Felicia U. Eke

Malaria-induced renal damage: facts and myths

Malaria infections repeatedly have been reported to induce nephrotic syndrome and acute renal failure. Questions have been raised whether the association of a nephrotic syndrome with quartan malaria was only coincidental, and whether the acute renal failure was a specific or unspecific consequence of Plasmodium falciparum infection. This review attempts to answer questions about “chronic quartan malaria nephropathy” and “acute falciparum malaria nephropathy”. The literature review was performed on all publications on kidney involvement in human and experimental malarial infections accessible in PubMed or available at the library of the London School of Hygiene and Tropical Medicine. The association of a nephrotic syndrome with quartan malaria was mostly described before 1975 in children and rarely in adult patients living in areas endemic for Plasmodium malariae. The pooled data on malaria-induced acute renal failure included children and adults acquiring falciparum malaria in endemic areas either as natives or as travellers from non-tropical countries. Non-immunes (not living in endemic areas) had a higher risk of developing acute renal failure than semi-immunes (living in endemic areas). Children with cerebral malaria had a higher rate and more severe course of acute renal failure than children with mild malaria. Today, there is no evidence of a dominant role of steroid-resistant and chronic “malarial glomerulopathies” in children with a nephrotic syndrome in Africa. Acute renal failure was a frequent and serious complication of falciparum malaria in non-immune adults. However, recently it has been reported more often in semi-immune African children with associated morbidity and mortality.

A position statement on kidney disease from powdered infant formula-based melamine exposure in Chinese infants.

Melamine, a man-made non-nutritive substance containing nitrogen, can falsely elevate measures of protein content in foodstuffs. Several manufacturers of powdered infant formula in China apparently added melamine to raise the measured protein content and thereby exposed thousands of infants and young children to very high levels of melamine. Such exposure resulted in cases of acute kidney failure and nephrolithiasis. This Editorial from members of the world-wide Pediatric Nephrology community provides a common-sense approach to the care of infants who may have been exposed to powdered infant formula in 2007–2008.

Paediatric acute peritoneal dialysis in southern Nigeria

Background: Acute peritoneal dialysis (APD) is the preferred treatment for isolated failure of the kidney. The authors reviewed children with acute renal failure (ARF) who had APD in Port Harcourt, Nigeria. Results: 221 patients, 147 boys and 74 girls (M: F, 1.99:1), mean (SD) age 5.4 (4.9) years had ARF. Dialysis was indicated in 112 cases. The main clinical indication being convulsion/uraemia 30 (26.8%) Only 27 patients (21 boys and 6 girls) had APD, giving an access rate of 24.1%. The commonest dialysis related complication was catheter malfunction 12 (44.4%). The mortality rate among the dialysed patients was 22.2%. Lack of dialysis and intractable hypertension significantly increased mortality (χ2 = 7.13, p<0.01) and (χ2 = 14.9, p<0.001) respectively. Conclusion: APD is effective in reducing mortality of children with ARF. However, there were low dialysis access rate and few complications.

An open comparative study of dispersible piroxicam versus soluble acetylsalicylic acid for the treatment of osteoarticular painful attack during sickle cell crisis.

Summary We compared the efficacy and tolerability of oral piroxicam 1 mg/kg/day with soluble aspirin given at 100 mg/kg/day taken four‐hourly in 58 patients with sickle cell anaemia and severe ostcoarticular painful attacks requiring hospitalization in a randomized, paralleled study. Main investigational criteria were pain relief, limitation of movement, fever, and insomnia or agitation. Both groups were well‐matched at the commencement of therapy but most patients on piroxicam showed remarkable and significant pain relief and improvement in other parameters within 24 h. Unwanted effects were absent in the piroxicam‐treated group whereas those treated with aspirin experienced nausea and vomiting. There were no significant changes in liver function tests with both forms of treatment. Oral piroxicam is an effective and safe treatment in the management of the osteoarticular painful crisis in sickle cell anaemia. It might prevent the use of parenteral analgesics and hospitalization and reduce the loss of school hours in patients who are being treated for bone pain crises that characterize sickle cell anaemia.

Steroid Induced Diabetic Ketoacidosis (DKA) in a 13 year Old Female with Renal Disorder

Background: Diabetic ketoacidosis (DKA) is a common complication of poorly controlled diabetes mellitus in children and a rare complication of steroid therapy. Patients on steroid therapy may develop hyperglycemia as a complication, but presentation with DKA is rather unusual. Aim: To highlight a rare clinical entity of DKA induced by prednisolone in a 13 year old female on treatment for nephrotic syndrome. Case report: NC was a 13 year old female who presented with first episode of generalized body swelling, oliguria, massive proteinuria and hypercholesterolenaemia with normal renal function. She was not a known diabetic and had no family history of diabetes mellitus. She was started on prednisolone at 20 mg three times daily for nephrotic syndrome. Two weeks after commencement of prednisolone, she developed DKA with blood glucose of 31.1 mmol/l, glycosuria and ketonuria. She received intravenous insulin, fluids and was discharged on mixtard insulin with withdrawal of prednisolone. Her fasting blood sugar gradually normalized to between 3.1-4.5 mmo/L and insulin stopped after 4 months of treatment. She has remained normoglycaemic on follow up. Conclusion: The possibility of hyperglycaemia and DKA should be anticipated on every adolescent on steroid therapy for nephrotic syndrome. We therefore recommend routine blood glucose monitoring for early identification of DM in order to avoid DKA in such patients.