Pediatrics

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CHILDHOOD NEPHROTIC SYNDROME IN KADUNA STATE
(1985-01) ABDURRAHMAN, M. B. M. B.
The clinicopathological features of childhood nephritic syndrome in tropical Africa are different from those in temperate countries of Europe and America. However, detailed clinicopathological features of the disease have not been comprehensively described in all parts of Africa. Plasmodium malariae has been shown to be strongly associated with the disease in some parts of Africa, and the association has been postulated to be causal. Childhood nephrotic syndrome was studied in Kaduna State of Nigeria in an attempt to define the clinicopathological features of the disease. In particular, the study set out to assess the role of P. malariae in the aetiology or pathogenesis of childhood nephrotic syndrome, and to look for other possible aetiological factors. One hundred consecutive children with nephrotic syndrome who had had no treatment previously were studied. In addition to routine biochemical and haematological investigations, malaria parasitaemia, protein selectivity index, serum hepatitis B surface antigen and percutaneous renal biopsy were done. As described in other parts of tropical Africa, children with nephrotic syndrome presented with massive oedema, prominent ascites, and very low serum proteins. P. malariae parasitaemia was present in 31% of nephrotic children, compared with 7% in the control group of children. The frequency of P. malariae parasitaemia was 40% in patients with membranoproliferative glomerulonephritis, 40% in quartan malarial nephropathy, and 21% in proliferative glomerolunephritis. Serum hepatitis B surface antigen was positive in the sera of 31% of patients compared with 30% in control but the concentration of antigen was stronger in the patients. Schistosoma mansoni ova were found in the stool or rectal snip of six patients: histology of renal biopsy showed membranoproliferative glomerulonephritis in four of these patients. Protein selectivity index was determined by comparing the clearances of albumin and immunoglobulin IgG. The index was good in 34% of patients. However, the test was not found useful in identifying those lesions likely to respond to corticosteroid therapy. Percutaneous rena1 biopsy was successful in 98 of the 1OO patients. By light microscopy, the most common histological diagnoses were membranopro 1iferative glomerulonephritis (25 cases), quartan malarial nephropathy (20), and proliferative glomerulonephritis (19 cases). Together they formed 65% of the biopsies. Immunofluorescence was abnormal in 92%: there were deposits of immunoglobulins, C3, P. malariae and hepatitis B surface antigen. Schistosome antigens were not looked for. Short-term prognosis of the disease was not as good as in children in Europe or North America, but did not seem to be as poor as in children studied in Ibadan. Quartan malarial nephropathy was not the predominant type of childhood nephritic syndrome seen in Kaduna State, since it accounted for less than a quarter of the cases studied. This is in contrast to the finding in Ibadan where quartan malarial nephropathy was responsible for over 80% of cases of childhood nephrotic syndrome. There was some evidence that hepatitis B surface antigen could also play a role in the aetiology or pathogenesis of the disease in Kaduna State. There is still no satisfactory treatment for childhood nephrotic syndrome in tropical Africa. Eradication or control of infectious diseases should result in reduced incidence of the disease.
Nephrotic syndrome complicating cyanotic congenital heart disease: A report of two cases
(West African College of Physicians/ West African College of Surgeons., 2008) Ogunkunle, O. O.; Asinobi, A. O.; Omokhodion, S. I.; Ademola, A. D.
BACKGROUND: Renal complications are said to be common in cyanotic congenital heart disease (CCHD), but have not been documented frequently in Nigerian children. Nephrotic syndrome (NS) is an uncommon complication of CCHD. OBJECTIVES: To report two cases of NS complicating CCHD who presented within months of each other, in order to draw attention to the problem. METHODS: The details of the clinical presentation, course and outcome of two children with CCHD, presenting with features of NS within months of each other, were reviewed. The patients were fully assessed clinically and were further investigated with chest X-ray, ECG ad echocardiography. RESULTS: A 12-year old girl with Fallot’s tetralogy underwent a Blalock-Taussig shunt at the age of 2 years, but subsequently defaulted from follow-up. She reappeared 10 years later with features of NS. Echocardiography revealed impaired myocardial function. Despite initial clinical improvement following three plasma exchanges and Enalapril therapy, she suddenly died on the 15th day of admission. The second patient was a 7-year old boy with tricuspid atresia, diagnosed at the age of 10 months, and similarly defaulted, reappearing six years later with features of NS. Oedema regressed with similar treatment, but his renal function deteriorated. He was stable enough to be discharged after six weeks on admission. CONCLUSION: Proteinuria is likely to be more common in Nigerian children with CCHD than has been previously appreciated. Early intervention in patients with CCHD is desirable in order to prevent development of complications which worsen the prognosis. Patients with CCHD should be screened regularly for proteinuria in order to detect and address renal complications early.
Minimal change nephrotic syndrome and Graves’ disease in a Nigerian child
(Nigerian Association of Nephrology, 2008) Ademola A. D; Asinobi A. O.; Ayoola O. O.; Ogunkunle O. O.; Olusola O. A.
We report a 12 year old Nigerian boy with steroid sensitive nephrotic syndrome who developed Graves’ disease 12 months after the diagnosis of nephrotic syndrome. He had two relapses of the nephrotic syndrome with early response to steroids on both occasions. Renal biopsy showed normal findings on light microscopy. Graves’ disease is rare among black African children, minimal change nephrotic syndrome is also not commonly reported among them. The coexistence of these two disorders in our patient underscores possible similar immunologic mechanisms in the aetiology of both diseases.
Peritoneal dialysis in childhood acute kidney injury: experience in Southwest Nigeria
(International Society for Peritoneal Dialysis, 2012) Ademola, A. D.; Asinobi, A. O.; Ogunkunle, O. O.; Yusuf, B. N.; Ojo, O. E.
Background: The choices for renal replacement therapy (RRT) in childhood acute kidney injury (AKI) are lim¬ited in low-resource settings. Peritoneal dialysis (PD) appears to be the most practical modality for RRT in young children with AKI in such settings. Data from sub-Saharan Africa on the use of PD in childhood AKI are few. Methods: We performed a retrospective study of chil¬dren who underwent PD for AKI at a tertiary-care hospital in southwest Nigeria from February 2004 to March 2011 (85 months). Results: The study included 27 children (55.6% female). Mean age was 3.1 ± 2.6years, with the youngest being 7 days, and the oldest, 9 years. The causes of AKI were in¬travascular hemolysis (n = 11), septicemia (n = 8), acute glomerulonephritis (n = 3), gastroenteritis (n = 3), and hemolytic uremic syndrome (n = 2). Peritoneal dialysis was performed manually using percutaneous or adapted catheters. Duration of PD ranged from 6 hours to 12 days (mean: 5.0 ± 3.3 days). The main complications were peri¬tonitis (n = 10), pericatheter leakage (n = 9), and catheter outflow obstruction (n = 5). Of the 27 patients, 19 (70%) survived till discharge. Conclusions: In low-resource settings, PD can be suc¬cessfully performed for the management of childhood AKI. In our hospital, the use of adapted catheters may have contributed to the high complication rates. Peritoneal di¬alysis should be promoted for the management of childhood AKI in low-resource settings, and access to percutaneous or Tenckhoff catheters, dialysis fluid, and automated PD should be increased.
Diagnosing renal failure due to diethylene glycol in children in a resource-constrained setting
(Springer International Publishing, 2012) "Akuse, R. M.; Anyiam, J.; Eke, F. U.; Ademola, A. D.; Fajolu, I. B.; Gbelee, H. O.; Ihejiahi, U.; Bugaje, M. A.; Anochie, I. C.; Asinobi, A. O.; Okafor, H. U.; Adeleke, S. I.; Audu, L. I.; Otuneye, A.; Disu, E.; Idris, H.; Aikhonbare, H.; Yakubu, A.; Ogala, W.; Ogunrinde, O.; Wammanda, R.; Orogade, A.; Eseigbe, E.; Umar, L.; Musa, H.; Onalo, R.; West, B.; Paul, N.; Lesi, F.; Ladapo, T.; Boyede, O.; Okeowo, R.; Mustapha, A.; Akinola, I.; Chima-Oduko, O.; Awobusuyi O.
Background In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource constrained countries, this study investigated whether AKI associated with DEG could be identified by other means. Methods: This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children withAKI over a 6-month period were reviewed. Results Sixty (50.4%) of 119 children ingested “My pikin” teething syrup. Compared to children who had not ingested it, they were significantly (p<0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management. Conclusions Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.
Kidney disease in hospitalised HIV positive children in Ibadan, South West Nigeria
(College of Medicine, University of Ibadan, 2012) Ademola, A. D.; Asinobi, O. O.; Oladokun, R. E.; Ogunkunle, O. O; Okolo, C. A; Ogbole. G. E.
Background: There is a paucity of data on the clinicopathologic pattern of kidney disease in Human Immunodeficiency Virus (HIV) seropositive children from sub-Saharan Africa and non from South West Nigeria. Objective: To determine the clinical pattern and outcome of kidney disease among HIV positive children hospitalised at a tertiary hospital South West Nigeria Methodology: A retrospective study of all HIV positive children who were hospitalised and managed for kidney diseases over a period of 78 months at the University College Hospital Ibadan, South West Nigeria was reviewed. Patients were followed up over the duration of hospital admission. Results: Ten children (six males and four females) aged 4 -15(10.4±3.2) years were identified. Four presented in acute kidney injury, (AKI) three with nephrotic syndrome (NS) and two in chronic kidney failure (CKF). One patient had left renal artery stenosis. Renal biopsy performed in three children showed focal segmental glomerulosclerosis in two patients and membranous nephropathy in the third. Management included antiretroviral therapy, Angiotensin Converting Enzyme Inhibitors and acute haemodialysis. Mortality was 40%. Conclusion: AKI, NS and CKF were the predominant clinical patterns of kidney disease in hospitalised HIV positive children and the mortality is high
Plasma homocysteine and B vitamins levels in Nigerian children with nephrotic syndrome
(African Field Epidemiology Network (AFENET), 2014) Orimadegun, B. E.; Orimadegun, A. E.; Ademola, A. D.; Agbedana, E. O.
Introduction: Available data on plasma homocysteine level in patients with nephrotic syndrome (NS) are controversial with increased, decreased and unchanged values reported. Therefore, plasma homocysteine and serum B vitamins in Nigerian children with NS were assessed in this study Methods: Fasting blood samples were analysed for plasma homocysteine, serum folate and B vitamins in 42 children with NS and 42 age and sex-matched healthy controls in this case control study. Data were compared between NS and control using t test and Chi square. Relationships were tested with regression analysis with p set at 0.05. Results: Prevalence of hyperhomocysteinaemia, low folate and cyanocobalamin in NS was 57.1%, 14.3% and 9.5% respectively. The mean homocysteine level was significantly higher in NS than control (11.3±2.6μmol/L versus 5.5±2.3μmol/L). Also, NS had lower folate and cyanocobalamin than control: 9.1±3.9ng/mL versus 11.2±3.1ng/dL and 268.5±95.7pg/mL versus 316±117.2pg/mL respectively. Weak but significant correlation between homocysteine and serum albumin (r = 0.347), folate (r = -0.607) and vitamin B12 (r = -0.185) were found in the NS group. Significant relationship was also found between homocysteine and vitamin B12 (ß = -0.64, 95% CI = -1.20, -0.08) after controlling for folate and vitamin B6 levels. Conclusion: Clinically important hyperhomocysteinaemia and low B vitamins occur in Nigerian children with nephrotic syndrome. This data suggest that potential usefulness of folate and vitamin B supplementation for reducing high homocysteine levels in nephrotic syndrome need to be further investigated
Paediatric end-stage renal disease in a tertiary hospital in South West Nigeria
(Asian Pacific Society of Nephrology, 2014) Asinobi, A. O.; Ademola, A. D.; Ogunkunle, O. O.; Mott S. A.
Background: Children and adolescents with end-stage renal disease (ESRD) in sub-Saharan Africa may have the worst outcomes globally. Barriers to management include late presentation, poor socioeconomic conditions, absence of medical insurance, limited diagnostic facilities and non-availability of chronic renal replacement therapy (RRT). Our study was to determine the incidence, aetiology, management and outcomes of paediatric ESRD in a tertiary hospital in Nigeria. Methods: A retrospective case review of paediatric ESRD at the University College Hospital Ibadan, Nigeria, over 8 years, from January 2005 to December 2012. Results: 53 patients (56.6% male), median age 11 (inter quartile range 8.5-12) years were studied. Mean annual incidence of ESRD in Ibadan for children aged 14 years and below was 4 per million age related population (PMARP) while for those aged 5-14 years it was 6.0 PMARP. Glomerulonephritis was the cause in 41 (77.4%) patients amongst whom, 29 had chronic glomerulonephritis and 12 had nephrotic syndrome. Congenital anomalies of the kidneys and urinary tract (CAKUT) accounted for 11 (21.2%) cases, posterior urethral valves being the most common. Acute haemodialysis, acute peritoneal dialysis or a combination of these were performed in 33 (62.3%), 6 (11.3%) and 4 (7.5%) patients respectively. Median survival was 47 days and in-hospital mortality was 59%. Conclusions: Incidence of paediatric ESRD in Ibadan is higher than previous reports from sub-Saharan Africa. Glomerulonephritis, and then CAKUT are the most common causes. Mortality is high, primarily due to lack of resources. Preventive nephrology and chronic RRT programmes are urgently needed.
Enabling the genomic revolution in Africa: H3Africa is developing capacity for health-related genomics research in Africa
(American Association for the Advancement of Science, 2014) Rotimi, C.; Abayomi, A.; Abimiku, A.; Adabayeri, V. M.; Adebamowo, C.; Adebiyi, E.; Ademola, A. D.
Factors associated with medication nonadherence among hypertensives in Ghana and Nigeria
(Hindawi Publishing Corporation, 2015) Boima, V.; Ademola, A. D.; Odusola, A. O.; Agyekum, F.; Nwafor, C. E.; Cole, H.; Salako, B. L.; Ogedegbe, G.; Tayo, B. O.
Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication non-adherence (MNA); our study therefore aimed to determine factors associated withMNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (𝑛 = 120), Ghana; and University of Port Harcourt Teaching Hospital, (𝑛 = 73) Apapa General Hospital Lagos (𝑛 = 79) and University College Hospital Ibadan (𝑛 = 85), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (𝑟 = −0.208, 𝑃 < 0.001), concern about medications (𝑟 = −0.0347, 𝑃 = 0.002), and knowledge of hypertension (𝑟 = 0.14, 𝑃 = 0.006). MNA was associated with formal education (𝑃 = 0.001) and use of herbal preparation (𝑃 = 0.014). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (𝑃 = 0.032). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (𝑃 = 0.006). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation.
Spectrum of behavioural abnormalities in children with nephrotic syndrome in South Western Nigeria
(JsciMed Central, 2015) Balogun, F.; Ademola, A. D.
Nephrotic syndrome is a chronic childhood disease characterized by relapses and children with this condition tend to have behavioural problems associated with the disease. These behavioural problems are usually not anticipated in most resource limited settings and can be frightening thereby making the children and the care givers to be distressed. Seven children with nephrotic syndrome who developed various behavioural abnormalities while on admission were discussed. There were four girls and three boys with age range seven to fourteen years. The abnormal behaviours noted were visual and auditory hallucinations, inappropriate speech and behaviour, attempted suicide, attention seeking behaviour and social withdrawal. Those behavioural abnormalities were related to prednisolone therapy in five of the children. Diagnosis made wore psychosis and delirium while treatment given included counselling, Risperidone, Halloperidol, Diazepam and reduction or withdrawal of Prednisolone. Abnormal behaviour was not anticipated in those children so the caregivers were takon unaware. This can be worse in infants or in mild cases. Most of the behavioural abnormalities were also associated with the use of prednisolone. There is an urgent need to design guidelines for the management of behavioural abnormalities in nephrotic syndrome especially steroid therapy in resource limited settings. Harmonisation of the skills of paediatric nephrologist and child psychiatrist is also important to obtain the best outcome.
Trends in the histopathology of childhood nephrotic syndrome in Ibadan Nigeria: preponderance of idiopathic focal segmental glomerulosclerosis
(BioMed Central, 2015) Asinobi, A. O.; Ademola, A. D.; Okolo, C. A.; Yaria, J. O.
Background: Reports on the histopathology of childhood nephrotic syndrome (NS) had emanated from our Centre since the 1960s and by the late 1980s and early 1990s, a change was observed and reported. Taking into consideration the worldwide changing trend in the histopathology of the NS and our Unit policy change in the indications for renal biopsy, a change was envisaged. We therefore evaluated the current histologic pattern of childhood NS in Ibadan with the view to highlighting any variations from the past and comparing the findings with regional and global trends. Methodology: We reviewed our database and analyzed the renal biopsy findings in patients who were biopsied before treatment was administered between 1997 and 2001 and those with mostly idiopathic steroid resistant NS (SRNS) and secondary NS, managed between 2006 and 2013. A comparative analysis of the findings from the present study was carried out with two previous reports from our Unit in the 1970s and early 1990s and also with reports from other Centres. Results: A total of 78 patients had successful biopsies done during the study period in children aged between 2 ½ and 16 years. In both pre-treatment biopsy era (1997–2001) and post-treatment biopsy era (2006–2013), focal segmental glomerulosclerosis (FSGS) predominated. 75 % of the patients had idiopathic NS and among the patients that had idiopathic steroid resistant NS, FSGS was the most common followed by MPGN. For secondary NS, MCD was the most common but could be the early stages of either membranous nephropathy (MN) or FSGS. Chronic pyelonephritis and chronic interstitial nephritis occurred in 25 % of the study population but they were more prevalent in secondary nephrotic syndrome. Conclusion: FSGS is the most common histopathology in children requiring renal biopsy in Ibadan presently. FSGS is also the most common histopathology in idiopathic SRNS, which is in keeping with reports from most parts of the world. There has been a transition from the preponderance of Quartan Malarial Nephropathy (QMN) in the 1960s to MPGN in the 1980s to FSGS presently. This has great implications with regards to searching for new aetiologic factors, providing more efficacious treatment modalities and ensuring facilities for immunofluorescence, electron microscopic and genetic studies.
Human heredity and Health (H3) in Africa kidney disease research network: a focus on methods in Sub-Saharan Africa
(American Society of Nephrology, 2015) Osafo, C.; Raji, Y. R.; Burke, D.; Bamidele, O. T.; Tiffin,N.; Moxey-Mims, M. M.; Rasooly, R. S.; Kimmel, P. L.; Ojo, A.; Adu, D.; Parekh, R. S.; Ademola, A. D.
CKD affects an estimated 14% of adults in sub-Saharan Africa, but very little research has been done on the cause, progression, and prevention of CKD there. As part of the Human Heredity and Health in Africa (H3Africa) Consortium, the H3Africa Kidney Disease Research Network was established to study prevalent forms of kidney disease in sub-Saharan Africa and increase the capacity for genetics and genomics research. The study is performing comprehensive phenotypic characterization and analyzing environmental and genetic factors from nine clinical centers in four African countries (Ghana, Nigeria, Ethiopia, and Kenya) over a 5-year period. Approximately 4000 participants with specified kidney disease diagnoses and 4000 control participants will be enrolled in the four African countries. In addition, approximately 50 families with hereditary glomerular disease will be enrolled. The study includes both pediatric and adult participants age <1 to 74 years across a broad spectrum of kidney diseases secondary to hypertension-attributed nephropathy, diabetes, HIV infection, sickle cell disease, biopsy-proven glomerular disease, and CKD of unknown origin. Clinical and demographic data with biospecimens are collected to assess clinical, biochemical, and genetic markers of kidney disease. As of March 2015, a total of 3499 patients and controls have been recruited and 1897 had complete entry data for analysis. Slightly more than half (50.2%) of the cohort is female. Initial quality control of clinical data collection and of biosample and DNA analysis is satisfactory, demonstrating that a clinical research infrastructure can be successfully established in Africa. This study will provide clinical, biochemical, and genotypic data that will greatly increase the understanding of CKD in sub-Saharan Africa.
An Audit of the Use of Renal Function Tests among Paediatric Mortalities
(Sciencedomain International, 2016) Asinobi, A. O.; Ademola, A. D.; Ogunku, O. O.
Background: Acute kidney injury is a frequent and serious complication encountered in critically ill children and is an independent risk factor for mortality. Major causes of childhood mortality in our environment are conditions frequently complicated by kidney failure, yet kidney failure is conspicuously absent in many of the reports. The actual proportion of these critically ill children subjected to renal function tests is not known. In view of the low representation of kidney failure as a cause of mortality in our environment, we sought to know what proportion of critically ill/dying patients had renal functions tests done and to identify any cases of missed diagnosis. Methods: This was a descriptive study of the mortalities in the Department of Paediatrics, University College Hospital, Ibadan, between August 2004 and May 2006, particularly those due to kidney failure. Data from the departmental mortality database collected on a weekly basis were analyzed. Results: Out of 4,941 admissions, there were 542 mortalities (age 1day -13 years) giving a mortality rate of 11%. Low birth weight, malaria, severe perinatal asphyxia, meningitis and neonatal tetanus were the leading five causes of death. Over 80% of the mortalities were under-fives
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.
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.
Haemodialysis for paediatric acute kidney injury in a low resource setting: experience from a tertiary hospital in South West Nigeria
(Oxford University Press, 2016) Asinobi, A. O.; Ademola, A. D.; Alao, M. A.
Background: Acute kidney injury (AKI) is an important cause of preventable mortality among children. Management of AKI may require renal replacement therapy (RRT) but access to RRT for children in low resource settings is limited. Our study explored the role of haemodialysis in the management of children with AKI in a low resource setting in terms of aetiology and outcomes. Methods: A review of patients managed in the Paediatric Nephrology Unit, University College Hospital Ibadan, South-West Nigeria, who underwent haemodialysis for AKI from January 2006 to December 2014. Results: Sixty-eight patients (55.9% males), aged 3–16 (mean ± standard deviation, 9.0 ± 3.4) years were studied. The causes of AKI were sepsis (22.1%), malaria (17.6%) and glomerulonephritis (17.6%), intravascular haemolysis—cause unknown (16.2%), G6PDH deficiency (7.4%), malignancy (8.8%) and haemoglobinopathy (5.9%). The number of sessions of haemodialysis ranged from 1 to 10 (mode = 2 sessions) over a period of 1–55 days. Mortality was 27.9% (n = 19) and was related to the aetiology of AKI (P = 0.000): no deaths among patients with intravascular haemolysis or malaria, six deaths among patients with sepsis (40%), six (50%) among the patients with glomerulonephritis, while all the patients with malignancies died. Conclusions: The outcome of haemodialysis for AKI in Nigeria is relatively good and is related to the underlying aetiology of AKI. In addition to peritoneal dialysis, intermittent haemodialysis may have a role in the management of paediatric AKI in low resource settings and should be supported.
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.
Trends in the epidemiology of severe pediatric non-surgical renal disorders in Ibadan Nigeria: A marked increase in the incidence of acute kidney injury
(Sciencedomain International, 2016) Asinobi, A. O.; Ademola, A. D.; Ogunkunle, O. O.; Yaria, J.
Background: Renal disorders are increasingly being recognized as major contributors to morbidity and mortality. Variability in their pattern in different populations and regions of the world and changes occurring with time have been demonstrated. We aimed to determine the current trends in the pattern of severe non-surgical childhood renal disorders at our Centre and compare the findings with previous studies. Methodology: A descriptive analytical study was carried out on consecutive incident cases of nonsurgical renal disorders aged 14 years and below, managed in the Pediatric Nephrology Unit of the University College Hospital, Ibadan, Nigeria. Two separate time periods were studied. Results: A total of 869 incident cases of severe non-surgical disorders were admitted during the study periods. There was an increase in the hospital incidence from 1.5 to 2.2 per 100 pediatric admissions and in the average yearly admission from 43 to 103. The crude annual incidence increased from 42 per million age-related population (PMARP) to 86 (PMARP) at the end of the two study periods. The most remarkable increase occurred with Acute Kidney Injury, which showed a 6.5-fold rise and was the most common cause of renal morbidity and mortality in children encountered in the study. Interventional measures resulted in early detection, prompt treatment and reduced mortality. Conclusion: The study has shown an increase in the incidence of severe childhood renal disorders in Ibadan, with Acute Kidney Injury being the leading non-surgical renal disorder. A significant decline in case fatality rates was demonstrated in recent years.
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.