Agrochemical use in Farming Practices and Risk Factors for Kidney Disease among Dwellers of Rural Farming Communities in South-West Nigeria.

BACKGROUND: The outlook of chronic kidney disease (CKD) in low-and-medium-income-countries is poor. Modern farming practices in Nigeria are becoming increasingly associated with the use of herbicides and pesticides. AIM: The study aimed to evaluate agrochemical use in farming practices and risk factors for kidney disease among dwellers of rural farming communities in South-West Nigeria. METHODS: This was a cross-sectional survey of adult dwellers of an agrarian rural farming community in South-West Nigeria. Participants provided information on demographics, lifestyles, knowledge, and awareness of risk factors for kidney disease, and the use of agrochemicals in farming practice. Anthropometric measurements and blood pressure values were obtained while blood and spot urine were collected for random blood glucose, serum creatinine, urinalysis, and albumin-creatinine ratio. RESULTS: A total of 572 rural dwellers were enrolled in the study, with a mean age of 49.9 ± 17.5 years while 39.3% were male and 88.9% engaged in active farming. The prevalence of traditional risk factors for kidney disease was hypertension (24.3%), Diabetes mellitus (2.8%), cigarette smoking (7.5%), alcohol intake (20.8%) and herbal consumption (57.1%). The use of pesticides/herbicides was reported in 69.9%, while 25.3% did not use protective gear during its use. Proteinuria, hematuria, and reduced eGFR were observed in 29.8%, 6.1%, and 33.9% of participants, respectively. CONCLUSION: This study showed a high prevalence of herbicides and pesticide use and traditional risk factors for kidney disease, in addition to the high prevalence of markers of kidney damage among the dwellers of rural farming settlements in South-West Nigeria.

Abnormalities of Kidney Function in Acute Malarial and non-Malarial Infections.

INTRODUCTION: The tropical environment is endemic with malaria and non-malarial infections which are responsible for the high morbidity and mortality in these low- and middle-income countries. In particular, acute malarial infection can cause significant multi-organ dysfunction, including kidney involvement. Early detection of kidney dysfunction will help to improve the quality of care and reduce associated morbidity and mortality. This study aimed at identifying the spectrum of kidney dysfunction in patients with acute malaria and non-malarial infections. METHODS: This was a prospective observational study in which participants with acute malarial infection, acute non-malarial infection, and apparently healthy individuals were enrolled. For acute malarial infection, participants with thick blood smear parasite density of ≥1000 parasite/µl and falciparum species on thin smear were enrolled. Demographic, clinical, and laboratory parameters were measured. The renal abnormalities examined were urea, creatinine and eGFR, albuminuria, electrolytes, and presence of acute kidney injury (AKI). RESULTS: The following electrolyte abnormalities were observed in participants with acute falciparum infection: hyponatraemia (10.7%), hypernatraemia (4.0%), hypokalaemia (8.0%), and hyperkalaemia (13.3%). The mean serum urea in participants with acute malaria was 33.8±8.8mmol/l while participants with non-malarial febrile illnesses and healthy controls had 34.7±9.0mmol/l and 26.8±7.6mmol/l, respectively. The mean serum creatinine among participants with acute falciparum infection was 1.0±0.3mg/dl compared to those of participants with non-malarial infections and healthy controls which were 1.1±0.4mg/dl and 0.8±0.3mg/dl, respectively. The difference in the observed mean serum creatinine among the 3 groups was statistically significant (p=0.023). The mean urinary sodium among participants with non-malarial infection was highest at 23.03mmol/l. There was transient albuminuria in 6.7% of participants with acute malarial infection which resolved after recovery from the infection. CONCLUSION: A relatively high frequency of serum electrolyte abnormalities, albuminuria and urine microscopic abnormalities were observed among subjects with acute malaria compared to those without malaria infection.

INTRODUCTION: L'environnement tropical est endémique d'infections paludéennes et non paludéennes qui sont responsables d'une morbidité et d'une mortalité élevées dans ces pays à revenu faible et moyen. En particulier, l'infection palustre aiguë peut provoquer un dysfonctionnement significatif de plusieurs organes, y compris une atteinte rénale. La détection précoce du dysfonctionnement rénal permettra d'améliorer la qualité des soins et de réduire la morbidité et la mortalité associées. Cette étude visait à identifier le spectre du dysfonctionnement rénal chez les patients atteints d'une infection palustre aiguë ou d'une infection non palustre. MÉTHODES: Il s'agit d'une étude prospective d'observation à laquelle ont participé des personnes souffrant d'une infection palustre aiguë, d'une infection non palustre aiguë et des personnes apparemment en bonne santé. Pour l'infection palustre aiguë, les participants présentant une densité de parasites sur frottis sanguin épais de ≥1000 parasites/µl et des espèces de falciparum sur frottis mince ont été enrôlés. Les paramètres démographiques, cliniques et de laboratoire ont été mesurés. Les anomalies rénales examinées étaient l'urée, la créatinine et le DFGe, l'albuminurie, les électrolytes et la présence de lésions rénales aiguës (IRA). RÉSULTATS: Les anomalies électrolytiques suivantes ont été observées chez les participants atteints d'une infection aiguë à falciparum : hyponatrémie (10,7 %), hypernatrémie (4,0 %), hypokaliémie (8,0 %) et hyperkaliémie (13,3 %). L'urée sérique moyenne chez les participants atteints de paludisme aigu était de 33,8±8,8mmol/l alors que les participants atteints de maladies fébriles non palustres et les témoins sains avaient 34,7±9,0mmol/l et 26,8±7,6mmol/l, respectivement. La créatinine sérique moyenne chez les participants atteints d'une infection aiguë à falciparum était de 1,0±0,3mg/dl par rapport à celle des participants atteints d'infections non palustres et des témoins sains qui étaient de 1,1±0,4mg/dl et 0,8±0,3mg/dl, respectivement. La différence dans la créatinine sérique moyenne observée entre les 3 groupes était statistiquement significative (p=0.023). Le sodium urinaire moyen parmi les participants atteints d'une infection non palustre était le plus élevé à 23,03 mmol/l. Une albuminurie transitoire a été observée chez 6,7 % des participants atteints d'une infection palustre aiguë, qui s'est résorbée après la guérison de l'infection. CONCLUSION: Une fréquence relativement élevée d'anomalies des électrolytes sériques, d'albuminurie et d'anomalies microscopiques de l'urine a été observée chez les sujets atteints de paludisme aigu par rapport à ceux qui n'étaient pas infectés par le paludisme. Mots-clés: Anomalies de la fonction rénale, infection aiguë par le paludisme à falciparum, infections non palustres.

Comparative analysis of fibroblast growth Factor-23 as a correlate of cardiovascular disease among individuals with chronic kidney disease, hypertensives, and healthy controls.

Background: Chronic kidney disease (CKD) is a global growing public health epidemic with attending morbidity and huge financial cost. Cardiovascular disease (CVD), a major complication of CKD, contributes to its excessive mortality rate. The aetio-pathogenesis of the excess burden of CVD in CKD is a feature yet to be unravelled. Fibroblast growth factor-23 (FGF-23) has been implicated as a risk factor for CVD among patients with CKD. However, most of these studies were predominantly among the Caucasian population. Aim: This study aims to determine the correlation between FGF-23 and CVD among Nigerians with CKD. Patients and Methods: A cross-sectional comparative study composed of three groups: participants with CKD, hypertensives without CKD, and healthy individuals, represented as group 1, 2, and 3, respectively. Information obtained included demographic data and occurrence of risk factors for CVD. Cardiovascular risks were assessed by echocardiography and all the participants had kidney function tests done with plasma FGF-23. Results: The study sample size consisted of 135 participants. The mean (SD) age for participants with CKD and controls were 50.2 (12.7), 54.3 (15.5), and 40.2 (14.1) years, respectively. The median [interquartile range (IQR)] of plasma FGF-23 for participants with CKD 210 (139-304) RU/ml, and controls 124 (86-170) RU/ml, and 71 (38 - 89) RU/ml P < 0.001. Most participants with CKD had left ventricular hypertrophy (LVH) (80.0%), compared to the controls; 28.9% and 6.7% P < 0.001. Similarly, majority of participants with CKD had elevated plasma FGF-23 with LVH (85.7%) compared to controls 55.6% and 11.5%, whereas for aortic valve calcification with elevated plasma FGF-23 among CKD and controls were 53.6% (P = 0.29), 37.0% (P = 0.03), and 19.2% (P = 0.06), respectively. Conclusion: Individuals with CKD had frequencies of elevated plasma FGF-23, LVH, and cardiac valve calcification, which are surrogates of cardiovascular events.

Impact of Impaired Kidney Function on Outcomes of Nigerians with COVID-9 Infection: Report of Two Cases from the University College Hospital, Ibadan.

COVID-19 infection predominantly affects the respiratory system; however, other systems and organs are also affected. The kidneys are among the organs commonly affected by SARS-CoV-2 and this has been reported to be a predictor of increased severity, need for intensive care (ICU), admission, and death. We presented two cases of COVID-19 that were associated with co-morbidities that include diabetes mellitus, systemic hypertension and impaired kidney function. The relationship of the multiple co-morbidities particularly the impaired kidney function with the outcomes of COVID-19 infection and the challenges of offering dialysis for patients with COVID-19 infection with kidney failure were discussed. The two cases presented also highlighted the state of preparedness for the management of COVID-19 and its various complications and co-morbidities, particularly kidney failure in a tertiary hospital in Nigeria at onset of the COVID-19 outbreak.

L'infection au COVID-19 affecte principalement les voies respiratoires système; cependant, d'autres systèmes et organes sont également affectés. Les reins font partie des organes les plus fréquemment touchés par SRAS-CoV-2 et cela a été rapporté comme étant un prédicteur de gravité accrue, besoin de soins intensifs (USI),l'admission, et la mort. Nous avons présenté deux cas de COVID-19 associés avec des comorbidités qui incluent le diabète sucré, systémique hypertension et le rénale affaibli. La relation des comorbidités multiples en particulier le rénale affaibli fonction des résultats de l'infection au COVID-19 et de la défis de l'offre de dialyse aux patients atteints de COVID-19 une infection avec insuffisance rénale a été discutée. Les deux cas présentés ont également mis en évidence l'état de préparation à la gestion du COVID-19 et de ses divers complications et comorbidités, en particulier insuffisance rénale dans un hôpital tertiaire au Nigéria au début du COVID-19 épidémie. Mots clés: lésion rénale aiguë, maladie rénale chronique, comorbidité, COVID-19.

Adherence to Medication among Patients with Chronic Hepatitis B Infection Attending a Tertiary Hospital in South Western Nigeria.

INTRODUCTION: Chronic hepatitis B (CHB) is an international public health problem. Treatment reduces its morbidity, mortality and infectivity. The aim of this study was to determine adherence among CHB infected patients on Tenofovir and the reasons for non-adherence. METHODOLOGY: It was a cross-sectional study of patients on tenofovir for at least 6 months. Information was obtained on bio- data, adherence to tenofovir, duration and reasons for nonadherence using an interviewer administered questionnaire. Non- adherence was defined as patient reporting missing medication at all. Chi square or Fisher exact test and Student's t-test were used to determine associations. P value less than 0.05 was considered significant. RESULTS: A total of 150 participants comprising of 76 (50.7%) females and 74 (49.3%) males with mean age of 39.2 ± 11.4 years, participated in the study. Non adherence rate was 65%. There was no significant association between non-adherence and tribe (p=0.7), level of education (p=0.8), religion (p=0.2), sex (p=0.9), clinical state (p=0.8), treatment experience (p=0.8) and months on Tenofovir (0.1) while a significant association existed with age (0.01), the presence of comorbidity (p=0.02) and taking another medication apart from tenfovir (0.00). The reasons for non-adherence included out of station 22 (14.7%), financial constraint 19(12.5%), unavailability of the drug 19 (12.5%), forgetfulness 15 (10%), perceived side effects 12 (8%), undetectable serum DNA quantification 11 (7.3%), ignorance of continuous use of Tenofovir 10 (6.7%), and pregnancy 9 (6%) among others. CONCLUSION: Adherence to Tenofovir is poor among CHB patients attending University College Hospital, Ibadan.

INTRODUCTION: L'hépatite B chronique (HCB) est un problème de santé publique international. Le traitement réduit sa morbidité, sa mortalité et son infectiosité. Le but de cette étude était de déterminer l'adhésion chez les patients infectés par CHB sur Tenofovir et les raisons de la non-adhésion. MÉTHODOLOGIE: Il s'agissait d'une étude transversale de patients sous ténofovir depuis au moins 6 mois. Des informations ont été obtenues sur les données biologiques, l'adhésion au ténofovir, la durée et les raisons de la nonadhésion à l'aide d'un questionnaire administré par un intervieweur. La non-observance a été définie comme un patient déclarant qu'il n'y avait aucun médicament manquant. Le test du chi carré ou exact de Fisher et le test t de Student ont été utilisés pour déterminer les associations. Une valeur p inférieure à 0,05 a été considérée comme significative. RÉSULTATS: Un total de 150 participants comprenant 76 (50,7%) femmes et 74 (49,3%) hommes avec un âge moyen de 39,2 ± 11,4 ans, ont participé à l'étude. Le taux de non-adhésion était de 65 %. Il n'y avait pas d'association significative entre la non-adhésion et la tribu (p = 0,7), le niveau d'éducation (p = 0,8), la religion (p = 0,2), le sexe (p = 0,9), l'état clinique (p = 0,8), l'expérience du traitement (p=0,8) et des mois sous Ténofovir (0,1) alors qu'il existait une association significative avec l'âge (0,01), la présence de comorbidité (p=0,02) et la prise d'un autre médicament en dehors du tenfovir (0,00). Les motifs de non-observance inclus hors station 22 (14,7%), contrainte financière 19 (12,5%), indisponibilité du médicament 19 (12,5%), oubli 15 (10%), effets secondaires perçus 12 (8%), quantification de l'ADN sérique indétectable 11 (7,3 %), méconnaissance de l'utilisation continue du ténofovir 10 (6,7%) et grossesse 9 (6 %) entre autres. CONCLUSION: L'adhésion au ténofovir est faible chez les patients infectés par CHB fréquentant l'University College Hospital d'Ibadan. MOTS-CLÉS: Infection chronique par l'hépatite B, ténofovir, observance, Nigéria.

Exposure to Agrochemicals and Markers of Kidney Damage among Farmers in Rural Communities in Southwestern Nigeria.

BACKGROUND: Chronic kidney disease of unknown origin (CKDu) is assuming an epidemic proportion, especially in farming communities worldwide. We explored the relationship between CKD markers and agrochemical exposure among rural farmers in South Western Nigeria. METHODS: We studied selected farming communities in Southwestern Nigeria where the use of agrochemicals was widespread. A pre-tested questionnaire was administered to participants. Anthropometric data, information on use of agro-chemicals; urine and blood samples were obtained. Informed consent was obtained from participants. The study was approved by the Institutional Ethics committee and complied with 1975 Helsinki declaration, as revised in 2000. RESULTS: A total of 438 farmers made up of 202 males (46.1%) and 236 females (53.9%) were studied. The mean microalbuminuria was 30.2 ±11.7 mg/dl. Majority of the farmers had CKD stage 2(42.0%) and CKD stage 3 (37.7%). The type of farming engaged in had a positive, but not significant, correlation with eGFR (r=0.012, p=0.832). There was positive correlation between type of farming and GFR category (r=0.24, p=0.000). Frequency of use of hexachlorocyclohexane had a positive and significant correlation with eGFR (r=0.111, p=0.045). Annual crop farming had a correlation with UACR (r=0.149, p=0.024). CONCLUSION: Annual crop farming had a positive correlation with UACR, eGFR and GFR category. The prolonged use of agrochemicals on an annual basis can cause kidney damage.

Hepatitis B virus infection: implications in chronic kidney disease, dialysis and transplantation.

Hepatitis B virus (HBV) infection occurs worldwide but is most prevalent in Southeast Asia and sub-Saharan Africa with reported prevalence rates varying from 3 - 26 %. The higher prevalence of infection has been reported in patients with HBV and human immunodeficiency virus (HIV) co-infection. Hepatitis B virus not only affects the liver but has also been implicated in the pathogenesis of membranous, membranoproliferative and mesangial proliferative glomerulonephritides. Though controlling the spread of HBV infection in renal dialysis units has been one of the major triumphs in the management of end-stage renal disease, transmission of HBV can still occur through contamination of equipments and environmental surfaces and the use of multiple dose vials of drugs. Some reports have indicated that prior HBV infections have negative impact on graft and host survival following transplantation. Interferon can be used in the treatment of HBV-associated glomerulonephritides (HBV- GN) but is contraindicated in transplantation because of its immuno-modulatory effects. Despite the fact that patients with chronic kidney disease (CKD) have suboptimal response to HBV immunization, immunization is still beneficial to these patients. However, reports indicate that most patients with CKD were either not immunized or were given suboptimal doses. Control of HBV in the population by immunization can lead to a reduction in the prevalence of HBV- GN. In addition, immunization of patients with CKD will help in controlling HBV infection in dialysis settings and can lead to improved graft and host survival following transplantation.

Effects of supplemental methionine and lysine on the nutritional value of housefly larvae meal (Musca domestica) fed to rats.

The performance and blood composition of rats fed housefly larvae meal supplemented with, or without, methionine and lysine, or fed at high concentration were investigated. Rats fed supplemental methionine alone achieved highest body weight gain (P < 0.05). Dietary supplementation of both methionine and lysine or high dietary concentration of larvae meal depressed (P < 0.05) rat feed intake. The blood composition of rats was superior (P < 0.05) on methionine-supplemented larvae meal. Additional amino acids from larvae elicited higher (P < 0.05) serum proteins, cholesterol and triglyceride; however, other blood biochemical profiles were lower (P < 0.05) than in the unsupplemented group. In conclusion, housefly larvae meal seemed deficient in methionine and it benefited the rat tremendously to supplement with this amino acid: however, additional lysine and high dietary inclusion of larvae meal as sole protein source appeared nutritionally inconsequential.

Diabetic retinopathy in Nigerians: relation to duration of diabetes, type of treatment and degree of control.

The results of a prospective study of the prevalence of diabetic retinopathy among Nigerian diabetics attending a Nigerian Teaching Hospital over a one and a half-year period are presented. Diabetics with mature cataracts whose fundi could not be visualised were excluded from the study. 15.1% of the 377 diabetic patients included in the study group had changes consistent with diabetic retinopathy. The prevalence was found to increase with increasing duration of disease, being 12.7%, 16.8% and 20.0% in patients with duration less than 5 years, between 5 and 10 years and greater than 10 years respectively. A considerably higher prevalence was also found in the insulin treated diabetics compared to the non insulin treated group (P less than 0.05). The degree of glycaemic control appeared to be poorer in the diabetics with retinopathy compared to those without, even though the differences between the mean fasting plasma glucose concentrations between the two groups did not reach statistical significance. Proteinuria was found to be significantly commoner in diabetics with retinopathy (P less than 0.025). It was concluded that diabetic retinopathy is on the increase among Nigerians and that efforts should be directed at evolving preventive measures and early identification of high risk patients.

Dyslipoproteinaemia in Nigerians with the nephrotic syndrome (an increased risk for ischaemic heart disease?).

Plasma lipids and lipoproteins were measured in 24 Nigerians with the nephrotic syndrome and 29 healthy subjects. None of the patients had been commenced on treatment. Plasma total cholesterol, low density lipoprotein (LDL) cholesterol group (P less than 0.005). By contrast, the HDL-cholesterol to total cholesterol ratio as well as the HDL-cholesterol concentrations were found to be significantly lowered in the nephrotics than the controls (P less than 0.005). A strong correlation was observed between plasma total cholesterol and LDL cholesterol values but not between the other biochemical parameters (r = 0.98.P less than 0.01). These results, though not definitive, suggest that Nigerians with the nephrotic syndrome may represent a risk group for the development of ischaemic heart disease. Long term prospective studies in such patients are desirable to define the effect of these lipid and lipoprotein abnormalities.

Plasma lipids and lipoprotein-cholesterol distribution in nephrotic syndrome patients during short term high dose steroid treatment.

Plasma lipids and lipoprotein-cholesterol profiles were studies in 11 consecutive patients (eight females and three males) with the nephrotic syndrome (NS) during a short term treatment with high dose prednisolone. A significant fall from the high mean pre-treatment levels of total cholesterol and LDL-cholesterol was demonstrated at four, eight and 12 weeks of treatment (p < 0.005) while the fall in the mean triglyceride level only became significant at eight weeks (p < 0.01). The mean HDL-cholesterol level did not change significantly throughout, although there was a significant rise in the mean HDL-cholesterol total cholesterol ratio at four weeks (p = 0.01) and at both eight and 12 weeks (p < 0.005). The study has demonstrated a significant improvement in the lipids and lipoprotein-cholesterol profile of patients with the nephrotic syndrome during a shortterm high dose steroid treatment.

Traditional herbal preparations and acute renal failure in south west Nigeria.

Fifty-three cases (36 men; mean age 30.2 +/- 9.5 years) of acute renal failure (ARF) in which traditional herbal ARF could have been prevented by proper education and awareness.

Temporal variations and meteorological factors in hospital admissions of chronic renal failure in south west Nigeria.

A study of hospital admissions of chronic renal failure cases during the 5 years 1987-1991 in a major referral centre in South West African showed a significant departure from a uniform monthly distribution (P < 0.01). Admission rates were high in February-March and June-August showing 2 peaks. There was no absolute seasonal effect. Mean monthly admissions did not differ between the dry (9.7 +/- 0.6 SE) and wet (9.8 +/- 0.6 SE) seasons. Possible reasons for the variations are discussed. For health planning, high admission rates can be anticipated and resources mobilized to meet the increased demands at these periods when they occur.

Oral slow-release nifedipine in the rapid treatment of severe hypertension in Nigerians.

The effect of the oral slow-release formulation of Nifedipine in rapidly lowering blood pressure was studied in 20 severely hypertensive Nigerians (8 males, 12 females). A significant fall (p < 0.05) in mean systolic, diatolic, and mean arterial pressure was obtained 30 minutes after administration of Nifedipine. The fall in all three parameters of blood pressure remained sustained and significant (p < 0.05) 6 hours after a single dose administration. Side effects were minimal and limited to headaches in 20% of patients and palpitations in 10%. All patients showed a sustained control of blood pressure over a three month follow up period on slow release Nifedipine. Addition of methyldopa resulted in improved blood pressure control in one patient with chronic renal failure. It was concluded that oral slow release Nifedipine is a drug of choice in the rapid and sustained control of blood pressure in severely hypertensive patients especially in a setting where critical intensive monitoring facilities are limited.

Rapidly progressive glomerulonephritis in adult Nigerians: a report of 4 cases.

The clinicopathological features of rapidly progressive glomerulonephritis (RPGN) were studied in 4 young adult Nigerians who presented with acute GN. There was a predilection for males with a male to female ratio of 3:1. Hypertension. nephrotic-range albuminuria, haematuria granular and cellular urinary casts, and a rapid progression to severe renal failure or death were the findings in all four patients. Renal biopsy revealed histological features compatible with findings in RPGN in all the patients, including the presence of crescents and epithelial cellular proliferation. The study shows that the early development of hypertension and deterioration of renal function in patients with features of acute glomerulonephritis should arouse suspicion of a rapidly progressive GN whose course could be altered by appropriate therapeutic measures, some of which are highlighted.

The viability of hemodialysis as a treatment option for renal failure in a developing economy.

The viability of hemodialysis as a treatment option for renal failure in a developing economy like Nigeria was assessed in this study to determine whether committing huge capital in establishing such centres all over the country is justifiable. A total of 158 patients dialysed at the Owena Dialysis Centre over a period of 3 years (January 1991-December 1993) were studied. There were 112 males and 46 females, ranging in age between 15 and 81 years. 17 of patients had acute renal failure (ARF), while 141 had chronic renal failure (CRF). During the period of study, a total of 1,452 dialysis sessions were carried out ranging between 8 and 77 sessions per month (mean 40 sessions/month). Dialysis sessions ranged between 1 and 101 sessions per patient. A progressive increase in the number of dialysis sessions between 1991 and 1993 was noted, and new patients who required dialysis were being seen at a rate of between 1 and 10 per month. 112 patients (70.8%) could afford dialysis for less than one month while only 3 (1.9%) could afford to continue dialysis for over 12 months. All cases of ARF (except one) recovered normal renal function after dialysis, while 116 CRF patients were discharged home after less than 10 sessions of dialysis due to financial constraints. The study shows that hemodialysis is a relevant treatment option for renal failure even in a developing economy like Nigeria subject to adequate health planning. The major limitations to its profitable utilization under the present health care dispensations are highlighted.

Glomerular function in sickle cell disease patients during crisis.

An 8 month prospective study was carried out in 20 adult sickle cell disease (SCD) patients 16 sickle cell anaemia (Hbss) and 4 sickle cell Hbc disease (Hbsc); who had vaso-occlusive crises within the study period to determine the extent of the effect of sickle cell crisis on glomerular function in SCD patients during crisis. The male: female ratio was 1:57 and their mean age was 21.1 +/- 7.9 years. Creatinine clearance (CCr), as an index of glomerular function, was determined at the pre-crisis, crisis, 2 and 4 weeks post-crisis and at the end of the study period. The mean values of their CCr dropped from 113.37 +/- 33.80mls/min at pre-crisis stage to 96.39 +/- 30.13mls/min during crisis (p < 0.001) indicating glomerular dysfunction. It improved significantly to 107.75 +/- 30.20mls/min at 4 weeks post-crisis (p < 0.001). There was no significant differences in the mean values of CCr at the end of the study (116.20 +/- 31.43mls/min) compared to the pre-crisis stage (p > 0.05). It is concluded that glomerular dysfunction in SCD patients during crisis is potentially reversible.

Short-term haemodialysis in pregnant patients with acute renal failure: a report of two cases.

Haemodialysis in pregnancy is not common although, successful dialysis in pregnancy have been reported. It has also been found to improve survival of both mother and child especially, in patients with chronic renal failure, with pre-term labor being a common occurrence. Out of the 2,995 patients that were dialyzed at the University College Hospital, Ibadan in the last 10 years, only 2 of the patients were pregnant and both of them had acute renal failure. We present here the two cases, which represents our experience at the University College Hospital, Ibadan, Nigeria.

Prevalence of hepatitis B and C viruses in pre-dialysis patients with chronic renal failure.

CRF affects people in their prime of life; they are often the Nation's workforces thereby leading to severe economic and social problems. Many patients with CRF who need dialysis, present for the first time in end stage renal failure. The commonest causes of CRF in Nigeria and other tropical countries have been reported to be hypertensive nephrosclerosis and chronic glomerulonephritis. Various studies in and outside Nigeria have documented an increased seroprevalence of anti-HCV and HBsAg in chronic renal failure patients on maintenance haemodialysis. Any association established between these viruses and CRF would suggest that the prevention and/or treatment of these viruses may likely lead to a reduction in the prevalence of CRF. Thus, forty-five (45) consecutive subjects with CRF and (45) age- and sex-matched control subjects who satisfied the eligibility criteria for the study were enrolled. Marker of HBV (HBsAg) was assayed using HUMAN Enzyme linked Immunosorbent Assay (ELISA) Test. Marker of HCV (anti-HCV) was determined using the HUMAN ELISA Test. The mean age of the subjects was 37 +/- 14 years (range 17 to 62 years) while the mean age of the control subjects was 38 +/- 14 years (range of 18 to 66 years). There were no statistically significant differences in the prevalence of HBsAg and anti-HCV in the CRF patients and controls P=0.74 and P=1.0 respectively. Although, the sample was small anti-HCV seropositive CRF patients were significantly younger than anti-HCV seropositive controls P<0.027. In conclusion, this study has shown that there were no significant differences in the prevalences of HBsAg and anti-HCV in the CRF patients and controls. A larger scale study may be more desirable in defining the role of these viruses in patients with chronic renal failure.

The influence of cuprophan and polysulfone membranes on dialyzer reusability and intradialytic complications.

The influence of cuprophan and polysulfone membranes on dialyzer reuse and intradialytic complications was examined in patients receiving chronic haemodialysis. Mean uses were 2.7 +/- 1.3 S.D. and 2.2 +/- 1.0 S.D. for cuprophan and polysulfone respectively (P < 0.001). 20.8% and 35.5% of cuprophan and polysulfone dialyzers respectively did not survive first use (X(2) = 17.4, P < 0.001), being unsuitable for further use. The most common number of uses obtainable was 3 for each type. 2.6% of cuprophan but none of the polysulfone dialyzers were usable over 5 times. Hypotension occurred in 12% and 29% of dialyses with cuprophan and polysulfone dialyzers (P < 0.001), and the difference persisted, but the frequency in each membrane group decreased, with reuse (P < 0.001). First use reactions occurred in 9.5% and 3.9% of dialyses with cuprophan and polysulfone respectively (P < 0.001), and the difference was not affected by reuse (P > 0.1), but the frequency decreased in each group (P < 0.001). Clotting of the dialyzer occurred in 2.2% and 1.9% of cases respectively (P > 0.5), diminished with reuse of cuprophan (P < 0.001), but not with polysulfone (P > 0.5). Cuprophan membrane was more reuseable and was associated with fewer episodes of hypotension, while polysulfone was associated with fewer episodes of first use reactions. Rational choice of membranes can be made during haemodialysis.