Paediatric Renal Stone Management in Africa: A Scoping Review and Analysis of Current Practices.

Renal stones are solid deposits formed from minerals and salts that develop within the kidneys and urinary tract. While the condition is more common among adults, children and even infants can also be affected. There is an increasing incidence of paediatric renal stones in Africa alongside multiple challenges faced in managing the condition. This scoping review aimed to provide an overview of the management modalities of paediatric renal stones in Africa. This study utilised Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A systematic search was conducted in three electronic databases: PubMed, African Journal Online (AJOL), and Google Scholar, with 1,180 articles curated. After extensive examination, 10 articles satisfied the inclusion criteria. The review found that calcium oxalate stones were the most prevalent type, accounting for 34.03% of cases, followed by whewellite stones and ammonium urate stones. The most frequent location for stones was the kidney, and the most common symptom was pain. Abdominopelvic ultrasound was the most frequently utilised investigation. Of the 886 patients managed for renal stones, 75.4% were managed surgically, 2.9% medically, and 21.7% spontaneously resolved without intervention. This review identifies opportunities for improving the management of paediatric renal stones in Africa, including the need for standardised diagnostic and treatment protocols and the development of evidence-based guidelines tailored to the African context. Overall, this scoping review provides valuable insights into the patterns and management of paediatric renal stones in Africa and highlights the need for further research to improve the management of this condition in the region.

A Scoping Review of Kidney Transplantation in Africa: How Far have We Come?

INTRODUCTION: Kidney transplantation is a life-saving treatment for end-stage kidney disease (ESKD) patients. However, access to this treatment in Africa lags behind other regions, leading to significant disparities in care. We aimed to analyse the indications, demographics, and outcomes of kidney transplantation in Africa. METHOD: We conducted a systematic review of studies from PubMed, Google Scholar, and African Journal Online using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We pooled and analysed data on procedure type, graft outcomes, donor type, prophylaxis, post-operative complications, and survival from 33 eligible studies. RESULT: The most common causes of ESKD requiring transplantation were glomerulonephritis and nephroangiosclerosis. Open nephrectomy was the predominant surgical approach (95%). Living donors accounted for 56.3% (4221) of all donors, with 68.5% being related to the recipient. Cadaveric donors accounted for 43.7% (3280) of transplants. Graft rejection was the most common surgical complication (39.44%), and 60.49% of patients developed hypertension in the follow-up period. CONCLUSION: Our study highlights the potential of kidney transplantation to improve the lives of ESKD patients in Africa. However, further research and infrastructure development are necessary to make this treatment more widespread and successful.

Diagnostic Dilemma and Surgical Management of Circumcaval Ureter: A Case Report.

Circumcaval ureter (CVU) is an uncommon congenital anomaly, in which the proximal ureter makes a loop posterior to the inferior vena cava (IVC) usually resulting in ureteric obstruction with consequential hydronephrosis and a right nonfunctioning kidney. It is also called a retrocaval or postcaval ureter. CVU is rarely encountered and, hence, may pose a diagnostic dilemma for radiologists and urologists. Clinical presentation occurs in the 3rd and 4th decades of life, manifesting mainly with flank pain. We present our experience in the diagnosis and management of CVU in a Nigerian Centre. A 56-year-old man presented with a 2-year history of recurrent, colicky right flank pain. He had been seen in multiple tertiary hospitals with no definitive diagnosis or treatment. A computerised tomography urogram showed an abnormally dilated proximal ureter with the classical fish-hook appearance and medial displacement, posterior to the IVC. At surgery, via an open, flank, extraperitoneal approach a CVU was found with significant stenosis and prestenotic dilatation. An excision of the stenotic segment with ureteroureterostomy was performed over a 6F D-J stent, and he had a smooth postoperative period. A CVU is extremely rare, and hence, the diagnosis can be missed. If left unattended, CVUs can progress to hydronephrosis and, eventually, a nonfunctioning right kidney. A high index of suspicion and early surgical intervention are key to a successful outcome.

Bacterial Colonization in Double J Stent and Bacteriuria in Post-Renal Transplant Patients.

Background and objective Urinary tract infections (UTI) in kidney transplant recipients can cause significant morbidity and negatively impact both, graft and patient survival. Ureteric stenting in renal transplantation is aimed at reducing the risks of complications like ureteric leak and stenosis. Ureteric stents are not without their potential complications which may include UTI. We aimed to compare urine bacteriology and bacterial colonization of DJ stent following kidney transplantation, and to establish antimicrobial susceptibility to guide the choice of empirical antibiotics in the event of UTI in post-transplant patients with DJ stent. Materials and methods This was a prospective study carried out over a year period (February 2020 to January 2021). Eighty post-renal transplant patients with indwelling ureteral stents were recruited for the study. An early morning midstream urine sample was taken for analysis from consenting patients that met the inclusion criteria. All stents were removed via rigid cystoscopy and the distal end of the stent (4cm) was cut off and put in a sterile bottle for microbiological analysis. Sensitivity and resistance were tested against a panel of 19 antibiotics on all microbial isolates. Results were considered statistically significant when p < 0.05. Results The mean age of the patients was 47.9+ 12.1 years. Male patients were 60 (75%) while 20 (25%) were females. Fifty-one (52%) patients had hypertension while 25 (26%) had diabetes mellitus. Hypertension and diabetes were noted in 20 (21%) patients while only one patient (1%) had HCV. Prior to renal transplantation, patients had negative urine cultures. The majority of the patients (76, 95%) had their stent retrieved after 4 weeks, 2 (2.5%) of them had stents retrieved after 2 weeks, and 2 (2.5%) had stents retrieved after 8 weeks. There was a significant association between the duration of stent and stent colonization (p=0.031). No organism was cultured in both the urine and stent in 13 (14.4%) patients. Nine (10%) had positive stent culture with a negative urine culture while 5 (5.6%) had positive urine culture with a negative stent culture. The same organism was noted in both urine and stent in 58 (64.4%) of patients while different organisms were cultured in 5 (5.6%) of the patients. Escherichia coli was the most common organism cultured in the urine of 38 (65.5%) patients and 36 (58.1%) stents, respectively. The sensitivity pattern shows that the organisms were more susceptible to nitrofurantoin and gentamicin, and resistant to tetracycline and ceftriaxone. Tigecycline showed good susceptibility and poor resistance. Conclusion This study shows that stent colonization was slightly higher than urine bacteriology, with both demonstrating similar microbiological patterns. Selection of the initial empiric treatment should be based on local epidemiological data. Initial therapy should be de-escalated to the most narrow-spectrum antibiotics to complete the course of therapy once culture and sensitivity data is available. Antibiotics stewardship will help in reducing the trend of MDR pathogens.

Impact of COVID-19 on renal replacement therapy: perspective from a Nigerian renal transplant centre.

Introduction: COVID-19 has had a huge impact on the health system and the world at large. Patients with kidney failure are a select group which have been affected significantly by the scourge of the disease. In the COVID-19 era, renal replacement therapy (RRT) in the form of dialysis and kidney transplantation required modifications in many centres in order to maintain high quality care and reduce infection rates among this susceptible group of patients. The objectives were to describe some of the challenges experienced in one of the leading renal care centres in Nigeria during the height of the COVID-19 pandemic and analyse the impact of practice changes on select outcomes. Methods: a retrospective cross-sectional review of haemodialysis activities and kidney transplantation among chronic kidney disease patients was done over a 15-month period ranging from April, 2019 to June, 2021. Data was extracted from the electronic media record (EMR) and analysed using SPSS version 22. Results: there was an initial significant drop in the number of haemodialysis sessions and kidney transplant surgeries by 16.7% and 66% respectively in the first 2 months of COVID-19 in our centre following the national lockdown. The mean monthly kidney transplant rate was 9±3.29 before the COVID-19 and the national lockdown, this figure reduced to 3.0±0.1 during the lockdown. Activities however normalized at 6 months following the initial lockdowns have remarkable exceeded pre-COVID numbers as at early 2021. Conclusion: after the initial drop in numbers of patients for haemodialysis and renal transplantation, there was an increase in numbers in the following months. It was instructive to put several steps in place in order to continue to offer high level RRT in the COVID-19 pandemic. RRT can safely be practiced in the COVID-19 pandemic.

Donor Nephrectomy Through Mini-Flank Incision: A Single-Centre Experience Among Nigerian Patients.

Background and objective The field of kidney transplantation in sub-Saharan Africa is still in the rudimentary stages. The majority of patients with chronic kidney disease have no access to renal replacement therapy, leading to very high mortality rates. Donor nephrectomy (DN) is an important aspect of kidney transplantation. Over the last two decades, open DN (ODN) has given way to minimally invasive techniques like laparoscopic DN (LDN) and robotic-assisted DN. In this study, we aimed to describe our experience with mini-flank incision donor nephrectomy (MIDN) at a Nigerian renal transplant center. Materials and methods We conducted a retrospective review of all DN cases performed at a single Nigerian kidney transplantation center over a three-year period. Information obtained from these patients was classified into pre-, intra-, and postoperative. The data included sociodemographic characteristics, preoperative preparation, details of intraoperative techniques, and postoperative findings. These were entered into a proforma and analyzed using SPSS Statistics version 21 (IBM Corp., Armonk, NY). Results A total of 230 patients underwent ODN during the study period. The majority of the donors were males (92.8%) with a mean age of 30.83 ±8.43 years. The body mass index (BMI) of most (76.1%) of the donors was within the normal range (18.5-24.9 kg/m2). The duration of DNs ranged from 72 to 154 minutes with a mean duration of 130 ±28 minutes. The length of flank incisions ranged from 7.8 to 12 cm with a mean incision length of 10.8 ±1.0 cm. Donors who had MIDN attained satisfactory postoperative pain control with about 90% of them having a BMI of <30 kg/m2. Oral intake and ambulation were commenced on the first postoperative day, and the cosmetic outcomes were deemed acceptable in over 90% of kidney donors. Conclusion Mini-incision for DN through the flank approach is a suitable alternative to LDN in the developing world where facilities and skills for LDN or robotic nephrectomies are largely unavailable. It offers a short recovery time, early ambulation, and excellent allograft outcomes.

Kidney Transplantation in Sickle Cell Disease Patients: Case Series and Experience from a Nigerian Kidney Transplant Center.

Sickle cell nephropathy is one of the long-term complications of sickle cell disease (SCD). About a quarter of SCD patients who survive up to 40 years of age will require some form of renal replacement therapy in their lifetime. Organ transplantation in SCD patients poses great challenges, particularly in lower middle income countries (LMIC) like Nigeria. This report highlights the management of three SCD patients who successfully underwent renal transplantation. The patients were aged 39, 47, and 58 years, respectively, with similarly previous history of multiple blood transfusions, recurrent vaso-occlusive crises, and had all progressed to end-stage renal disease. Preoperative exchange blood transfusion and plasmapheresis were offered in one and two of the patients, respectively. One of them required preoperative vaccination against encapsulated organisms due to autosplenectomy. Antithymocyte globulin was used as induction therapy in two of these patients while basiliximab was used in the third. All patients are alive with good renal function 18, 24, and 48 months post transplantation, respectively. In conclusion, kidney transplantation can be safely carried out on SCD patients with a satisfactory outcome.

An exploration of profile, perceptions, barriers, and predictors of research engagement among resident doctors: a report from CHARTING study.

Purpose/Aims: This research aimed to study the profile, perceptions, barriers, and predictors of Nigerian resident doctors' level of engagement in scientific research. Methods: This study was a descriptive cross-sectional quantitative survey of 438 resident doctors in Nigeria. This study forms a part of the big CHARTING Study, the protocol of which was published in "Nigeria Journal of Medicine 2019;28:198-205." Results: Three hundred and eighteen (72.8%) respondents were male and 119 (27.2%) were female. There were 229 (52.4%) registrars and 208 (47.6%) senior registrars, while residents in surgical versus nonsurgical specialties were 190 (44.5%) and 237 (55.5%), respectively. Three hundred and sixty-eight (85%) respondents had participated previously in research; 67 (15.6%) and 72 (16.6%) had their papers published in local or international journals, respectively; and only 46 (10.6%) had held first authorship positions in peer-reviewed journal publications. The significant barriers to research identified among them included lack of funding, lack of free time, inadequate training/knowledge on research methodology, and the onerous nature of clinical research. The independent predictor of previous engagement with research was years on current job (P = 0.007). This was similar to finding for the first authorship of a peer-reviewed article among the respondents (P = 0.017). Conclusion: This study concludes that publication and grantsmanship rates were very low among the surveyed resident doctors, despite their high rate of engagement in research projects. There is a need for increased research capacity building among resident doctors in Nigeria.

Congenital bilateral iliac vein anomalies in a Nigerian pediatric kidney transplant recipient: A case report and literature review.

The finding of bilateral congenital common iliac vein anomalies is indeed uncommon. This article presents the case of an 11-year-old boy with end-stage renal disease who had kidney transplantation (KT). At presentation, he was found to have a large superficial vein running from the left groin over the suprapubic area. The arterial pulsation of both lower limbs was preserved, and there was no pedal edema. Contrast-enhanced computed tomography scan revealed aplasia of the right common iliac vein, stenosis of the left common iliac vein, and marked dilatation of the left external and internal iliac veins. There were also varicosity of numerous pelvic veins and a collateral vein draining the right lower limb. This preoperative diagnosis was key to planning for surgery. On KT surgery, the renal allograft vein was anastomosed in an end-to-side fashion to the inferior vena cava and artery to the common iliac artery. The patient had a smooth postoperative recovery and continues to enjoy a normal renal function.

Résumé La découverte d'anomalies bilatérales congénitales de la veine iliaque commune est en effet rare. Cet article présente le cas d'un garçon de 11 ans avec insuffisance rénale terminale ayant subi une transplantation rénale (KT). Lors de la présentation, il a été découvert qu'il avait une grosse veine superficielle s'écoulant de l'aine gauche sur la zone sous-pubienne. La pulsation artérielle des deux membres inférieurs a été préservée et il n'y avait pas d'œdème pédale. La tomodensitométrie avec du contrast a révélé une aplasie de la veine iliaque commune droite, une sténose de la veine iliaque commune gauche et une dilatation marquée des veines iliaques externes et internes gauches. Il y avait aussi une varicosité de nombreuses veines pelviennes et une veine collatérale drainant la membre inférieure droite. Ce diagnostic préopératoire était essentiel à la planification de la chirurgie. Lors de la chirurgie KT, la veine d'allogreffe rénale a été anastomosée dans un mode à la veine cave inférieure et artère à l'artère iliaque commune. Le patient a eu une récupération postopératoire en douceur et continue de profiter d'une fonction rénale normale. Mots clés: Aplasie de la veine iliaque, Congénitale, Greffe de rein, Nigéria, Pédiatrique.

Profile and determinants of intention to migrate by early career doctors in Nigeria: A report from CHARTING study.

INTRODUCTION: Recently, there has been an upsurge in the migration of medical personnel, especially early career doctors (ECDs) from low- and middle-income countries, Nigeria inclusive, to high-income countries with wide-ranging consequences on the social and economic systems of the donor countries. This study assessed the profile and determinants of intention to emigrate by ECDs in Nigeria. METHODS: A cross-sectional study conducted among Nigerian ECDs from nine tertiary hospitals. Socio-demographic characteristics, intention & reasons to emigrate and willingness to return were collected using a self-administered semi-structured questionnaire. Data were analysed using Statistical Package for Social Sciences (SPSS) version 23. RESULTS: A total number of 763 ECDs participated in the study. The majority (88.2%) were less than 40 years of age and the male to female ratio was 2:1. Majority of the participants (69.4%) received monthly income ≤833 US Dollar. About two-thirds of ECDs had plans to emigrate and most to developed countries. Common reasons for intention to migrate were better quality of postgraduate training, improved quality of life and better remuneration. CONCLUSION: High proportion of Nigerian ECDs has intention to emigrate out with potential adverse effect on the fragile health system in the country.

Factors Driving the Acquisition of University Postgraduate Degrees among Resident Doctors in Nigeria.

The study examined the characteristics and factors driving the acquisition of postgraduate academic degrees among resident doctors in Nigeria. About 10% of the respondents had a form of university postgraduate degree with majority being master's degree. Having more than seven years of professional practice was the only factor predicting the acquisition of postgraduate academic degrees amongst the respondents [AOR: 0.243 (95% CI: 0.069,0.856; p = 0.028)]. The acquisition of postgraduate degree is not common among the surveyed resident doctors; and those that will acquire it do so in the later part of their career.

Successful Third Kidney Transplantation in a Nigerian Kidney Transplant Center: A Case Report.

Patients with end-stage renal disease have limited options in the course of their management. Kidney transplantation (KT) remains the gold standard for the management of renal replacement therapy. There is increasing evidence supporting the viability of third and fourth KTs. Due to the complexities of carrying out a successful third KT and the scarcity of living organ donors, it is not a common procedure in Nigeria's few renal transplant centres. To date, there is no reported case of a successful third KT in Nigeria. Here, we present the first reported case of a third KT carried out in Nigeria on a 44-year-old hypertensive, hepatitis B-infected, non-diabetic male patient. He had the first living donor KT eight years ago, which he lost due to poor immunosuppressive medication adherence. He then had a second living donor, KT, four years ago. Both KTs were from altruistic donors and were performed in the same hospital outside Nigeria. He developed allograft nephropathy after receiving the AstraZeneca COVID-19 vaccine 16 months ago and lost the second graft as a result. He was worked up and transplanted at our centre. Third kidney transplantation can be performed successfully despite the challenges of human leukocyte antigen (HLA) sensitization, antibiotic resistance, and surgical placement of the graft.

Anatomical variations of the renal artery: a computerized tomographic angiogram study in living kidney donors at a Nigerian Kidney Transplant Center.

BACKGROUND: Understanding of the renal vascular anatomy is key to a safe and successful donor nephrectomy, which ultimately impacts on the renal graft function and survival in kidney transplant recipients. OBJECTIVE: To report the various anatomical configurations of the renal artery identified in living kidney donors in a Nigerian kidney transplant institution. MATERIALS AND METHODS: The computerized tomography angiograms of 100 consecutive living kidney donors were prospectively reviewed over an 18-month period. Anatomical variations of the renal arteries including accessory arteries and early divisions were noted. Duration of surgery and ischemic time were recorded intra-operatively. Data analysis was carried out using IBM SPSS version 20. RESULTS: There were variations in renal artery configuration in 50 (50%) cases, 32% were accessory renal arteries while 18% were early branches of the renal artery. The classical bilateral solitary renal arteries were found in 50 (50%) of potential donors. There was statistically significant longer operating and ischemic time in donors with multiple renal arteries as compared with solitary arteries (p<0.05). CONCLUSION: There are a wide variety of renal artery configurations seen in potential kidney donors. The classical solitary renal artery remains the commonest and most favourable configuration for donor nephrectomy and transplantation.

Evaluating the Relationship between Duty Hours and Quality of Life of Nigerian Early Career Doctors.

This study explored association between early career doctors (ECDs) duty hours and their quality of life (QoL). Information was collected on socio-demographics, duty hours and QoL of 391 Nigerian ECDs. Results showed median of 70 duty-hours weekly, 10 call-days monthly and 6 sleep-hours daily. Weekly duty-hours and daily sleep-hours were significantly negatively and positively correlated respectively with all four domains of WHOQoL. QoL potentially affects health of ECDs especially mental health. Policies targeted at improving ECDs workforce, working conditions should improve QoL and curtail the potential impact of brain drain and attrition among ECDs in Nigeria.

Diagnostic performance of transrectal ultrasound for prostate volume estimation in men with benign prostate hyperplasia.

BACKGROUND AND AIM: Despite transrectal ultrasound (TRUS) being regarded as gold standard for prostate volume estimation, concerns have been raised in the literature concerning its accuracy especially in men with above-average prostate volumes. We aimed to evaluate the performance of TRUS for prostate volume estimation in a cohort of sub-Saharan African men since they are known to have relatively large mean prostate volumes. METHODS: This was a prospective study of 77 sub-Saharan African men who had open simple prostatectomy for benign prostate hyperplasia (BPH). Pre-operative TRUS determined total prostate volume (TPV) and transition zone volume (TZV). Following surgical enucleation, the adenoma was weighed (EPW) and its volume (EPV) also determined by fluid displacement. TRUS was repeated six weeks post-operatively to calculate the TRUS-estimated specimen volume (TESV). RESULTS: The mean EPV, EPW, TRUS-estimated TZV, TRUS-estimated TPV and TESV were 79.1 ± 62.9 ml, 79.1 ± 62.9 g, 53.3 ± 28.5 ml, 93.1 ± 48.9 ml and 69.9 ± 44.6 ml, respectively. Pearson's correlation showed a perfect relationship between EPW and EPV with no difference in their mean values (r = 1.000; P < .001). Pearson's correlation between TRUS-estimated TPV vs EPV, TRUS-estimated TZV vs EPV, and between TESV vs EPV were 0.932, 0.865 and 0.930, respectively (P = .0000). TRUS significantly under-estimated the TZV and TESV by 25.8 ml and 9.2 ml, respectively; unrelated to the severity of prostate enlargement. CONCLUSION: TRUS underestimates prostate volume, independent of prostate size. We propose simple formulae that could be used to improve the prostate volume determination from TRUS, especially if magnetic resonance imaging is not readily available or contraindicated.

Exploring Issues and Challenges of Leadership among Early Career Doctors in Nigeria Using a Mixed-Method Approach: CHARTING Study.

(1) Background: leadership behaviour is a poorly explored phenomenon among early-career doctors (ECDs). Good leadership is vital in maximising the effective management of patients in a clinical setting. While a good number of studies, though with small sample surveys, have researched the role of leadership in clinical setting quantitatively, qualitative investigations are yet to be done in Nigeria. This study aims to explore the attitudes, skills, and experience of ECDs in Nigeria on issues pertaining to leadership in a medical setting, using a mixed-method approach. (2) Methods: we conducted two sessions of key informant focus group discussion (FGD) that involved 14 ECD leaders in Nigeria, exploring their leadership experience in a clinical setting. Furthermore, we used a self-administered questionnaire to quantitatively survey 474 ECDs from seven Nigerian teaching hospitals to explore their attitudes, skills, and experience on issues pertaining to medical leadership. (3) Results: taking on leadership roles is a common phenomenon (52.7%) among the surveyed ECDs; however, the medical leadership position can be very challenging for ECDs in Nigeria. Despite the fact that many (91.1%) of the surveyed ECDs perceived leadership skills as essential skills needed by a doctr, many (44.1%) of them were yet to be formally trained on medical leadership. About three out of every 10 (23.6%) of surveyed ECDs that have ever held leadership positions in a medical setting experienced major leadership challenges while in such office due to their lack of training on leadership skills. Leadership skill acquisition programmes are highly recommended to become an integral part of medical training programmes in Nigeria. (4) Conclusion: there is a need for a structured leadership skill acquisition programme for ECDs in Nigeria. This programme will help in the robust delivery of highly effective healthcare services in Nigeria, as effective leadership is crucial to patient care services.

Unusual presentation of advanced prostate cancer in a black population of South-Western Nigeria.

There are growing concerns on the varying pattern of advanced prostate cancer (PCa) presentation across the world. We report some of the unusual presentations of PCa at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, South-Western Nigeria. A review of all patients with histologically confirmed PCa who had unusual presentations between January 2014 and December 2015 was done. Unusual presentation was defined as an atypical feature in the absence of lower urinary tract symptoms (LUTS), with the diagnosis of PCa only suspected after abnormal digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) assay. Thirteen patients had an unusual presentation in OAUTHC during the study period. Five (38.5%) had left supraclavicular swellings while four (30.8%) had haematochyzia and tenesmus. Other unusual presentations include large bowel obstruction requiring emergency colostomy (2;15.4%) and a scalp mass (1;7.7%). All patients had appropriate treatment for stage of PCa and are being followed up in the out-patient clinic. The change in presentations of PCa may suggest the need for DRE and serum PSA assay among all middle-aged and elderly men presenting at health facilities. Large scale studies on PCa across different population groups may also help at identifying related clinical, demographic and epidemiological factors as well as possible validation of some of these unusual presentations.

Experience with arteriovenous fistula creation for maintenance hemodialysis in a tertiary hospital in South-Western Nigeria.

End-stage renal disease (ESRD) is prevalent in our region. A major mode of treatment is by maintenance hemodialysis, and reliable vascular access is paramount for this to be successful. Arteriovenous fistula (AVF) creation offers permanent vascular access in patients with ESRD. We present our experience on AVF creation over a 10-year period. Our objective was to retrospectively review the outcome of all cases of AVF that have been created for ESRD patients at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between January 2006 and December 2015. The demographic characteristics, indications, clinical and intraoperative findings, operative complications and outcomes were filled into a pre-designed proforma. A total of 80 cases were reviewed. The age range was 17-80 years, with a mean of 49.03 ± 16.34 years. Males (85%) were more common than females (15%). Chronic glomerulonephritis and hypertension accounted for about 77.5% of etiology of ESRD in these patients. The left (non-dominant) upper limb was used in 88.1% of cases whereas 11.9% were created on the right upper limb. The distal radio-cephalic AVF (76.3%) was most commonly performed; with either the end (vein) to side (artery) (68.8%) or side-to-side (31.2%) anastomotic techniques employed. There was a primary failure in six patients (7.5%). Primary failure was more common in diabetics and thrombosis (7.5%) was the most common cause for primary failure. AVF creation has very good outcome in well-selected patients.

Bellini duct carcinoma of the kidney masquerading as an iliac bone tumour in an adult Nigerian.

Bellini Duct Carcinoma (BDC) of the Kidney is a rare type of Renal Cell Carcinoma. It usually presents with features of local advancement or metastasis and rarely diagnosed incidentally. We present a case report of a young man who was found to have BDC of the Right Kidney following presentation with an iliac bone tumour. A 40 year old man presented to the Orthopaedic outpatient clinic on account of right sided pelvic pain and limping following a trivial fall at home. There was no antecedent history of loin pain, loin mass or haematuria. On evaluation, he was found to have a huge right iliac bone tumour invading the contiguous muscles. An incidental hypodense central ipsilateral renal mass with enlarged peri-hilar lymph nodes were found. He subsequently had right radical nephrectomy via a right sub-coastal approach and wide local excision of the Iliac bone tumour in two separate procedures. The resection margins were negative for tumour cells. Histology of the resected specimens were consistent with a metastatic right BDC of the kidney. He had a smooth post-operative recovery. One third of BDC of the kidney presents with metastasis. A high index of suspicion is required in order to diagnose BDC following such unusual presentations.