Kidney Function in Hypertensive Patients with Left Ventricular Hypertrophy.

BACKGROUND: Impairment of kidney function is one of the long-term sequelae of hypertension and it contributes to increased morbidity and mortality in hypertensive patients. Left ventricular hypertrophy (LVH) is a common complication of hypertension which can worsen the outcome in affected patients. This study was designed to compare kidney function in hypertensive patients with LVH with that in hypertensive patients without LVH. METHODS: The study was conducted among hypertensive patients attending cardiology clinics at two tertiary hospitals in Nigeria. A questionnaire was used to obtain demographic and clinical information from the participants. Kidney function was determined by measuring serum urea and creatinine, urinary creatinine and microalbumin. Echocardiography was performed to detect LVH. Results of kidney function tests were compared between participants who had LVH and those who did not. RESULTS: Of the 105 participants recruited, 58 (55.2%) were males. The median age of all participants was 52 (interquartile range (IQR) 40-61) years and LVH was confirmed in 48 (45.7%) of them. Participants with LVH were older (55 vs 49 years; p=0.02) but had lower weight (74 vs 78 kg; p=0.04). Participants without LVH had higher microalbuminuria (5.2 vs 4.05 mg/dl; p=0.03), lower estimated glomerular filtration rate (62 vs 92 ml/min/1.73 m2; p=0.004), and higher stages of CKD. CONCLUSION: Hypertensive patients with LVH had lower levels of microalbuminuria, higher estimated GFR, and lower stages of CKD compared to those with no LVH.

CONTEXTE: L'altération de la fonction rénale est l'une des séquelles à long terme de l'hypertension et contribue à une morbidité et une mortalité accrues chez les patients hypertendus. L'hypertrophie ventriculaire gauche (HVG) est une complication fréquente de l'hypertension qui peut aggraver le pronostic chez les patients concernés. Cette étude visait à comparer la fonction rénale chez les patients hypertendus avec HVG à celle des patients hypertendus sans HVG. MÉTHODES: L'étude a été menée auprès de patients hypertendus fréquentant des cliniques de cardiologie dans deux hôpitaux tertiaires au Nigeria. Un questionnaire a été utilisé pour obtenir des informations démographiques et cliniques auprès des participants. La fonction rénale a été déterminée en mesurant l'urée sérique et la créatinine, la créatinine urinaire et la microalbuminurie. Une échocardiographie a été réalisée pour détecter l'HVG. Les résultats des tests de fonction rénale ont été comparés entre les participants présentant une HVG et ceux qui n'en présentaient pas. RÉSULTATS: Sur les 105 participants recrutés, 58 (55,2 %) étaient des hommes. L'âge médian de tous les participants était de 52 ans (plage interquartile (IQR) de 40 à 61) et l'HVG a été confirmée chez 48 (45,7 %) d'entre eux. Les participants avec une HVG étaient plus âgés (55 vs 49 ans ; p=0,02) mais avaient un poids plus faible (74 vs 78 kg ; p=0,04). Les participants sans HVG avaient une microalbuminurie plus élevée (5,2 vs 4,05 mg/dl ; p=0,03), un taux de filtration glomérulaire estimé plus bas (62 vs 92 ml/min/1,73 m2; p=0,004) et des stades plus élevés de maladie rénale chronique. CONCLUSION: Les patients hypertendus avec HVG présentaient des niveaux plus faibles de microalbuminurie, un taux de filtration glomérulaire estimé plus élevé et des stades plus bas de la maladie rénale chronique par rapport à ceux sans HVG. MOTS-CLÉS: Hypertrophie ventriculaire gauche, Hypertension, Fonction rénale, Maladie rénale chroniqu.

Sex Hormone-Binding Globulin Level Enhances Prediction of Gestational Diabetes Mellitus in a Sub-Saharan African Population.

BACKGROUND: The burden of Gestational Diabetes Mellitus (GDM) in the Sub-Saharan African region has been on the rise despite increased diagnosis and treatment. Current risk factor-based prediction approaches in the region lack strong predictive value, hence the need for effective early prediction and preventive interventions. AIM: The aim of this study was to assess the diagnostic improvement in prediction of GDM by the addition of Sex Hormone-Binding Globulin (SHBG) assay to current approaches which assess early pregnancy maternal clinical risk factors in the study population. METHODS: This was a multi-centre hospital-based prospective observational study carried out over a period of 18 months in which serum SHBG levels were assayed and maternal clinical risk factors for GDM evaluated in a cohort of 271 pregnant women at 9 to 16 weeks gestational age. These participants were subsequently tested for GDM using a diagnostic 75g oral glucose tolerance test (OGTT) at 24 to 28 weeks of gestation. RESULTS: Clinical risk factor-based prediction approach had a diagnostic sensitivity of 59.6%, specificity of 69.4% and an area under the ROC curve of 0.758 (95% CI = 0.686, 0.830; p < 0.001). Following addition of SHBG assay to the maternal risk factors as predictors of GDM, the diagnostic sensitivity increased to 70.2%, specificity to 76.3% and there was a significant increase in the area under the ROC curve of 0.061 (95% CI = 0.006, 0.117; p = 0.030). CONCLUSION: Current maternal clinical risk factor-based GDM prediction approach in early pregnancy lacks strong predictive value in the study population. Thus, addition of biochemical predictors like SHBG may improve early prediction of GDM and enable timely intervention.

CONTEXTE: Le fardeau du diabète sucré gestationnel (DG) dans la région de l'Afrique subsaharienne est en augmentation malgré l'augmentation des diagnostics et des traitements. Les approches actuelles de prédiction basées sur les facteurs de risque dans la région ont des performances médiocres, d'où la nécessité d'une prédiction précoce efficace et d'une intervention préventive.OBJECTIF: L'objectif de cette étude était d'évaluer l'amélioration diagnostique de la prédiction du DG par l'ajout du dosage de la globuline liant les hormones sexuelles (SHBG) à l'approche actuelle qui évalue les facteurs de risque cliniques maternels en début de grossesse dans la population étudiée. METHODES: Il s'agissait d'une étude observationnelle prospective multicentrique en milieu hospitalier menée sur une période de 18 mois au cours de laquelle les taux sériques de SHBG ont été dosés et les facteurs de risque cliniques maternels de DG évalués dans une cohorte de 271 femmes enceintes de 9 à 16 semaines d'âge gestationnel. Ces participants ont ensuite été testés pour le DG à l'aide d'un test de diagnostic oral de tolérance au glucose (OGTT) de 75 g entre 24 et 28 semaines de gestation. RESULTATS: L'approche de prédiction basée sur les facteurs de risque clinique avait une sensibilité diagnostique de 59.6 %, une spécificité de 69.4 % et une aire sous la courbe ROC de 0.758 (IC à 95 % = 0.686, 0.830 ; p < 0.001). Suite à l'ajout du test SHBG aux facteurs de risque maternels en tant que facteurs prédictifs de DG, la sensibilité diagnostique est passée à 70.2 %, la spécificité à 76.3 % et il y a eu une augmentation significative de l'aire sous la courbe ROC de 0.061 (IC à 95 % = 0.006, 0.117; p = 0.030). CONCLUSION: L'approche actuelle de prédiction du DSG basée sur les facteurs de risque cliniques maternels en début de grossesse a de faibles performances dans la population étudiée. Ainsi, l'ajout de prédicteurs biochimiques comme SHBG peut améliorer la prédiction précoce du DG et permettre une intervention rapide. Mots-clés: Âge gestationnel, Diabète gestationnel, Facteurs de risque cliniques maternels, Prédiction, Sex hormone-binding globulin (SHBG), Afrique subsaharienne.

Coagulation profile in severe pre-eclampsia and eclampsia in Ilorin, Nigeria: implications for anaesthetic management in operative obstetrics.

BACKGROUND: Severe preeclampsia and eclampsia are associated with coagulopathy which may be a contraindication to central neural axial blockade for caesarean section. Many investigations of bleeding tendencies are not done in our environment because of logistic reasons and emergency presentations of these patients.The study was designed to determine the coagulation profile of severe preeclamptic and eclamptic women in labour and possibly arrive at affordable and readily available investigation(s) that can be used in excluding bleeding tendencies in these patients. STUDY DESIGN: In a prospective study, 50 severely preeclamptic/eclamptic patients in labour and, 50 parturients with normal pregnancies, and, in labour were recruited. Full blood count including platelet count, prothrombin time (PT) using the International Normalized Ratio (INR) and partial thromboplastin time with kaolin (PTTK) were done in all the patients. RESULTS: Mean platelet count was significantly lower in study patients than in controls, 158.1 × 10(9)/l versus 216.9 × 10(9)/l, p = 0.0001. Mean INR and PTTK were within the reference values for the reagents used but mean INR was significantly greater in cases than in controls, 1.06 ± 0.01 versus 0.92 ± 0.01 (p = 0.001) while PTTK was also significantly longer in cases than in controls, 38.4 ± 0.21 versus 34.3 ± 0.44 seconds (p = 0.002). CONCLUSION: As platelet count can be readily obtained and it is affordable in our environment, it can be used in assessing bleeding tendencies in these patients for their effective management.

Body size preference among Yoruba in three Nigerian communities.

Following our previous observation of an aversion to weight reduction in Nigerians with type 2 diabetes, we measured several parameters of body dimensions and preferences in otherwise healthy adults in three communities to study the phenomenon further. The study population of 524 participants (304 F) was 99.8% of Yoruba ethnic origin with a mean age of 43.9 ± 17.2 years. Females had a significantly (p > 0.001) higher body mass index (BMI), waist circumference, hip circumference compared to the males; the values being 24.55 ± 5.5 vs. 21.75 ± 3.71 kg/m(2); 84.98 ± 12.67 vs. 80.92 ± 9.85 cm; 96.32 ± 12.94 vs. 89.36 ± 8.06 cm, respectively. There was a high level of satisfaction amongst respondents with their body size (Kendall's t = 0.52, p < 0.001) which they also predicted with a high degree of certainty even without the prior use of a weighing scale. The relationship between current body size (CBI) and BMI emerged as CBI = 1.22 + 0.32 BMI. In the 41% of respondents who expressed unhappiness with their current body size, there was a strong aversion for a smaller body size and the preference was often for a bigger body figure. Strikingly, many more women than men were less dissatisfied with their bigger body sizes. Stepwise regression indicated that CBI and gender were the two most important variables that best related to casual blood sugar (RBS) among the factors entered. The mathematical relationship between these variables that emerged was: [Formula: see text] where gender = 0 for male and 1 for female. The results suggest that larger body sizes were positively viewed in these communities consistent with our previous observations in type 2 diabetes.

Utility of estimated glomerular filtration rate equations in Nigerians with stable chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem. The incidence and prevalence are increasing worldwide, while the outcomes remain poor and treatment cost high. Unfortunately, CKD in Sub-Sahara Africa is usually diagnosed late and supported with limited treatment facility. OBJECTIVE: This study aimed at filling the gap created by late diagnosis by assessing utility of estimated glomerular filtration rate (eGFR) in Nigerians and possibly proposing routine reporting of eGFR for earlier diagnosis of CKD. METHODS: This study was carried out among patients with established and stable chronic kidney disease (CKD) from the renal unit of the University of Ilorin Teaching Hospital. A total of 64 patients with CKD, comprising 48 males and 16 females were selected by simple random sampling technique for the study. Their creatinine clearance using 24-hour urine collection method, the Cockcroft and Gault [CG] formula and Modification of Diet in Renal Disease (MDRD) formula was determined. Creatinine clearance from CG formula and endogenous creatinine clearance were corrected to 1.73m2 body surface area. RESULTS: The mean creatinine clearance from 24-hour urine collection was 21.75ml/min/1.73m2. We obtained 32.18 ml/min/ 1.73m2 from Cockcroft and Gault and 26.56 ml/min/ 1.73m2 from MDRD formulae respectively. There was no statistically significant difference between the mean creatinine clearance values obtained from the 24- hour urine collection when compared with those obtained from the Cockcroft-Gault formula (p >0.5) and the MDRD formula (p > 0.5). Also, when creatinine clearance from 24-hour urine collection was subjected to correlation analysis; correlation coefficients of 0.905 and 0.904 were obtained for Cockcroft-Gault and MDRD formula respectively. CONCLUSION: Our results thus show that the formula method (eGFR) for calculating clearance is 95% reliable in patients with chronic kidney disease in this environment. To promote early detection of CKD which is usually amenable to treatment we recommend routine reporting of eGFR.

Glycated haemoglobin and glycaemic control of diabetics in Ilorin.

OBJECTIVES: With increasing adoption of Western Lifestyle in Nigeria, the incidence of Diabetes Mellitus is on the increase in the country with its attendant complications. The objective of this study was to determine the prevalence of patients at risk of developing diabetic complications in Ilorin, Nigeria, among our patients with diabetes mellitus. METHODS: A cross-sectional study of diabetic patients attending the University of Ilorin Teaching Hospital ted haemoglobin as an index of medium term glucose control was assayed in established diabetics. The result obtained was evaluated against the bench mark HbA1c value of 7.2% for the development of complication. RESULTS: Fifty-six percent of the subjects were females and all of them were forty years and above in age. Only four percent of the patients were below the age of forty years. Seventy-two percent of the subjects had diabetes for less than 10 years. Only female patients had BMI values greater than 30 kg/m2. About 64% of the patients had HbA1c value > 7.2%. More males (73.7%) had HbA1c 7.2% than females (64.5%) (P < 0.05). The patients had a mean HbA1c value of 8.0%, while the mean HbA1c in the control was 5.2%. These two mean HbA1c values gave a P-value of 0.0001 on Student t-test. The female diabetic patients had a mean HbA1c value of 7.8% (SD = 1.96) against the value of 5.1% (SD = 1.13) for the female control patients (P-value of 0.0001). Similarly, the male patients and male control subjects had mean HbA1c values of 8.1% (SD = 1.96) and 5.6% (SD = 1.00) respectively with P-value of 0.0001. The control subjects had a mean fasting blood glucose level of (+/- SD) 4.93 +/- 1.09 mmol/L and the corresponding value for the diabetics was 8.5 +/- 4.2 mmol/L. when these two values were compared we got a P-Value < 0.05. CONCLUSIONS: The mean HbA1c values between the patients and the control subjects were significantly different. Diabetics in our environment with mean HbA1c value of 8.0% are prone to developing complications because of poor glycaemic control. We therefore advise that, periodic estimation ofglycated haemoglobin be carried out along side fasting blood glucose, in our diabetics.

Andropause: an emerging world health problem.

Andropause is an emerging clinical concept that is gaining an increasing recognition, as the world becomes more aging. The clinical features though subtle are easy to identify and appropriate treatment of diagnosed cases will to a goodextent alleviate a lot of age-related complaints and improve the general quality of life in the elderly men. Low level of clinical suspicion secondary to inadequate knowledge about this clinical entity remains the major obstacle to appropriate treatment. In this review, the literature has been perused and the definition, epidemiology, pathophysiology, clinical features, diagnosis and treatment are outlined.

Permanent hypoparathyroidism developing post-thyroidectomy.

A case of permanent hypocalcaemia following a subtotal thyroidectomy for a simple multinodular goiter in a 35 year -- old married teacher is presented. This further confirms the need for utmost precaution during thyroid surgery to prevent the damage or inadvertent removal of the parathyroid glands and its consequential complications. It also throws more light on the problem faced in the management of hypocalcaemia vis a vis patient compliance and availability of proper medications in this environment.

Awareness of atherosclerosis risk factors in Nigeria.

Non-communicable diseases, which include hypertension and diabetes mellitus, have become an important cause of morbidity and mortality in Nigeria. The determination of serum lipid levels is used routinely to assess the risk of atherosclerosis. This study was performed in order to determine the frequency of serum lipid requests in the community. Information on both lipid and total chemical pathology requests for the study period (May 1998 to April 2000) was obtained from the Department of Chemical Pathology, University of Ilorin Teaching Hospital, whilst data on the total hospital attendance was obtained from the hospital's Record Department. The number of serum lipid requests increased from year to year (May 1998 to April 1999 = 780; May 1999 to April 2000 = 1,357; May 2000 to April 2001 = 1,382). The percentages of total requests for serum Lipids when compared with the total laboratory requests for the period of study were 12.0%, 13.3% and 14.0% for the first, second and third year respectively. More men than women had their serum lipid levels determined; 31.3% of the patients had hyper-cholesterolaemia (> 5.2 mmol/L), while 9.9% had values > or = 6.2 mmol/L. Industrial disputes (strikes) affected our results. For the three-year period there was no remarkable increase in the use of the lipid profile facilities available in the centre. This reflects the inadequate awareness of lipid disorders as a risk factor for atherosclerosis.

Plasma lipids and lipoproteins during first trimester in pregnant Nigerian women: Ilorin experience.

Thirty-two pregnant women in their first trimester with a mean age of 29.5 years, 32 age matched non-pregnant controls were included in this study. They were bled after 14-hour fasting. This study was between October 2000 and October 2001. Plasma total cholesterol, triglyceride and HDL- cholesterol were assayed. LDL-cholesterol was obtained through Frieldwald formula average as mean were calculated using Epi info version 6.0 and level of significant difference decided at p<0. 05. The mean age of the subjects was 9.5 years. Compared to the concentration in non-pregnant women [controls] the plasma level of total cholesterol and HDL-cholesterol were found to be significantly lower p<0.05. However the levels of plasma triglyceride and LDL-cholesterol were found to be significantly higher in the pregnant women than the control group [p<0.05]. This study revealed that the level of total plasma cholesterol is low in middle part of first trimester. We therefore suggest that in interpreting the result of total cholesterol in first trimester the gestation age should be put into consideration.

Glycated haemoglobin and associated variables in diabetics: Ilorin experience.

One hundred and fifty type 2 diabetes mellitus patients were investigated to determine extent of haemoglobin glycation and factors that might influence it. Factors so considered were age, sex, disease duration, and body mass index. The mean HbA(1c) was 8.0%. Ninety-six (about 64%) of the subjects had HbA(1c) > 7.2%. Seventy-one of these were males. Sex and age did not have significant effect on HbA(1c) and so was disease duration in our center. Almost 70% of the female diabetics were overweight. Correlation was very poor between BMI and haemoglobin glycation. However, assessment of the individual group results tended to suggest that glycation decrease with increasing BMI.

The usefulness of serum albumin and urinary creatinine as biochemical indices for monitoring the nutritional status of Nigerians with pulmonary tuberculosis.

The objective is to evaluate the relative roles of urinary creatinine and serum albumin as biochemical markers for monitoring the nutritional status of pulmonary tuberculosis patients during treatment. Thirty-one newly diagnosed pulmonary tuberculosis patients were placed on six months short course regimen. Their weight, body mass index, serum albumin and 24-hour urinary creatinine excretion were determined before treatment, at the end of the 1st, 2nd, 4th and 6th month of treatment. Subjecting the mean values of the weight, BMI and Urinary Creatinine excretion and serum albumin to Friedman test showed significant changes for all the four indices. Further analysis with paired student t-test of the pre-treatment values with end of 6th month values confirmed significant changes in the mean values of weight, BMI and serum albumin. Of these three indices serum albumin with chi-square value of 103.515 demonstrated the most significant changes, while the minimal change observed in urinary creatinine excretion could not be confirmed with paired t-test. We recommend serum albumin (as a more sensitive index) for monitoring the nutrition of patient with pulmonary tuberculosis.

Creatinine clearance: alternative approach to traditional 24-hour urine collection in normal individuals.

Clinically, the commonly used routine test for assessing impaired renal function is the determination of creatinine clearance. The traditional 24 hour urine collection method is unreliable and inconvenient, particularly in ambulatory patients and outpatients because of errors in collection, timing of collection, and measurement of urine volume. The purpose of this study was to evaluate the possibility of determining creatinine clearance from urine collected for less than the traditional 24 hours. Thirty clinically healthy adult subjects with no history of renal dysfunction were used for the study. Each of the subjects had his creatinine clearance determined from 4 hour, 20 hour and 24 hour urine collections as well as from the formula of Cockcroft and Gault. The mean creatinine clearance obtained from 4 hour urine collection (male = 92.8 ml/ min/1.73 m2 & female = 84.5 ml/min/1.73 m2) and 20 hour urine collection (male = 98.9 ml/min/1.73 m2 & female = 88.6 ml/min/1.73 m2) shows no significant difference from that obtained from the traditional 24 hour urine collection (male = 97.9 ml/min/1.73 m2 & female = 88.1 ml/min/1.73 m2) (P > 0.05). We therefore suggest that determination of creatinine clearance from fewer hours of urine collection especially in patients with renal impairment be explored towards their adaptation to routine practice.

Effect of drug-induced hyperuricaemia on renal function in Nigerians with pulmonary tuberculosis.

Some anti-tuberculosis chemotherapeutic agents have been established as causing hyperuricaemia. Hyperuricaemia in turn causes renal damage. This study therefore aims at establishing the effect of anti-tuberculosis drugs-induced hyperuricaemia on renal function of the patients. Fifty patients with newly diagnosed pulmonary tuberculosis with mean age of 36.8 years (SD 13.69) consisting of 14 females and 17 males were longitudinally studied each for 6 months to determine the effect of drug-induced hyperuricaemia on their renal function. The Biochemical indices determined included serum urate level, serum creatinine level, and creatinine clearance of newly diagnosed patient with tuberculosis, before and during treatment with anti-tuberculosis therapy. Serum urate level revealed that 16 (51.6%) and 15 (48.4%) of the patients were hyperuricaemic at the end of the first and second months of anti-tuberculosis therapy. There was no significant difference in the mean serum creatinine level of the control group 96 micromol/L when compared with both the pre-treat value 89 micromol/L (P > 0.25) as well as the value at the end of the sixth month of treatment 91 micromol/L (P > 0.40). However, there was a statistically significant difference in the mean creatinine clearance of the control group 102 ml/min/1.73 m2 when compared with the patient's mean pre-treatment value (89 ml/min/1.73 m2) P < 0.05. Also the mean creatinine clearance increased to (103 ml/min/1.73 m2) by the end of the 6th month of treatment, a value that is statistically significant when compared with the pretreatment value of (89 ml/min/1.73 m2) P < 0.05. We submit as follows: that pulmonary tuberculosis as a disease with significant impairment of renal function; despite the associated drug-induced hyperuricaemia recorded during the treatment, renal function steadily improved with the treatment of pulmonary tuberculosis to the extent that comparable values with control was obtained at the end of treatment. We conclude therefore that drug-induced hyperuricaemia associated with treatment of pulmonary tuberculosis has no detectable negative effect on renal function of the patient.