Is renal medullary carcinoma the seventh nephropathy in sickle cell disease? A multi-center Nigerian survey.

INTRODUCTION: Previous studies had enlisted renal medullary carcinoma (RMC) as the seventh nephropathy in sickle cell disease (SCD). Clinical experience has contradicted this claim and this study is targeted at refuting or supporting this assumption. OBJECTIVE: To estimate the prevalence of RMC and describe other renal complications in SCD. MATERIALS AND METHODS: 14 physicians (haematologists and urologists) in 11 tertiary institutions across the country were collated from patients' case notes and hospital SCD registers. RESULTS: Of the 3,596 registered sickle patients, 2 (0.056%) had been diagnosed with RMC over a ten year period, thereby giving an estimated prevalence rate of 5.6 per 100,000. The most common renal complication reported by the attending physicians was chronic kidney disease (CKD). The frequency of routine renal screening for SCD patients varied widely between centres - most were done at diagnosis, annually or bi-annually. CONCLUSION: The ten year prevalence of RMC in Nigerian SCD patients was determined to be 5.6 (estimated incidence of 0.56). RMC is not more common in SCD patients and therefore cannot be regarded as a "Seventh Sickle nephropathy". Most of the managing physicians reported that the commonest nephropathy observed in their SCD patients was chronic kidney disease.

Comparison of absolute neutrophil to CD4 lymphocyte values as a marker of immunosuppression in cancer patients on cytotoxic chemotherapy.

BACKGROUND: The absolute neutrophil count (ANC) is currently used to assess immune status of patients on cytotoxic therapy. The CD4 lymphocytes have also been shown to be of importance in protection against opportunistic infections. In people of African descent a low baseline ANC has been recorded and the currently accepted neutropaenic threshold may not be appropriate. OBJECTIVE: This study was aimed at comparing the change in ANC to CD4 lymphocyte count in adult cancer patients following chemotherapy. PATIENTS AND METHODS: Eighty chemotherapy-naive patients with various malignancies had their ANC and CD4 lymphocyte counts done at days 0 and 12 of the first cycle of various chemotherapeutic regimens. The paired sample t-test was done to assess the significance between these values. Socio-demographic data was obtained using questionnaires. RESULTS: ANC and CD4 pre-chemotherapy differed significantly from their post-chemotherapy values (p=0.001) for both parameters). The CD4 count showed significant reduction in patients with Non-Hodgkin's lymphoma (p=0.043), colorectal carcinoma (p=0.037) and other malignancies (p=0.030), while the ANC did not. Patients who had received COPP for Hodgkin's lymphoma also had significant CD4 depletion (p=0.037). CONCLUSION: The CD4 lymphocyte count may be a more suitable parameter than ANC, for monitoring immuno-depletion in cancer patients on cytotoxic chemotherapy. Further studies are required to validate these findings, especially in the Negroid population.

Stroke prevalence amongst sickle cell disease patients in Nigeria: a multi-centre study.

BACKGROUND: Stroke is a life-changing, debilitating complication of sickle cell disease (SCD). Previous studies had recorded high stroke prevalence amongst this group of patients. Nigeria has a large population of people affected by this condition and this study aims to assess the stroke prevalence in this large population. METHODOLOGY: Stroke prevalence data from 14 physicians working in 11 tertiary health centres across the country was collated by doctors using the sickle cell registers and patient case notes. This data was then collated and used to obtain the overall stroke prevalence in adult and children. RESULTS: The stroke prevalence in sickle cell disease patients in Nigeria was observed to be 12.4 per 1000 patients. Prevalence in the adult patients was 17.7 per 1000 patients and 7.4 per 1000 patients in children. Twenty three percent of the affected patients had more than stroke episode. CONCLUSION: The stroke prevalence in Nigeria is lower than previously recorded rates and further studies will be required to investigate other factors which may play a role.