FACULTY OF CLINICAL SCIENCES

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    Spectrum of childhood obstructive uropathy in Ibadan, Nigeria
    (MedPrime, 2019) Asinobi, A. O.; Ademola, A. D.; Lawal, T. A.; Takure, A. O.; Shittu, O. B.
    Background and Objectives: Obstructive uropathy (OU) is an important cause of morbidity and mortality in childhood with congenital OU being among the top three aetiologies of paediatric end-stage kidney disease (ESKD). With paucity of data on the impact of childhood OU in a setting of largely unaffordable facilities for ESKD management, further studies are needed. The aim of the study was to appraise the aetiological pattern and short- term outcome of childhood OU. Methods: A descriptive cross-sectional study was conducted on consecutively presenting children aged 15 years and below with features of urinary tract obstruction at the University College Hospital, Ibadan between January 2009 and December 2012. Their biodata, clinical presentation, aetiology, treatment, and short- term outcome were analysed in addition to the prevalence of OU in relation to other childhood renal disorders. Results: Eighty-six children aged one day to 15 years with a median age of 2.5 years and a modal age of 6 years were recruited over a 4-year period. The male to female ratio was 4.7:1. Congenital OU occurred in 81% of cases, with the lower urinary tract more frequently affected (78%). Posterior urethral valves (PUV) was the most common cause of OU (59.3%) followed by pelvi-ureteric junction (PUJ) obstruction in 17.4%; 73.3% of all PUJ obstructions occurred in females. Only 3.5% of cases were detected prenatally. Of all incident admissions into the Paediatric Nephrology Unit, OU accounted for 20.7%. An in-hospital mortality rate of 5% occurred. Conclusion: Childhood OU is a significant cause of renal disease in Ibadan accounting for one-fifth of new paediatric renal admissions. It was majorly congenital with a male preponderance and PUV was the most common cause. Contrary to expectations, PUJ obstruction occurred more often in females. Prenatal diagnosis rate was very low.
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    Paediatric peritoneal dialysis in a developing country: practice, challenges and opportunities
    (African Paediatric Nephrology Association, 2019) Asinobi, A. O.; Ademola, A. D.; Akuse, R. M.
    Background: The practice and challenges of peritoneal dialysis (PD) in a developing country may be uniquely different from what obtains in developed countries. Method: A review of the practice and challenges of PD in Nigeria as a case study and documentation of opportunities for improvement Review: There has been renewed interest in the provision of PD to children in acute kidney injury in Nigeria and this has led to adaptations such as use of nasogastric tubes as PD catheters and use of constituted PD fluid. The use of adaptations is lifesaving but complication rates may be higher than with the use of standard gadgets. Other challenges include limited availability and high cost of PD catheters and PD fluid. There are also challenges with the availability of expertise for the insertion of PD catheters and the PD procedure. Opportunities to advance paediatric PD include sustained efforts to provide PD with the use of adaptations, collection of data on outcomes of PD, advocacy for more support from government, non- governmental organisations and industry in the forms of insurance coverage, access to consumables and/or training in paediatric PD. Conclusion: Sustained provision of PD with adaptations, documentation of outcomes, and advocacy may lead to improvement in paediatric PD services.
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    Acute kidney injury among paediatric emergency room admissions in a tertiary hospital in South West Nigeria: a cohort study
    (Oxford University Press, 2019) Ademola, A. D.; Asinobi, A. O.; Ekpe-Adewuyi, E.; Ayede, A. I.; Ajayi, S. O.; Raji, Y. R.; Salako, B. L.; James, M.; Zappitelli, M.; Samuel, S. M.
    Background. Epidemiological data on paediatric acute kidney injury (AKI) in sub-Saharan Africa are limited and largely retrospective. We performed a prospective study of AKI among patients admitted through the emergency room. Methods. Children admitted to the post-neonatal emergency room of the University College Hospital, Ibadan, Nigeria between February 2016 and January 2017 were studied. AKI was defined by Kidney Disease: Improving Global Outcomes serum creatinine criteria. AKI ascertainment relied on serum creatinine measurements carried out in routine care by post admission Day 1. We compared in-hospital mortality by post-admission Day 7 for patients with and without AKI (no-AKI). Results. Of the 1344 children admitted to the emergency room, 331 were included in the study. AKI occurred in 112 patients (33.8%) with a median age of 3.1 years [interquartile range (IQR) 0.9–9.4] and was Stage 3 in 50.5% of the cases. The no-AKI group had a median age of 1.8 (IQR 0.7–5.8) years. The underlying diagnoses in patients with AKI were sepsis (33.0%), malaria (12.5%) and primary renal disorders (13.4%). Twenty-four of the patients with AKI underwent dialysis: haemodialysis in 20 and peritoneal dialysis in 4. By Day 7 of admission, 7 of 98 (7.1%) patients in the AKI group had died compared with 5 of 175 (2.9%) patients in the no-AKI group [odds ratio 2.6 (95% confidence interval 0.8–8.5)]. Outcome data were not available for 58 (17.5%) patients. Conclusions. AKI is common among paediatric emergency room admissions in a tertiary care hospital in sub-Saharan Africa. It is associated with high mortality risk that may be worse in settings without dialysis.
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    Prevalence and determinants of depression among patients with hypertension: A cross‑sectional comparison study in Ghana and Nigeria
    (Wolters Kluwer ‑ Medknow, 2020) Ademola, A. D.; Boima, V.; Odusola, A. O.; Agyekum, F.; Nwafor, C. E.; Salako, B. L.
    Background: Despite evidence linking depression to poor blood pressure (BP) control and increased hypertension‑related morbidity and mortality, there is paucity of data about depression among patients with hypertension in sub‑Saharan Africa. We assessed factors associated with depression among patients with hypertension in Ghana and Nigeria. Subjects and Methods: Patients with hypertension were recruited from four hospitals: In Ghana, Korle Bu Teaching Hospital (n = 120), and in Nigeria, the University of Port Harcourt Teaching Hospital, the Lagos State General Hospital, and the University College Hospital Ibadan (n = 237). Demographic, socioeconomic, psychosocial, and clinical factors which predicted depression among the study cohort were assessed by logistic regression. Depression and beliefs about medications were assessed with the Patient Health Questionnaire (PHQ‑9) and the Beliefs about Medication Questionnaire, respectively. Depression was regarded as PHQ‑9 score >4. Results: The mean ages of the Ghanaian and Nigerian cohort were 57.0 ± 13.7 years (58.3% female) and 56.4 ± 12.9 years (57.0% female), respectively. Prevalence of depression was 41.7% and 26.6% among the Ghanaian and Nigerian cohorts, respectively. Significant predictors of depression in the Nigerian cohort were age in years [OR 0.97 (0.95–0.99)], concern about medications [OR 1.15 (1.03–1.30)], and poor BP control [OR 2.06 (1.09–3.88)]. Young age was the only independent predictor of depression in the Nigerian cohort. In the Ghanaian cohort, none of the factors significantly predicted depression. Conclusion: Prevalence of depression is high among patients with hypertension in Ghana and Nigeria. Screening and treatment of depression among patients with hypertension in Ghana and Nigeria may have important implications for improving outcomes.
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    Childhood nephrotic syndrome in tropical Africa: then and now
    (Taylor and Francis, 2017) Olowu, W. A.; Ademola, A. D.; Ajite, A. B.; Saad, Y. M.
    This descriptive and comparative review examines the changing epidemiology, treatment, renal and patient outcome of childhood nephrotic syndrome (NS) in tropical Africa (TpAfr). In the 1960s to 1980s, corticosteroid-resistant non-minimal change disease (nMCD) including quartan malaria nephropathy (QMN) was the dominant renal histopathology type. The overall incidence of NS was 0.35–1.34% of hospital admissions. Median age at onset of NS ranged between 4.0 and 12.0 years while the mean (SD) age range was 5.8 (3.8) to 10.3 (4.8) years across studies. The male: female ratio was 1.6:1.0. The overall mean (SD) incidence of idiopathic minimal change disease (MCD) [21.6 (18.6%)] compared with idiopathic nMCD [59.1 (25.7%)] demonstrates significant dominance of the latter (p = 0.0001). Post-1989, the following mean (SD) incidences of histopathological types were: MCD 20.4 (17.7%), focal segmental glomerulosclerosis 39.0 (26.3%), membranoproliferative glomerulonephritis 25.4 (16.8%), proliferative glomerulonephritis 16.7 (27.0%) and membranous nephropathy 7.4 (4.5%). While the mean (SD) proportion of steroid resistance (SR) [73.5 (19.2%)] was significantly greater than the mean complete remission (CR) [26.5 (19.2%)] during 1960-1989 (p=0.005), mean (SD) SR [27.4 (25.3%)] was significantly lower than mean (SD) CR [66.1 (28.0%)] post-1989 (p < 0.001). Unlike QMN, hepatitis B virus, HIV infection, sickle cell disease and systemic lupus erythematosus are now increasingly being associated with NS in TpAfr. Mean (SD) renal survival post-1989 was 58.3 (37.0%) while all-cause mortality was 9.8%. Children with NS now survive better than before, reflecting improved access to healthcare and transition to a clinical pattern favouring idiopathic NS and increased sensitivity to corticosteroids.
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    Kidney disease in hepatitis B surface antigen-positive children: experience from a centre in south-west Nigeria and a review of the Nigerian literature
    (Taylor and Francis, 2017) Asinobi, A. O.; Ademola, A. D.; Okolo, C. A.; Adepoju, A. A.; Samuel, S. M.; Hoy, W. E.
    Background: Kidney disease is an important extra-hepatic manifestation of hepatitis B virus (HBV) infection. However, there is paucity of recent literature on kidney disease in children and adolescents with HBV infection from several parts of sub-Saharan Africa including Nigeria. Objective: To review the pattern of kidney disease in hepatitis B surface antigen (HBsAg)-positive children and adolescents seen at a tertiary hospital in south-west Nigeria. Methods: A retrospective study was undertaken of HBsAg-seropositive children with kidney disease managed at University College Hospital, Ibadan, from January 2004 to December 2015. Patients were identified from the paediatric nephrology unit admissions and the renal histology registers. Results: 24 children and adolescents were studied, 17 of whom were male (70.8%), and the median age was 10.0 years (range 3–15). Ten (41.7%) had nephrotic syndrome, five (20.8%) had non-nephrotic glomerulonephritis, five (20.8%) were in end-stage renal disease (ESRD), including a patient with posterior urethral valves, and four had acute kidney injury secondary to acute tubular necrosis. Renal histology was available for 10 patients: nine had nephrotic syndrome associated with minimal change disease in six, focal segmental glomerulosclerosis in two and one had membanoproliferative glomerulonephritis. The patient with non-nephrotic glomerulonephritis had diffuse global sclerosis. Conclusion: The pattern of kidney disease in HBV-positive children demonstrated a predominance of nephrotic syndrome, followed by non-nephrotic glomerulonephritis, ESRD and acute kidney injury. Better diagnostic facilities and treatment are required. Prevention of HBV infection by universal childhood immunisation is the ultimate goal.
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    Congenital anomalies in Ibadan, Nigeria
    (Spectrum Books. Publisher, Ibadan Nigeria, 2016) Ayede, A. I.; Adeleye, A. O.; Olusanya, A. A.; Ademola, A. D.; Olayemi, O.; Ogbole, G. I.; Akinmoladun, J. A.; Agunloye, A. M.; Akinrinoye, O. O.; Takure, A. O.; Oyewole, O. B.; Oluwatosin, O. M.; Omokhodion, S. I.
    Background: There is a need for a multidisciplinary database that can be used as a potential source for developing a protocol and a guideline for a possible nationwide prospective surveillance of congenital anomalies in Nigeria. Methods: This five-year cross-sectional retrospective survey of data from January 2009 to December 2013 was done at the University College Hospital, Ibadan. Data were collected from the admission records on the wards in 8 specialty units with the most workable documented clinical records of congenital anomalies in their care using a predesigned proforma. Proportions of congenital anomalies were determined based on systemic classification of the anomalies and the descriptive terms used were according to the ICD_10-chapter XVIII_RCPCH extension. Result: The total number of patients with congenital anomalies whose records were obtained from the ward registers was 1311, there were 75 (5.7%) missing case notes while information was obtained on 1236 (94.3%) patients. There were a total of 1479 anomalies with multiple anomalies seen in 16.1% of the patients. The male/female ratio was 2:1 and multiple births as well as positive family history of birth defects were seen in about 2.4% and 2.2% of cases respectively. Prenatal diagnosis of the anomalies was documented in only 11 cases (0.9%). Only about one in five cases presented within the neonatal period, and defects of the abdominal wall as well as the cranial-facial-orbital regions were the most prevalent. Next were those in the cardiovascular, spinal column, anorectal and genital, as well as musculoskeletal systems. Conclusion: The size and pan-systemic profiles of the birth defects documented in this study calls for further action on this all-important cause of childhood mortality and significant life-long morbidity in our country.
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    A case report of suspected angioedema in a child after administration of mebendazole, cotrimoxazole and leaf extracts
    (Association of Resident Doctors (ARD), UCH, Ibadan, 2016) Ashubu, O. F.; Ademola, A. D.; Asinobi, O. A.
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    Influence of disease remission on renal dimensions in childhood nephrotic syndrome in Ibadan, South West Nigeria
    (Paediatric Association of Nigeria, 2016) Afolabi O. S.; Atalabi O.; Asinobi A. O.; Adebowale D. A.
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    Genomic approaches to the burden of kidney disease in Sub-Saharan Africa: the Human Heredity and Health in Africa (H3Africa) kidney disease research network
    (International Society of Nephrology., 2016) Osafo, C.; Raji, Y. R.; Olanrewaju, T.; Mamven, M.; Arogundade, F.; Ajayi, S.; Ulasi, I.; Salako, B.; Plange-Rhule, J.; Mengistu, Y.; Mc’Ligeyo, S. O.; Moturi, G.; Winkler, C. A.; Moxey-Mims, M. M.; Rasooly, R. S.; Kimmel, P.; Adu, D.; Ojo, A.; Parekh, R. S.; Ademola, A. D.