iron psychology (FEPSY) was used to assess the memory, psychomotor speed, concentration, and attention using simple auditory reaction time (ART) and visual reaction time (VRT) tasks, recognition memory tests (RMT), finger tapping task (FTT), and binary choice task (BCT). Results: Using normative values generated in this study, 41 (51.3%) and 43 (53.8%) CKD patients had abnormal scores on ART dominant (D) and nondominant (ND) sides, respectively. Forty (50%) and 42 (52.5%) patients had abnormal scores on VRT D and ND sides, respectively. Twenty-one (26.3%) and 68 (85%) had abnormal scores on BCT and computer-assisted visual scanning task, respectively. Sixty-four (80%) and 65 (81.3%) had abnormal scores on RMT (words) and RMT, respectively. Fifty-two (65%) and 48 (60%) patients had abnormal scores on D and ND sides of (FTT), respectively. Factors associated with psychomotor speed impairment were duration of CKD from diagnosis (P = 0.0001 and 0.043 in D and ND ART, respectively), duration on dialysis (P = 0.0001 across board in D and ND ART as well as in D and ND VRT, respectively), and plasma urea (PU) and plasma creatinine (PCr) (P < 0.05). Factors found to be associated with memory impairment included age (P = 0.045 and 0.025 on words and figures RMT, respectively), PU (P = 0.002 and 0.005 on words and figures RMT, respectively), and PCr (P = 0.012 and 0.040 on words and figures RMT, respectively). Duration on dialysis (P = 0.032) and PCr (P = 0.001) were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD. Conclusion: Factors associated with psychomotor speed impairment were duration of CKD, duration on dialysis, and PU and PCr while age, PU, and PCr were associated with memory. Duration on dialysis and PCr were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD.

Cognitive function assessment in patients with end- stage renal disease in Nigeria: A single center experience

Aim: The purpose of this comparative study was to evaluate cognitive function in end-stage renal disease (ESRD) patients in comparison with age, sex, and level of education-matched control. Materials and Methods: This is a cross-sectional study involving 80 ESRD patients receiving maintenance hemodialysis treatment and recruited conservatively at the nephrology unit of our hospital. Eighty apparently healthy control, that were matched with the patients for age, sex and education, were also recruited. Following exclusion of depression and severe functional disability, a computer-assisted neuropsychological test, the FePsy, was used to assess memory, psychomotor speed, concentration and attention using simple auditory and visual reaction time tasks, recognition memory tests (RMTs), finger tapping task, and binary choice task (BCT) for both the ESRD patients and controls. Results: ESRD patients performed worse on simple auditory and visual reaction time tasks (P < 0.05), RMTs (P < 0.05), finger tapping task (P < 0.05), BCT, and computerized visual search task (P < 0.05). Conclusion: Performance in memory, psychomotor tasks, concentration, and attention tasks were found to be reduced among patients with ESRD compared with age, sex and level of education-matched control.

Prevalence, risk factors, and histological pattern of kidney disease in patients with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome at Aminu Kano Teaching Hospital: A clinicopathologic study

Background: Renal disease in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) contributes significantly to morbidity and mortality associated with HIV infection worldwide. Aim: To determine the prevalence, risk factors, and histological pattern of kidney disease in HIV-positive patients in Kano, Nigeria. Materials and Methods: Four hundred consecutive treatment naοve HIV-positive patients with no other condition known to cause kidney disease were screened for proteinuria and reduced glomerular filtration rate (GFR). Kidney disease was defined as the presence of persistent microalbuminuria/proteinuria or decreased GFR (<60 ml/min/1.73 m 2 ). Kidney biopsy was performed on 20 patients. Data were analyzed using SPSS version 17. Results: The mean ± standard deviation age of the study population was 34.03 ± 10.23 years with 240 (60%) being females. Kidney disease was found in 227 patients (56.8%), with a higher prevalence seen in males (odds ratio = 1.9305, 95% confidence interval = 1.2760-2.9207, P = 0.0018). Proteinuria including persistent microalbuminuria was found in 211 (52.8%) and reduced GFR was found in 64 (16.0%). The risk factors for developing kidney disease were age >40 years, male gender, low CD4 cell count, cigarette smoking, low body mass index, and low serum cholesterol. Logistic regression identified low CD4 cell count as an independent risk factor for kidney disease. Collapsing focal segmental glomerulosclerosis (FSGS) was the predominant histological pattern seen. Conclusion: The prevalence of renal disease in HIV-positive patients was high in Kano, Nigeria; and microalbuminuria was a manifestation of collapsing FSGS.

Out-patient percutaneous renal biopsy among children in Northern Nigeria: A single center experience

BACKGROUND The safety of percutaneous renal biopsy (PRB) has been debated. The primary aim of this study was to review the procedure and secondary aim is to evaluate the safety of PRB in children in a developing nephrology unit in Northern Nigeria. METHODS Renal biopsies carried out in the renal unit of a teaching hospital in northern Nigeria between November 2011 and April 2013 were retrospectively reviewed. All biopsies were carried out electively and under real-time ultrasound guidance using an automatic spring-loaded biopsy gun. Risk factors for complications were analyzed using logistic regression. RESULTS A total of 24 biopsies were carried out in 20 children with nephrotic syndrome during the period under review. Mean age was 8.3 ΁ 3.0 years. Steroid resistant nephrotic syndrome was the most common indication for biopsy in 11 (55%) cases. Adequate tissue was obtained in 91.7%. Complications occurred in 2 (8.3%) cases. One required hospitalization with blood transfusion. Pre-biopsy hemoglobin concentration of <10 g/dL was found to be a significant predictor for the development of complications (P < 0.05). There was no significant difference in the rate of complications between the in-patient biopsies and day case biopsies. CONCLUSIONS PRB can be safely carried out as an out-patient procedure in children. Low hemologlobin concentration was the major risk factor for complication.