Renal histology patterns in a prospective study of nephrology clinics in Lagos, Nigeria.

BACKGROUND: The burden of chronic kidney disease (CKD) in Nigeria is quite alarming. The prevalence of CKD ranges from 11 - 23.5%. Hypertension and chronic glomerulonephritis (CGN) remain the two leading causes of CKD in Nigeria. The etiology of CKD in many of these patients remains unknown, as few biopsies are done. In order to demystify the various glomerular diseases that culminate in CGN, performing a kidney biopsy offers a ray of hope. Few studies on renal biopsies have emanated from Nigeria; this study, however, is unique as the histopathological analysis involves light, immunofluorescence, and electron microscopies. METHODS: This study involved two teaching hospitals in Lagos. Patients from these centers, who met the inclusion criteria, underwent real-time renal biopsy; after providing written informed consent. RESULTS: Among the 52 patients analyzed 26, (50%) were males. The mean age was 31.7 ± 12.8, with age range of 13 - 56 years. The most common indication for kidney biopsy was nephrotic syndrome, accounting for 73%. Focal segmental glomerulosclerosis (FSGS) was the most frequent histopathological diagnosis seen in 25 patients (48.1%). CONCLUSION: The findings from this study highlight the role that renal biopsy plays in making a concrete diagnosis in nephrology practice in a developing country like Nigeria. As almost 80% of the study population was made up of patients with FSGS and lupus nephritis, it remains to be determined by further studies among our patients, the role that Apolipoprotein L1 (APOL 1) gene mutation will play in the etiology of renal diseases in Nigeria.

Kidneys From Deceased Elderly Donors: Factors Associated With Adverse Outcomes.

OBJECTIVES: We evaluated risk factors that could adversely affect outcomes from elderly deceased-donor transplants. MATERIALS AND METHODS: In this single center retrospective study (112 patients), we studied the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival. RESULTS: Mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years. Delayed graft function was 40.2%, whereas acute rejection episode rate was 38%. Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years. Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome. Acute rejection episode was an independent predictor of graft outcome (ß level = 2.857, t test = 2.3, P = .025). Donor age was a predictor of total graft survival duration (log-rank test gave chi-square test with 2 df = 12.292, P = .002). Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min (log-rank test gave chi-squared test with 1 df = 7.213, P = .007). Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome (P > .05), whereas acute rejection episodes (hazard ratio 5.443; 95% confidence interval, 2.226-15.311; P < .001) and donor estimated glomerular filtration rate (hazard ratio 0.449; 95% confidence interval, 0.209-0.945; P = .035) remained significant predictors of cumulative graft survival. CONCLUSIONS: The risk factors mentioned above should be avoided to achieve better graft survival. Emphasis should not be on donor age alone. Good donor kidney function and proper immunosuppressive therapy to reduce acute rejection episodes are cornerstones to improved outcomes.

A review of stroke admissions at a tertiary hospital in rural Southwestern Nigeria.

BACKGROUND: Stroke is a common neurological disorder and is the third leading cause of death and a major cause of long-term disability. The disease is expected to increase in low- and middle-income countries like Nigeria. There is no information on stroke in rural Nigeria. OBJECTIVES: To review the clinical patterns, risk-factors, and outcome of stroke in a tertiary hospital in rural Nigeria and examine the rural-urban variation of stroke hospitalization in Nigeria. MATERIALS AND METHODS: We carried out a retrospective study of patients who had a clinical diagnosis of stroke at the Federal Medical Centre, Ido-Ekiti, South-western Nigeria between November 2006 and October 2009. RESULTS: A total of 101 patients who had stroke were admitted during this review period, accounting for 4.5% of medical admission and 1.3% of total hospital admission. Women accounted 52.5% of cases, with a male to female ratio of 1 : 1.1. Their mean age was 68 ± 12 years. Stroke occurrences increased with age, as almost half (49.5%) of the cases were aged ≥70 years and majority (84.2%) of them were in low socioeconomic class. The mean hospital stay for stroke treatment was 12 ± 9 days, Glasgow coma score on admission was 11 ± 4. Ischemic stroke was 64.4%; hemorrhagic stroke, 34.7%; and indeterminate, 1.0%. Hypertension (85.2%), diabetes mellitus (23.8%), and tobacco smoking (22.8%) were the common identifiable risk factors for stroke. Of all the patients, 69% had ≥2 risk factors for stroke. Thirty-day case fatality was 23.8%; it increases with age and was higher among men than women (29.2 vs 18.9%) and in patients with diagnosis of hemorrhagic stroke (34.3 vs 18.5%). The numbers of identifiable risk factors of stroke has no effect on the 30-day case fatality. When compared with stroke in urban areas of Nigeria, we found no differences in frequency of hospitalization (1.3 vs 0.9 - 4%) and the major risk factor (hypertension). Hemorrhagic stroke was more common in urban than in the rural community (45.2 - 51 vs 34.7%) and the 30-day case fatality was lower in the rural community (23.8 vs 37.6 - 41.2%). CONCLUSION: Stroke is also a common neurological condition in rural Nigeria, in view of the fact that almost 70% of the patients had ≥2 risk factors of stroke. We recommend that, sustainable, community-friendly intervention programmes are incorporated into the health care system for the early prevention, recognition, and modification of the risk factors in persons prone to the disease.