Histopathologic Characteristics of Childhood Nephrotic Syndrome in a Tertiary Health Facility in Nigeria.

BACKGROUND: Globally, the predominant histopathologic characteristic of childhood nephrotic syndrome has been minimal change nephropathy (MCN). However, some studies from Africa and Nigeria have revealed otherwise. It is imperative that this pattern is re-examined from time to time given changing disease and environmental dynamics from place to place. OBJECTIVE: This study aimed to determine the histopathological characteristics of childhood nephrotic syndrome in Ilorin, northcentral Nigeria. METHODS: A prospective study of all new patients aged 2-14 years who presented with clinical features of nephrotic syndrome between January 2010 to December 2023 at the University of Ilorin Teaching Hospital, Ilorin was carried out. All eligible patients underwent renal biopsy. RESULTS: A total of 47 children with nephrotic syndrome were biopsied comprising of 21 males and 26 females making an M: F ratio of 1:1.2. The age range of subjects was 2-14 years with a mean of 7.8 ±3.6 years. The most common histological type of nephrotic syndrome was minimal change nephrotic syndrome (MCNS) which occurred in 35(74.5%) children followed by membranoproliferative glomerulonephritis (MPGN) in 5(10.6%) and focal segmental glomerulosclerosis (FSGS) in 2(4.3%). Of the 35 MCNS patients, 31(88.6%) were steroid sensitive while 4(11.4%) were steroid resistant. CONCLUSION: The predominant histopathological characteristic of childhood nephrotic syndrome was minimal change nephrotic syndrome, which was mostly steroid-sensitive.

CONTEXTE: Au niveau mondial, la principale caractéristique histopathologique du syndrome néphrotique de l'enfant a été la néphropathie à lésions minimales (NLM). Cependant, certaines études en Afrique et au Nigeria ont montré des résultats différents. Il est essentiel de réévaluer ce modèle régulièrement en raison de l'évolution des maladies et de l'environnement d'un endroit à l'autre. OBJECTIF: Cette étude visait à déterminer les caractéristiques histopathologiques du syndrome néphrotique de l'enfant à Ilorin, dans le nord-centre du Nigeria. MÉTHODES: Une étude prospective de tous les nouveaux patients âgés de 2 à 14 ans présentant des signes cliniques de syndrome néphrotique entre janvier 2010 et décembre 2023 à l'hôpital universitaire d'Ilorin, à Ilorin, a été réalisée. Tous les patients éligibles ont subi une biopsie rénale. RÉSULTATS: Au total, 47 enfants atteints du syndrome néphrotique ont été biopsiés, dont 21 garçons et 26 filles, soit un ratio H/F de 1/1,2. La tranche d'âge des sujets était de 2 à 14 ans avec une moyenne de 7,8 ± 3,6 ans. Le type histologique le plus fréquent du syndrome néphrotique était la néphropathie à lésions minimales (NLM), obser vée chez 35 (74,5 %) enfants, suivie de la glomérulonéphrite membranoproliférative (GMPN) chez 5 (10,6 %) et du sclérose segmentaire et focale (SSF) chez 2 (4,3 %). Parmi les 35 patients atteints de NLM, 31 (88,6 %) étaient cortico-sensibles et 4 (11,4 %) cortico-résistants. CONCLUSION: La principale caractéristique histopathologique du syndrome néphrotique de l'enfant était la néphropathie à lésions minimales, qui était principalement cortico-sensible. MOTS-CLÉS: Syndrome néphrotique, Enfant, Histopathologie, Nigeria.

Effect of sickle cell crises on glomerular filtration rate in children with sickle cell disease in Ilorin, Nigeria.

Children with sickle cell disease (SCD) are plagued with incessant crises. There are few studies on the effect of sickle cell crises on renal function as determined by the glomerular filtration rate (GFR). This study was done to assess the effect of sickle cell crises on GFR during crises and after recovery into the steady state. GFR was assessed using the formula derived by Schwartz et al., for consecutive SCD patients aged between 3 and 18 years who came in crises and after recovery into the steady state. A total of 81 patients with a mean age of 9.95 ± 4.15 years in 81 episodes of crises met the inclusion criteria. Majority of the children (47) had vasooclusive crises, 19 had hyperhaemolytic crises, and 15 had features of both vasooclusive and hyperhaemolytic crises. The means value of GFR in ml/min/1.73 m(2) rose from 81.09 ± 22.92 to 116.24 ± 22.11 subsequent to recovery from vasooclusive crises into the steady state, from 77.45 ± 18.48 to 99.54 ± 17.71 following recovery from hyperhaemolytic crises into the steady state and from 90.95 ± 17.53 to 114.01 ± 22.44 following recovery from crises with features of both vasooclusive and hyperhaemolytic crises with corresponding significant P values of 0.000, 0.001, and 0.004 respectively. The reduced GFR observed during vasooclusive and hyperhaemolytic crises improved significantly following recovery into the steady state.

Sickle cell Nephropathy in children seen in an African Hospital - Case Report.

AIMS AND OBJECTIVES: To determine and report the occurrence of overt renal presentations in children with sickle cell disease seen over the last 14 years (1995-2009) at the Emergency Paediatric Unit and Paediatric Ward and followed up at the Paediatric Nephrology clinic of University of Ilorin Teaching Hospital, Ilorin (UITH). PATIENTS AND METHODS: The five cases with overt renal presentations seen during the period were reported and analyzed for age, sex, and renal manifestations. RESULTS: The age range of the children was 9-15years with a mean of 11years. Four of the five patients were females, with one male. Three of the four females presented with features suggestive of nephrotic syndrome (NS) while the other one had gross haematuria which resolved within 24 hours. The only male had enuresis. The NS in one of the patients progressed to end stage renal disease requiring renal replacement therapy. CONCLUSION: Children with sickle cell disease should be screened for renal complications especially from the late first decade of life. This will help in the early detection of renal disorder that could lead to chronic kidney disease. It is also suspected that the severe forms of SCN such as NS may have a predilection for the female gender. A more extensive study is needed to test the veracity of this observation.

Bladder stone in a three-year-old Nigerian child with posterior urethral valve: a case report.

BACKGROUND: Stone in the bladder is an uncommon presentation in the tropics, especially in children. Its rarity makes the index of suspicion to be low. Patients presenting with it may be mistaken for urinary tract infection (UTI) because of the presence of frequency and dysuria. OBJECTIVE: To present a rare cause of urinary bladder stone in a child in the tropics. METHODS: The patient, a three-year-old boy, presented with recurrent episodes of dysuria and stragury for a duration of about one year. Work up included clinical evaluation and laboratory assessments, results of which informed surgical intervention. RESULTS: The child had been treated repeatedly for urinary tract infection. He was acutely ill with suprapubic tenderness dysuria and poor urinary stream. He was hypertensive. Micturating cystourethrography showed posterior urethral valves and a bladder stone. He had vesicolithotomy and valvotomy with improvement of his blood pressure. CONCLUSION: The coexistence of bladder stone with PUV coupled with delayed diagnosis may be a predisposing factor to hypertension in children. Conventional surgical treatment gives good results.

Urinary tract infections in children with primary nephrotic syndrome and acute glomerulonephritis.

BACKGROUND: The occurrence of urinary tract infection (UTI) in children with nephrotic syndrome (NS) has been widely reported by various workers, but not much has been documented about its occurrence among children with acute glomerulonephritis (AGN). Hence, the level of susceptibility to UTI by both diseases has not been compared. OBJECTIVE: To determine and compare the prevalence of UTI in children newly diagnosed of AGN or NS. METHODS: Urinary microscopy, culture and sensitivity of all children admitted with a diagnosis of NS and AGN between 1996-2004 were reviewed. Children with NS who had a relapse or were commenced on steroids, cytotoxic agents or antibiotics before admission were excluded from the study. RESULTS: A total of 35 and 32 children diagnosed of AGN and NS respectively met the study criteria. Urinary tract infection occurred in three (9%) children with AGN and one (3%) of the children with NS. The organisms isolated among the AGN patients included Coliforms, Klebsiella, and Staphylococcus aureus while Coliform was isolated in the only NS patient with UTI. CONCLUSION: There is a low prevalence of UTI in children newly diagnosed of AGN and NS.

Poisoning due to yam flour consumption in five families in Ilorin, Central Nigeria.

BACKGROUND: Food poisoning is known to occur sporadically from time to time due to poor hygienic preparation. Its occurrence rarely assumes epidemic proportion. OBJECTIVE: To report the ccurrence of food poisoning due to yam flour consumption among five families and to create public awareness about the condition. CASE REPORT: Food poisoning due to yam flour consumption which occurred almost in quick succession between February and July 2005 among five family clusters in Ilorin is reported. They presented variedly with diarrhoea, vomiting, abdominal pain, convulsion and loss of consciousness. They all recovered within 48 hours of admission. Even though we could not carry out toxicological tests, yam flour consumption was highly implicated as the cause. Investigations indicated that the use of certain lethal preservatives for the processing of the yam flour might be responsible. CONCLUSION: Poisoning from consumption of yam flour should be a differential diagnosis of acute seizure disorder or the occurrence of vomiting, diarrhoea and abdominal pain in the tropics. We recommend education on proper processing of all food products in view of the public health implication of doing otherwise.

Knowledge, attitude and perception of adults on childhood hypertension in a rural community in Nigeria.

BACKGROUND: Childhood hypertension is less common and not readily recognised compared to adult hypertension. It is being missed because of lack of routine blood pressure measurements in some health facilities in the developing countries. This setback is likely to affect the knowledge, attitude and perception of parents and caregivers to the disease. OBJECTIVE: To assess the knowledge, attitude and perception of childhood hypertension by adult respondents in a rural community in Nigeria. METHOD: The study was carried out with the aid of pre-tested questionnaires, which sought information on wide ranging issues bothering on knowledge, attitude and perception of childhood hypertension. RESULTS: Fifty-four 54/62 (89%) knew that hypertension implied high blood pressure. Fifty-eight 58/61(95%) also indicated that hypertension is detected by measuring the blood pressure. However 37/60 (62%) respondents did not think that childhood hypertension exist, while 53/59 (90%) respondents were not aware of any child diagnosed with hypertension. All our 62 respondents claimed to have seen 9 children with hypertension compared to 81 adults some of whom were related to them. CONCLUSIONS: We conclude that there is still a low awareness about the existence of childhood hypertension by the rural populace. While this problem is not a priority health problem in the community, an increased awareness of it is crucial the successful management of any child that develops it. Periodic community survey for childhood hypertension and mandatory routine blood pressure measurement in all children presenting for consultation is suggested.

Bacterial pathogens and outcome determinants of childhood pyogenic meningitis in Ilorin, Nigeria.

Empirical antimicrobial therapy remainsjustifiable in childhood pyogenic meningitis (CPM), but the continuing efficacy in a particular setting requires periodic microbiological surveillance. It was this need that informed the present five-year retrospective study of consecutive admissions for CPM at the Emergency Paediatric Unit (EPU) of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Of the 71 cerebro-spinal fluid [CSF] analyses, 41 (57.6%) were Gram-smear positive (GSP). Gram-positive cocci (GPC) were identified in 23 (56.1%) smears, while 14 (34.2.%) had Gram-negative bacilli (GNB). Only three (7.3%) had Gram-negative diplococci (GND). Despite corroborative biochemical findings, the remaining 30 (42.3%), including two with tuberculous meningitis proved smear-negative. GPC cases had a mean age of 4.49 +/- 5.3yrs, GNB, 3.06 +/- 4.8yrs and GND, 4.47 +/- 4.9yrs. CSF isolates were made in 28 (39.4%) cases. Streptococcus pneumoniae accounted for a predominant 22 (78.6%) (P = 0.00), Haemophilus influenzae for 2 (7.1%), and Neisseria meningitidis for only 1 (3.5%) case. Whereas Strept. pneumoniae and H. influenzae isolates were uniformly sensitive to each of sultamicillin, cefuroxime, ceftriaxone and ceftazidime, 7.7% of Strept. pneumoniae were resistant to crystalline penicillin, 6.7% to ampicillin, and 69.2% to chloramphenicol; one of the two H. influenzae isolates was chloramphenicol-resistant. Amongst the 30 (42.3%) fatal cases, the length of stay was significantly shorter in GNB-positive cases (P = 0.045). Mortality was significantly higher amongst cases with purulent/turbid CSF at admission (P = 0.03), and in those with CSF protein of >150mg/dl (P = 0.02) and glucose <1mg/dl (P = 0.047). The present aetiological preponderance of GPC and Strept. pneumoniae in our study population, the high case-fatality, and the emerging resistance profile suggest the need for exploring additional control options including vaccination. We emphasize the need for periodic auditing of local antimicrobial policies in CPM.

Serum electrolyte, urea and creatinine in clinically stable Nigerian newborn.

Serum electrolytes urea and creatinine of 80 clinically stable normal newborn comprising 60 preterm and 20 term appropriate for gestational age babies were prospectively studied. A negative correlation between the serum sodium, potassium, urea, creatinine and the gestational age was found. A statistical significant difference in the mean values of serum urea and creatinine in both preterm and term babies was obtained but there was no statistical significant difference in the mean value of serum sodium and potassium.