Clinical aspects and causes of rickets in a Kenyan population.

Twenty nine patients with rickets were studied in a one year period. The majority of patients (17/29) were below 2 years of age. Most of them had nutritional rickets resulting from a combination of factors. Premature delivery, nonexposure to sunlight, nutritional marasmus and inappropriate dietary intake. Some had familial hypophosphataemic rickets, others had renal tubular acidosis while the rest had rickets with a familial tendency. Both the previous hospital records and the present study indicate that rickets is a persistent problem in children in the community and should be suspected in children who present with features of failure to thrive, among other conditions.

Outcome of pregnancy in nephrotic syndrome: a report on five cases.

In a 6 year period (1984-1989) we have had the opportunity to take care of five patients who had nephrotic syndrome and became pregnant. Four of them had mesangial proliferative glomerulonephritis while one had focal segmental glomerulosclerosis. Four of the pregnancies went to term while one was terminated at 34 weeks gestation because of deteriorating renal function in the mother. All the pregnancies ended in delivery of normal babies. However, two patients have since died of end stage renal disease, while the remaining three continue to be nephrotic with reduced levels of renal function following the deliveries.

Ascites in patients undergoing intermittent haemodialysis at Kenyatta National Hospital.

In a two-year-period (August 1984 to August 1986), 77 patients were admitted into the maintenance haemodialysis programme at Kenyatta National Hospital. 24 (31.5%) of these had ascites during haemodialysis. Nine (37.5%) of the patients who had ascites had prior peritoneal dialysis, while 15 (62.5%) had congestive cardiac failure at the time of development of the ascites. In 21 (87.5%), the ascites responded to therapy with diuretics, salt and fluid restriction, antibiotics when indicated and to ultrafiltration during dialysis. In 3 (12.5%) of the patients, the ascites developed in the absence of any predisposing cause. The ascites progressively increased in amount and was associated with marked wasting. These patients were considered to have refractory ascites of haemodialysis.

Conversion from cyclosporin to azathioprine in renal allograft recipients.

Renal function in five patients who were on a combination of Cyclosporin A (CyA) and Prednisone for 2-6 years following renal transplantation, were evaluated, in order to consider change from CyA-prednisone combination to conventional therapy. (Azathioprine-prednisone combination). This was necessitated by CyA nephrotoxicity, its high cost and unreliable monitoring. The maintenance dose of CyA ranged between 200 and 400 mg per day. The BUN levels during CyA treatment ranged from 6 to 15 mmol/l (normal 3.7-6.7 mmol/l), and plasma creatinine from 200 to 300 Umol/l (normal 67-107 Umol/l). The serum electrolytes were normal. The urine outputs were normal. Rejections were treated by pulses of one gram of methyl-prednisolone daily for 3 days. Maintenance prednisolone ranged from 10-15 mg per day. After tapering off the CyA and eventually stopping it, Azathioprine 100-150 mg daily with prednisolone 10-15 mg per day were instituted. There were significant drops in creatinine and BUN levels after the change over, with general well being and good urinary outputs. The patients refused consent for renal biopsy to prove CyA histologic toxicity.

A community based longitudinal study of viral hepatitis B in a rural community.

Community based longitudinal epidemiological study of hepatitis B virus (HBV) was done in Maragua between June 1986 and November 1987. Hepatitis B surface antigen (HBsAg) carrier rate in the community was 3%. The high risk groups of HBV infection in the community were members of HBV carrier families and babies born to highly infectious mothers. Horizontal transmission of HBV at school did not seem to be very important.

Problems with a renal replacement programme in a developing country.

Since August 1984 patients with end-stage renal disease in Kenya have been started on haemodialysis with a view to renal transplantation. In a two year period (August 1984-August 1986) 77 patients mean age 29.6 years (49 males), have been dialysed. The mean duration on dialysis prior to death or transplantation was 2.9 months (range 1 day to 11 months). Fifty patients (65%) died while on dialysis, including 2 who had had unsuccessful transplantation. Fourteen patients were still on dialysis, 11 had discharged themselves to peripheral hospitals for conservative management, and 2 had had successful renal transplantation. The possible causes of this abysmal experience include admission of critically ill patients, shortage of trained staff, over-dependence on arteriovenous shunts for vascular access, lack of centralization of patient management, recurrent shortage of essential equipment and reagents and a slow pace of transplantation.