Comparative Evaluation of Prevalence, Risk Factors, and Pathologic Features of Kidney Disease in Highly Active Antiretroviral Therapy-Naive and Highly Active Antiretroviral Therapy-Experienced Patients at a Tertiary Health Facility in Maiduguri, Northeastern Nigeria.

Infection of the kidneys by human immunodeficiency virus (HIV) is known to cause kidney disease. HIV-associated nephropathy occurs with variable prevalence rates in various communities and is found to be higher among sub-Saharan Africans. The disease has not been studied in Northeastern Nigeria. This study was aimed at comparing the prevalence, clinical and histo-pathologic features of kidney disease among highly active antiretroviral therapy (HAART)-experienced and HAART-naive patients in northeastern Nigeria. Four hundred HIV-infected (200 HAART-experienced and 200 HAART-naïve) patients were recruited consecutively from the ART clinic. Their socio-demographic and laboratory data including CD4+ cell counts and viral loads were obtained and documented. Out of the 200 study participants in the HAART-experienced arm, 21 (10.5%) had kidney disease whereas 61 (30.5%) participants in the HAART-naïve group had kidney disease. Their mean ages were 41.43 ± 11.04 years and 37.42 ± 9.96 years in the HAART-experienced and HAART-naïve groups, respectively. The mean serum creatinine (SCr), CD4+ cell counts, and viral load were 185.67 ± 221.80 µmol/L, 493.26 ± 241.97/mm3, and 8,856.79 ± 19,747.11/mL in the HAART-experienced group, respectively. In the HAART-naïve group, the mean SCr, CD4+ cell count, and viral load were 141.88 ± 130.56 µmol/L, 270.00 ± 154.65 cells/mm3, and 139,217.70 ± 12,598.50/mL. Focal segmental glomerulosclerosis (FSGS) was the most common histologic diagnosis in 64.7% of kidney biopsies. Risk factors for chronic kidney disease among the study population included age, low weight and body mass index, high human immunodeficiency virus (HIV)-1 viral load, low CD4+ cell counts, low hemoglobin (Hb), and proteinuria. The prevalence of kidney disease is higher among HAART-naïve HIV-infected patients than in patients who are HAART-experienced patients. Factors associated with development of kidney disease included advanced age, low CD4+ cell counts, high viral load, proteinuria, and HAART-naivety. FSGS is the most common histologic diagnosis in our study population.

Role of Renal Dysfunction as a Prognostic Factor in Acute Stroke Patients at a Tertiary Hospital in Northeastern Nigeria.

Chronic kidney disease (CKD) and stroke share many common risk factors, and the presence of CKD confers added risk factors for stroke. With increasing interest and understanding of the close relationship between the kidney and the brain, this study aims to assess the prevalence and impact of renal dysfunction on outcomes acute stroke patients. This is a prospective hospital-based study carried out in the neurology unit of University of Maiduguri Teaching Hospital, Maiduguri, northeastern Nigeria. The study population consisted of adult patients (>18 years) admitted in the medical wards with a diagnosis of acute stroke. Sociodemographic variables and biochemical parameters were obtained from each patient. Patients' functional status assessment by modified Rankin scale, Barthel index, and National Institutes of Health Stroke Scale score were obtained at admission and discharge. Glomerular filtration rate (GFR) was calculated using the modification of diet in renal disease equation. Patients who have estimated GFR (eGFR) <60 mL/min/1.73 m2 were considered to have CKD. Patients were grouped into A: with GFR <60 mL/min and B: GFR >60 mL/min. Out of a total of 501 patients admitted during the study period, 448 patients had complete data and were recruited, out of which 275 (61.4%) were male and 173 (38.6%) were female. Their ages ranged from 38 to 89 years, with a mean age ± standard deviation of 53.85 ± 18.13 years. The mean eGFR of the study population was 66.55 ± 30.49 mL/min. Two hundred and twenty-five (50.2%) had renal dysfunction with GFR <60 mL/min. The mean GFR of patients with renal dysfunction was 32.84 ± 27.59 mL/min, and patients without renal dysfunction had a mean GFR of 73.68 ± 35.61 mL/min. Patients with renal dysfunction on admission had Barthel stroke score of 20.74 ± 18.74 as compared to patients without renal dysfunction (25.49 ± 20.34), P = 0.017. At discharge, the Barthel scores for the two groups were 53.87 ± 30.17 and 41.71 ± 30.29 (P = 0.000), respectively. Patients with renal dysfunction had longer hospital stay with a mean duration on admission of 45.66 ± 39.90 days and severe residual disability at discharge. Acute stroke patients who have associated renal dysfunction have severe disability on admission and discharge. Renal dysfunction is common among acute stroke patients.