Renal disease in HIV-seropositive patients in Nigeria: an assessment of prevalence, clinical features and risk factors.

In order to determine the pattern of renal disease and risk factors for renal disease in HIV-infected Nigerians, we studied 400 consecutive HIV/AIDS patients (210 males, 190 females) aged between 18 and 65 years (mean +/- SD; 34.6 +/- 9.4 years), and examined renal disease factors attributable to the infection. Diagnosis of renal disease was based on the consistent presence of at least 1+ albuminuria and/or elevated serum creatinine (>132 micromol/l) as well as the absence of other identifiable causes of chronic kidney disease (CKD). We determined socio-demography and clinical findings, as well as full laboratory work-ups including haemogram, CD4+ cell count, serum electrolytes, urea, creatinine, protein, cholesterol and urine analysis. Renal biopsies were taken in 10 patients who had moderate to massive proteinuria and had consented to the procedure. Finally, we compared HIV/AIDS cases with and without renal disease to determine the risk factors for nephropathy. We observed a high prevalence of renal disease (proteinuria and/or elevated serum creatinine), which was present in 152 (38%) of the patients. This subgroup included 74 males and 78 females with a M:F ratio of 1:1. The mean age (+/-SD) was 35.8 (+/-10.01) years. Systolic and/or diastolic hypertension was seen in 13.2% of these patients while the mean (+/- SD) body mass index (BMI) and packed cell volume (PCV) were 18.5 (+/-3.1) kg/m(2) and 25.26 (+/-6.81)%, respectively. The mean (+/-SD) CD4+ count was 246.49 (+/-192.8) cells/microl, while the mean (+/-SD) serum creatinine and 24-h urine protein excretion rates were 210.11 (+/-337.8) micromol/l and 2.57 (+/- 2.42) g/day, respectively. In subjects with and without nephropathy, there were significant differences in age, BMI, serum cholesterol, serum albumin and CD4+ counts, suggesting that these parameters may be risk factors for nephropathy. Histology revealed mainly focal glomerulosclerosis (FGS) with glomerular collapse. We conclude that the prevalence of proteinuria in HIV-seropositive patients is high in Nigeria. Such subjects show an equal male:female distribution, and glomerular histology revealed that a majority of biopsied patients had the collapsing FSGS variant. The risk factors for renal disease included severity of the HIV infection (inferred from the generally low CD4+ count), anaemia, malnutrition and increasing age.

Pattern and outcome of renal admissions at the University of Port Harcourt Teaching Hospital, Nigeria: A 4 years review.

BACKGROUND/OBJECTIVE: Renal diseases constitute an enormous health burden globally, more so in developing countries. This report determines the patterns and outcomes of renal diseases in the medical wards of the University Teaching Hospital in Nigeria. METHODS: A retrospective study of patients admitted for renal disease in 4 years. RESULTS: A total of 3841 patients were admitted to the medical wards, of which 590 (15.4%) had renal disease. Mean age of patients was 46 ± 15 years. Median duration of admission was 14 days (range 1-92 days). The most prevalent renal diseases were hypertensive nephropathy, diabetic nephropathy, chronic glomerulonephritis, and HIV-related renal disease constituting 22.8%, 16.6%, 14.4%, and 13.1%, respectively. Acute kidney injury constituted 12.4% of renal admissions. Analysis of outcome showed that 317 (53.7%) were discharged home, 49 (8.3%) patients discharged themselves against medical advice or absconded while 120 (20.3%) patients died of the disease. The highest mortality rate (22.5%) was observed among patients with the HIV-related renal disease. CONCLUSION: Renal disease remains a significant cause of morbidity and mortality in Port Harcourt, Southern Nigeria. This underscores an urgent need to institute measures for prevention and early detection of renal disease and reduction of its burden.

Prevalence of risk factors for chronic kidney disease among adults in a university community in southern Nigeria.

INTRODUCTION: The rising prevalence of chronic kidney disease (CKD) remains a global public health challenge particularly in developing countries, including our local environment, where subjects with the disease present late and may already be in need of renal replacement therapy. Early detection of modifiable risk factors of CKD is a plausible strategy to reduce its prevalence and burden. The 2014 World Kidney Day (WKD) exercise provided a veritable opportunity to identify CKD risk factors among adult Nigerians for early intervention. METHODS: Subjects were mobilized from the University community for the 2014 WKD exercise. The parameters assessed were demographics, Body mass index (BMI), blood pressures, proteinuria, glycosuria, serum creatinine and fasting plasma glucose. Glomerular Filtration Rate (GFR) was estimated using the Cockcroft-Gault equation. Data were analyzed using SPSS version 17.0. RESULTS: A total of 259 volunteers were studied, mean age of 28.3±9.7years (16-66years). Males comprised 135(52.1%) while 124(47.9%) were females. The frequency of risk factors of CKD observed were obesity in 31(12.2%) subjects, proteinuria and glycosuria in 32(12.4%) and 7(2.7%) subjects respectively. Hypertension and hyperglycaemia were seen in 54(20.8%) and 11(4.3%) of subjects respectively. Five subjects (1.9%) had e-GFR < 60mls/min/1.73m(2). CONCLUSION: Prevalence of CKD risk factors in this study population was high. There is need for continuous education, regular screening for early detection and early intervention by risk factor modification to prevent and/or reduce the growing burden of CKD and its sequelae in Nigeria.

Clinical outcomes of dialysis-treated acute kidney injury patients at the university of port harcourt teaching hospital, Nigeria.

Background. Acute kidney injury in adults is a common cause of hospitalization, associated with high morbidity and mortality especially in developing countries. In spite of RRT the in-hospital mortality rates remain high even in the developed countries. Though a proportion of our patients receive renal replacement therapy as part of their management, data on outcomes are sparse. Study Objective. To determine the clinical outcomes of dialysis-treated AKI in our hospital. Methods. A retrospective analysis of the clinical data of all adult AKI patients treated with haemodialysis at the University of Teaching Hospital during an interrupted six-year period was conducted. Analysis was done using SPSS version 17.0. Results. 34 males and 28 females with mean age of 41.3 ± 18.5 years were studied. The leading causes of AKI were sepsis (22.7%), acute glomerulonephritis (20.5%), acute gastroenteritis (15.9%), and toxic nephropathies (11.4%) and presented with mean e-GFR of 14.7 ± 5.8 mls/min/1.73 m(2). Of the 62 patients, 29 (46.8%) were discharged from the hospital, 27 (43.5%) died in hospital, while 6 (9.7%) absconded from treatment. Survivors had better Rifle grade than those who died (P < 0.001). Conclusion. Hospital mortality rate of dialysis-treated AKI patients is high and the severity of renal damage at presentation may be an important factor.

A single-center 7-year experience with end-stage renal disease care in Nigeria-a surrogate for the poor state of ESRD care in Nigeria and other sub-saharan african countries: advocacy for a global fund for ESRD care program in sub-saharan african countries.

Background. A single-center ESRD care experience in a Nigerian teaching hospital is presented as a surrogate case to demonstrate the prevailing ESRD care situation in Nigeria and most SSA countries. Methods. The data of 320 consecutive ESRD patients undergoing maintenance haemodialysis treatment during a seven-year period were retrospectively analyzed. Results. Over 80% of the subjects funded dialysis treatments from direct out of pocket payment. The mean duration on dialysis before dropout was 5.2 ± 7.6 weeks, with majority 314 (98.1%) of the patients unable to sustain dialysis above 12 weeks. Total dialysis sessions during the 7-year period was 1476 giving an average weekly dialysis session of 0.013 (0.05 hour/week) per patient per week. One hundred and twenty-eight (40%) patients died within 90 days of entry into dialysis care. Conclusions. ESRD care in this single centre was characterized by gross dialysis inadequacy and case fatality due to the inability to access and afford care. The opportunities for kidney transplantation are also very low. Poverty and the absence of government support for ESRD care are responsible for the poor outcomes. A global focus on ESRD care in SSA countries has thus become imperative.