HM Medical Clinic

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ABSTRACTS OF THE 12TH CONGRESS OF THE AFRICAN ASSOCIATION OF NEPHROLOGY (ACCRA, GHANA, 20-23 FEBRUARY, 2013) acute renal failure (ARF) in pediatrics, rarely practiced in black African hospital. APD began in January 2009. A SiNGlE BASEPAiR MuTATiON CAuSES
Before, children with ARF had no possibility of extrarenal CYSTiNOSiS iN ThE MAJORiTY OF WESTERN
purification apart from symptomatic treatment. We report the first results of the APD in this unit.
Jenisha Nandhlal1, Tricia Owen2, F Leisegang2, Priya Gajjar1, Methodology: From January to December 2009, we
Peter Nourse1 1Department of Pediatric Medicine, Red Cross War retrospectively studied 31 cases of ARF. The indication of Memorial Children's Hospital, School of Child and Adolescent the APD was made in 15 children among whom 10 were Health, University of Cape Town, Cape Town, South Africa, 2 Chemical Patholog y, UCT and NHLS, Cape Town, South Africa Results.: The sex ratio was 0.42 (3/7) with an average age
Background: Cystinosis is caused by mutations in the
of 9.7 years (2-19 years). Glomerular diseases (60%), malaria CTNS gene. While many mutations have been diagnosed in (20%), acute respiratory infection, post-operative ARF and other race groups, local mutations are unknown. The local infectious comment ARF (2 cases / 10) were the principals phenotype has also not been described.
etiologies. The time sold between the indication of ADP Method: In the last 5 years 17 patients with suspected
and the care of the patient was of maximum 12 pm in cystinosis were referred for molecular analysis of the 70% of the children. The mean duration of hospitalization CTNS gene. A retrospective chart review was conducted was 14.3 days (7-28 days). Complications were dominated on 14 of these patients where the clinical information was by peritonitis (3/10), secondary migration of the catheter available. Molecular analysis was done in all 17 patients and (1/10), the leak of the liquid of dialysis (3/10) and a defect six parents.
of drainage (2/10).
Results: Race : African Black (8) and Cape Coloured (9)]).
2 children recovered renal function, 5 have evolved into Mean age at presentation: chronic renal failure, there was 30% of deaths.
2 years and 5 months (range: 5 months-5 years). All patients Conclusion.: The ADP could be a means to reduce the
presented with a history of vomiting and polyuria and had mortality of the ARF of the young child to Africa. But developed Fanconi's syndrome .Six patients have developed in view of our experience it should come along with a Chronic Kidney disease (two end stage). 1 patient has better training of the teams of pediatric surgeons in the hypothyroidism. 13 patients had corneal cysteine crystals. installation of catheter and a bigger raising awareness to the All patients had raised white cell cysteine at diagnosis. A measures of asepsis.
molecular diagnosis of cystinosis was made in all 16/17 patients . 13 patients were positive for a homozygous G>A mutation in intron 11 (c.971-12G>A). Another was homozygous for S141F. Two were compound heterozygotes for c.971-12G>A and either c.16 del ctga or S141F.
ACTiViTiES REPORT OF AN AFRiCAN uNiT
Conclusion: Most patients in the Western Cape present
OF PEDiATRiC NEPhROlOGY AFTER ThREE
with a severe infantile cystinosis phenotype. Most mixed YEARS OF ExERCiSE
race and black patients have G>A mutation in intron 11 Adonis-Koffy Laurence, Diarrassouba Gnenefoly, Niamien Ekou, (c.971-12G>A) It is not a mutation reported in Caucasian Kouassi Folivi Unit Of Pediatric Nephrolog y Of Teaching Hospital patients. This will aid in the diagnosis of patients with Of Yopougon, Yopougon/ Abidjan, Cote D'ivoire Cystinosis in South Africa as well as ante-natal testing for introduction: pediatric nephrology is the discipline that
supports kidney of child. The care of these specific renal diseases motivated the creation of a unit in the pediatric department of the teaching hospital of yopougon since 2009. After three years of operation we present the result concerning consultations and hospitalization in the unit.
AuTOMATED PEDiATRiC PERiTONEAl
Methodology: It was a retrospective study from january
DiAlYSiS iN AFRiCA: ExPERiENCE OF ThE
2009 to December 2011. All the children who were received uNiT OF PEDiATRiC NEPhROlOGY OF
in the consultation or in hospitalization were included.
ThE TEAChiNG hOSPiTAl OF YOPOuGON
Results: After the first year, we recorded 666 consultations
(ABiDJAN iVORY COAST)
among which 184 patients and 50 hospitalizations. Adonis-Koffy Laurence1, Diarrassouba Gnenefoly1, Niamien Ekou1, During the second year, 740 consultations were recorded Coulibaly Pessa2, koutou Jean-Martial1, Koné Aïssatou0 and 60 hospitalizations. Concerning the third year, 554 1unit of pediatric nephrolog y of teaching hospital of Yopougon, consultations and 42 hospitalisations. The main concerned Yopougon/ Abidjan, Cote D'Ivoire, 2adult nephrolog y department age bracket was the children from 5 to 10 years old in the of teaching hospital of Yopougon, Yopougon/ abidjan, Cote D'Ivoire consultation and the sex-ratio was 1,53. The main diseases Automated Peritoneal Dialysis (APD) is a modality for were nephrotic syndrome (33%), congenital urinary tract African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) (16.7%), acute glomerulonephritis (9,4%), chronic renal 2Barts Health NHS Trust, London, UK, 3Queen Elizabeth Central failure( 10,3%), essential hypertension (0,36%), urinary Hospital, Blantyre, Malawi tract infection (0,16%) and others diseases (27%). About introduction: Renal replacement therapy in sub Saharan
hospitalization, the average age was 7,4 years and the sex- Africa is scarce due the high costs involved. Consequently, ratio was 1,1. Nephrotic syndrome was also the principal there is very little published data in this area to inform disease in hospitalization (31,5%), following by kidney clinical practice and service provision. We describe the failure (21,2%). 20,5 % among the hospitalized patients had operational activities and clinical outcomes of a new, three a peritoneal dialysis.
station, free at the point of access, haemodialysis unit in Conclusion: The creation of the unit allowed a better
care of the renal diseases of the child by the fact of early Methods: All patients receiving dialysis from 19/10/11
diagnoses and processings better adapted to the child such to 19/10/12 were included. Patient demographics, clinical as of the peritoneal dialysis.
diagnosis, laboratory results and outcomes were collected prospectively. Cause of kidney injury was ascertained from clinical review and laboratory results (kidney biopsies are not performed locally).
Results: Eighteen patients received haemodialysis in year
AMYlOSE ChilDhOOD iN AlGERiA
one. 15 (83.3%) were treated for end stage kidney disease Liela Azouaou, Mohamed Benabadji Hospital, Algiers, Algeria (median age 40.1 years (range 15.0-68.0), 11 (73.3%) males, 5 (33.3%) HIV positive). The case fatality rate since In pediatric AA amyloidosis is rare. In the early 20th century, the service began is 46.7%, 8 (53.3%) patients remain on AA amyloidosis secondary to infection and juvenile chronic maintenance haemodialysis. In 8/15 (53.3%) patients, the arthritis were very frequent.In recent years, there has been cause of kidney disease was unknown. Three patients were a sharp decline of this disease because of therapeutic dialysed for acute kidney injury; two caused by volume progress.Nowadays, the main causes of amyloidosis in depletion from cholera and 1 by post partum haemorrhage. children are autoinflammatoirediseases particularly the Their median age was 46.5 years (range 40-55), 1 (33.3%) FMF. Materials and methods:Retrospective study over a male. Of these 1 (33.3%) died, the remainder made a full period of 15 years the clinical and histological diagnosis of clinical and renal recovery.
amyloidosis carried within the pathology laboratories.We Conclusions: Haemodialysis services, while challenging,
have collected data for each patient: age, sex, circumstances has been successfully implemented and sustained. The of discovery and etiology majority of patients with either end stage or acute kidney Results: Epidemiology: 12 patients with amylose / 930 PBR
injury present with advanced kidney disease requiring of children from 1 January 1997 until July 2012, Frequency: emergency dialysis. Human and clinical resource investments 3.40% (12 amylose children / 344 total amylose) and 1.25% are needed in Malawi to initiate services for early detection (12PBR amylose child / 930 PBR total child) and management of kidney injury.
Discussion: The most commonage is 16 years old.We have
found out that sex did not influence the disease in children, sex ratio = 1 Circumstances of discovery is at a late stage to stage of nephrotic syndrome,Among the etiologies: 34% of chronic rheumatic diseases, 25 % digestive diseases CliNiCAl PRESENTATiON OF
chronic inflammatory, 25% of undetermined causes and PAEDiATRiC KiDNEY DiSEASE AT QuEEN
one case of Takayasu. We have found out that inflammatory EliZABETh CENTRAl hOSPiTAl(QECh),
autoimmune diseases, also called monogenic hereditary recurrent fevers are possibly underestimated in our study in Zondiwe Mwanza1, Gavin Dreyer2 particular familial Mediterranean fever 1Paediatrics and Child Health,College of Medicine,University of Conclusion: Amyloidosis in children is a rare disease;
Malawi, Blantyre, Malawi, 2Department of Medicine,College of the causes are variable over time. In this decade, Medicine,University of Malawi, Blantyre, Malawi autoinflammatoire diseases are the most frequent pathologies Background: Studies from sub Saharan Africa have
in particular the FMF. In our study,no patients have been indicated that glomerular disease is a leading cause of kidney labeled with FMF or monogenic autoinflammatoiredisease, injury and contributes to the burden of end stage kidney hence the importance of the genetic study.
disease However; anecdotal evidence suggests paediatric kidney disease in Malawi is common. However, there is no literature from Malawi or the sub-region on kidney disease in children. We conducted a prospective study at a teaching hospital in Malawi to determine the clinical phenotype of STARTiNG A NEW hAEMODiAlYSiS uNiT AT A
paediatric kidney disease.
CENTRAl hOSPiTAl iN MAlAWi - ACTiViTiES
Method: Fully anonymised demographic, clinical and
AND OuTCOMES FROM ThE FiRST YEAR OF
laboratory data were collected over 9 months for children presenting with kidney disease. Parameters were analysed Gavin Dreyer1, Faisal Khan2, Zuze Kawale3, Martha Katete3, by a nephrologist and paediatrician to determine the Maggie Kaliwa3, Eluby Ibrahim3, Madalitso Daza3, Grace Kanjere3, most likely underlying renal diagnosis. Renal histology is Enos Banda3 1Malawi College of Medicine, Blantyre, Malawi, African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) Results: Thirty eight patients were recruited, 19 male,
mean age 7.9 years. One tested HIV positive, 17 were non- reactive and 19 were HIV unknown. The median creatinine BiOPSY-EVAluATED NEPhROTiC SYNDROME
at presentation was 1 mg/dL (range 0.1-33 mg/dL). Twenty AMONG ChilDREN DiAGNOSED iN KANO: A
(53%) patients presented with glomerular disease; 11 with nephritic syndrome, 9 with nephrotic syndrome (all steroid Patience Obiagwu, Aliyu Abdu, Akinfenwa Atanda sensitive). Six (16%) patients were admitted with non- Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria glomerular acute kidney injury; 4 died during admission. Objective: To evaluate clinico-pathological features of
Four (10%) patients had urological disease with impaired children with nephrotic syndrome seen in a developing kidney function; two (5%) had chronic kidney disease and paediatric nephrology unit in northern Nigeria.
six (16%) had uncertain diagnoses.
Method: All children less than 15 years of age who presented
Conclusion: Glomerular diseases predominate in this study
with nephrotic syndrome and underwent renal biopsy at although the histological subtype is unclear. The mortality Aminu Kano Teaching Hospital (AKTH), Kano, between from acute kidney injury in children is high. Improving November 2011 and November 2012 were included in the patient outcomes by developing diagnostic services including study. Their microscopic diagnoses were evaluated alongside renal histopathology and early intervention for acute kidney clinical and other laboratory parameters.
injury are priorities for the paediatric renal service.
Results: Twenty nephrotic children were studied, 17 males
and 3 females. Peak age was 7 - 8 years (range 2.5 - 13 years). These represent 55% of total paediatric nephrotics in the recently established unit, the rest of which have never had renal biopsies. The indications for renal biopsy were AN AGE-SEx REGiSTER OF NEW PATiENTS
steroid-resistant nephrotic syndrome in 11 (55%) children, WiTh ADVANCED KiDNEY FAiluRE
nephrotic syndrome pre- steroid treatment in 6 (30%) PRESENTiNG TO KOMFO ANOKYE TEAChiNG
children and frequently-relapsing nephrotic syndrome in 3 hOSPiTAl [KATh], KuMASi: RESulTS AFTER 6
(15%) children. Hypertension was found in 7 (35%) children. Sixteen children (80%) had microscopic haematuria on Justice Arhinful1, Yaw Amoako1, Jacob Plange-Rhule2 ,3, Iain A M presentation. The most common histopathological diagnosis MacPhee3, John B Eastwood3 1Komfo Anokye Teaching Hospital, was focal glomerulosclerosis in 9 (45%) children (segmental Kumasi, Ghana, 2Kwame Nkrumah University of Science and = 8; global = 1). Minimal change disease was found in 4 Technolog y, Kumasi, Ghana, 3St George's, University of London, children (20%), membranoproliferative glomerulonephritis London, UK in 3 children (15%), membranous nephropathy in 3 children introduction: There are few data on the incidence and
(15%) and diffuse mesangial hypercellularity in 1 child (5%). prevalence of kidney failure in Africa, and few Age-sex Of the six children who had renal biopsy before treatment, 3 registers or Renal registries. In many countries such registries (50%) were found to have focal glomerulosclerosis.
have become a vital component in planning renal services. Conclusion: Focal segmental glomerulosclerosis was the
Our study was undertaken in an attempt to ascertain the most common histological subtype diagnosed in Kano numbers of new patients presenting with serum creatinine among children with nephrotic syndrome.
≥300 µmol/l, and to assess the severity of renal dysfunction. Collection of such information more widely could assist public health planners, and ultimately improve the prospects for patients with kidney disease.
Method: Starting on May 1st 2012, data, including age,
EPiDEMiOlOGY AND CliNiCOPAThOlOGiC
gender, serum creatinine and district of residence, were OuTCOME OF ChilDhOOD AND
collected on new patients presenting to KATH with a serum ADOlESCENTS' ChRONiCKiDNEY DiSEASE
creatinine of ≥300 µmol/L. Patients were identified both in Wasiu Olowu, Olufemi Adefehinti, Theophilus Aladekomo the Emergency department and in the Renal/Hypertension Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria Results: During this first 6 months 142 individuals [M 79,
introduction: Due to dearth of data, understanding of
F 63] were identified. Their mean age was 47.2±18.9 [males: chronic kidney disease (CKD) aetiology, manifestations and 47.0±19.2, females: 47.3±18.8. 52.8% of patients lived in management has been poor and outcome dismal in African the Kumasi metropolitan area. Serum creatinine: range 301– 5,091 µmol/L, mean 1246.0 ± 847.2 µmol/L; 72 of the 142 Method: A retrospective analysis of hospital data of 154
had a creatinine of >1000 µmol/L. The majority of patients CKD children and adolescents was conducted to determine [88.7%] had Stage 5 the epidemiology and clinicopathologic outcome of Chronic kidney disease.
paediatric CKD.
Conclusion: Newly presenting advanced kidney failure
Results: Overall mean incidence was 11 (6-20) per million
is common at KATH, there being 25–30 such patients a children population (pmcp)/year while prevalence averaged month. Our data show too that the patients present very late 48 (8-101) pmcp. There were 86 males (55.8%). Median in the course of their disease.
age was 10.0 (0.2-15.5) years with 83.8% ≥ 5 years old. Aetiologies were glomerular disease (GMD, 90.26%), congenital and acquired urinary tract (7.79%) and hereditary African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) (1.95%) disorder. CKD stages at diagnosis were 45.5% CKD-1, 22.7% CKD-2, 10.4% CKD-3, 2.6% CKD-4 and 18.8% CKD-5. Median progression time through the CKD RENAl FAiluRE iN hiV POSiTiVE PATiENTS -
stages was 24.0 (3-108) months. Mean dialysis incidence A SOuTh AFRiCAN ExPERiENCE
and prevalence were 1 (0-4) pmcp/year and 4 (1-12) pmcp, Ahmed Vachiat, Saraladevi Naicker, Shoyab Wadee, Eustasius respectively. Hypertension, heart failure (HF), malnutrition, Musenge University of the Witwatersrand, johannesburg, South anaemia, acute-on-CKD, and need for dialysis, azotaemia, hypercreatinaemia, and high calcium-phosphorous product Background: Renal disease is a major complication
(≥4.44 mmol2/ L2) were mortality risk factors. CKD-1 of HIV infection, with CKD occurring in 6-48.5% of survived significantly better than CKD stages 3-5 (p < 0.05) HIV-infected patients in Africa. There is paucity of data but not CKD-2 (p=0.098). Hypertensive CKDs without regarding the prevalence and outcomes of AKI in HIV- HF survived better (73.0%) than hypertensive CKDs with infected patients in sub-Saharan Africa. We reviewed the HF (16.0%) [Hazard ratio (HR): 0.34, 95% CI: 0.14-0.83]. outcomes of AKI in HIV- infected individuals compared GMD survived better (68.5%) than non-GMD patients with HIV-negative patients presenting in the same time (33.0%) [HR: 2.87, 95% CI: 1.16-7.06].
Conclusion: CKD was commoner among school than pre-
Method: A retrospective review of 101 HIV positive
school age children. GMD was the predominant aetiology antiretroviral therapy- naïve patients presenting with renal with better outcome than non-GMD. Comorbidity failure over a 1 year was undertaken.
prevalence increased significantly with increasing severity Results: A total of 684 patients presented with renal failure,
of CKD stage.
101(14.8%) of whom were HIV positive. Ninety-nine (98%) of HIV positive patients were black and 56 (55%) were male, with mean age 38 ± 9.9 years (range 21 - 61). HIV positive patients demonstrated severe immunosuppression, with mean CD4 count of 135 cells/µl (range 1-579cells/ PREVAlENCE OF RENAl DiSEASE iN
µl). Fifty-seven (56%) HIV positive patients presented with NiGERiAN ChilDREN iNFECTED WiTh
AKI, 21 (21%) with acute-on-chronic kidney disease and 23 ThE huMAN iMMuNODEFiCiENCY ViRuS
(23%) with chronic kidney disease; seven patients with AKI AND ON hiGhlY ACTiVE ANTi-RETROViRAl
were excluded due to lack of records.The causes of AKI in the HIV positive group included sepsis (62%), volume Nosakhare Iduoriyekemwen, Wilson Sadoh, Ayebo Sadoh depletion and haemodynamic instability (20%), toxins University of Benin Teaching Hospital, Benin/Edo State, Nigeria (10%), urological obstruction (8%) and miscellaneous Abstract: Background: Access to highly active anti-retroviral
(10%). 44 % of HIV positive and 47% of HIV negative therapy (HAART) has improved the prognosis of Nigerian patients with AKI demised (p=0.45). Hyponatraemia children infected with the human immunodeficiency (p<0.001), acidosis (p<0.001) and hyperphosphataemia virus (HIV); thus, more children are surviving. Long- (p<0.001) were predictors of mortality in HIV positive term exposure to HAART is potentially nephrotoxic. patients with AKI.
We therefore aimed at assessing the prevalence of renal Conclusion: HIV positive patients presented with AKI at
disease in Nigerian children infected with HIV, who are on a younger age and advanced stage of immunosuppression. HAART. Patients and Methods. we studied children, aged Appropriate support, including dialysis, resulted in similar ten months to 17 years, infected with HIV, attending the outcomes in both groups.
pediatric HIV clinics of the University of Benin Teaching Hospital. Demographic and clinical data were obtained by parental interview as well as from the medical records. Each child's urine was tested for albumin and microalbuminuria The serum creatinine level of each child was also estimated OuTCOMES OF hiV ChRONiC KiDNEY
and used in calculating the glomerular filtration rate (GFR). DiSEASE WiTh hiGhlY ACTiVE
Renal disease was defined as the presence of significant proteinuria of 1+ and above on dipstick or the presence Sadaf Rahmanian, Saraladevi Naicker, Nina Diana, June Fabian, of microalbuminuria of ≥20 mg and/or GFR <60 mL/ Stewart Goetsch min/1.73 m2.
University of the Witwatersrand, Johannesburg, South Africa Results: The overall prevalence of renal disease was 16.2%.
With the growing use of HAART, CKD is becoming an Microalbuminuria was seen in 11 children with renal disease increasingly important consideration. The main objective (11.1%), GFR of less than 60 mL/ min/1.73 m2 was seen of this study included assessment of outcomes of HIV in five children (5.1%) with renal disease, but none had positive patients with CKD on HAART.
end-stage renal disease (GFR less than 15 mL/min/1.73 Method: A retrospective study was done on 169 patients
m2). Renal disease was found to be significantly associated (divided into two groups) with CKD. Group 1 (n = 87) had with advanced stage of HIV infection (P < 0.049).
baseline pre-HAART initiation results available. Group 2 Conclusion: Prevalence of renal disease in HAART-
(n = 82) were on HAART prior to being referred to the treated Nigerian children is high and majority of them are HIV Renal Clinic.
asymptomatic of renal disease, but in the advanced stages of HIV infection.
African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) target blood pressure control. On further subjecting the data to multiple regression analysis, SBP (p=0.04), bicarbonate (p=0.03) and haemoglobin (0.04) remained significant.
Conclusion: Few of the study participants had worsening
of the renal function. BP improved at the end of follow- up. Systolic BP, acidosis and anaemia were independent risk factors for progression of CKD.
CliNiCOPAThOlOGiCAl CORRElATiON OF
RENAl DiSEASE iN hiV iNFECTiON
Nina Diana, Malcolm Davies, Saraladevi Naicker, Stuart Goetsch University of Witwatersrand, Johannesburg, South Africa Renal disease in HIV infection was 1st described by Rao et al in 1984 and for the first two decades of the HIV pandemic, HIVAN was synonymous with HIV renal disease. Since then the spectrum of HIV renal disease has widened. 216 HIV-infected patients underwent a renal biopsy, between January 2003 and November 2012, for standard indications *p<0.05 (Kruskal-Wallis test) Group 1: Baseline eGFR at our institution. Retrospective review of indication to increased from 20.8ml/min to 57.7ml/min (p<0.05) after biopsy; demographic data (race, gender, age); clinical 24 months. Baseline proteinuria dectreased from 3g/day to parameters (CD , HIV viral load, eGFR, cholesterol, 0.8g/day at 24 months (p<0.05). There were no significant albumin, proteinuria) and histopathological pattern was changes in Group 2. HIVAN (N=16) and HIVICD(N=11) performed. 159 patients were included. A comparison both improved with HAART. Factors associated with poor between different histopathological patterns with respect renal outcome were diabetes mellitus (OR 4.9, CI: 1.2 - 18.9, to indication to biopsy and clinical data was conducted.
p=0.02) and lower starting eGFR (OR 1.01, CI: 1-1.03, p Of the 159 patients, 151 were of Black African ethnic origin, 81 were male and 78 were female. Mean age was Conclusion: Initiating HAART before severe renal
35.64±9.44 years. Leading biopsy diagnoses were HIVAN dysfunction has developed improves renal outcomes and (21.9%), FSGS (16.9%) and HIVICK (14.4%). ANOVA of reduces the burden of HIV-CKD in resource-limited parameters by histology revealed eGFR to be statistically significant between groups. Histology was assessed by indication to biopsy. Nephrotic syndrome was the commonest biopsy indication. Comparing the HIVAN and HIVICK groups, eGFR was lower and proteinuria higher in the HIVAN group. Patients with non HIV-related renal PROGRESSiON OF ChRONiC KiDNEY DiSEASE
disease on biopsy were older, had lower serum cholesterol Nolubabalo Unati Nqebelele, Saraladevi Naicker, Sagren Naidoo, and worse eGFR.
Graham Paget With the use of HAART survival of HIV-infected University of the Witwtersrand, Gauteng, South Africa individuals has improved, resulting in the occurrence of Aim: To assess progression of CKD in a cohort of patients
HIV-related and non HIV-related kidney disease in infected attending a renal clinic.
persons. Due to overlapping clinical presentations and Method: The progression of CKD was studied in 122
difficulty in predicting histological pattern, renal biopsy patients with CKD of diverse aetiology in a retrospective remains critical to patient care.
study (observation time 3 years).
Results: There were 122 participants. Males comprised
(50.8%) of the participants. Blacks accounted for 55.7 % (n=68). The median age was 54.1±13.4. Diabetes mellitus and hypertension were the commonest causes of CKD. A 2 YEAR RETROSPECTiVE REViEW OF
GFR decreased from 37.9 to 33.7 (p<0.001). MAP decreased OuTCOMES OF ACuTE PERiTONEAl
from 131.4±21.1 to 121.4±14.5 mmHg (p<0.001). Eight DiAlYSiS iN KiNG EDWARD hOSPiTAl,
percent of the participants had doubling of the serum DuRBAN, SOuTh AFRiCA.
creatinine. Seventy two percent were on RAAS blockers. Kwazi Ndlovu1 ,2, Alain Assounga1 ,2 Serum creatinine positively correlated with SBP (r=0.235; Dept Nephrolog y, University of KwaZulu-Natal, Durban, South p=0.009), DBP (r=0.318; p<0.0001) and MAP (r=0.312; Africa, 2King p<0.0001); and negatively correlated with bicarbonate (r=- Edward VIII Hospital, Durban, South Africa 0.543; p<0.0001), haemoglobin (r=-0.464; p<0.0001) and Background: Acute peritoneal dialysis (PD) is a renal
albumin (r=-0.386; p<0.0001). Sixty three percent achieved replacement treatment modality that is still relevant today in many low resource centres due to its relative ease of African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) setup and operation in the treatment of patients presenting was stage 1 (21%), stage 2 (31%), stage 3 (33%) and stage with acute kidney injury or a new diagnosis of chronic 4 (15%). Chronic kidney disease is common and significant kidney disease requiring an urgent start to dialysis.
in internal medicine.
Materials & Method: A Single-center retrospective
observational study on 34 patient files that were successfully sourced from hospital records from a list 99 patients identified to have been offered acute PD via a rigid catheter as the initial modality of dialysis at King Edward RiSK FACTORS OF ChRONiC KiDNEY DiSEASE
VIII Hospital PD unit. Short-term clinical outcomes (urea iN GENERAl MEDiCiNE iN CONAKRY.
reduction rate (URR), fluid removal, metabolic control, Aderemi Adeniyi1, Carien Laurence2, Jimmy Volmink2, M Razeen and patient outcome) and complications (mechanical and infective) were evaluated.
1Division of Nephrolog y, Stellenbosch University and Tygerberg Results: There was an average URR of 69% and PD
Hospital, Cape Town, South Africa, 2Division of Community ultrafiltration of 12548.5 mls accomplished over an average Health, Stellenbosch University, Cape Town, South Africa PD ward stay of 4.6 days and 62.5 PD cycles. Acceptable Background: Chronic non-communicable diseases
metabolic control was achieved when comparing pre (CNCDs) cause almost half of the disease burden in poorer PD values (averages for urea, potassium, bicarbonate, countries. The African Partnership for Cohort research and phosphate of 54.14 , 5.74, 11.03 and 3.18 mmol/l and Training is a collaboration. One of the aims of the respectively) to post PD values (16.79 , 3.07, 25.16 and South African pilot study was to determine the prevalence 1.61 mmol/l respectively). Fifty percent of patients had of CKD and its association with cardiovascular disease catheter-related complications with 15% having infective (CVD) risk factors among school teachers in South Africa.
complications while 35% had mechanical complications. Method: A survey of 489 teachers in the Western Cape
There was a 32% mortality rate during PD ward stay.
was conducted. Questionnaires captured demographic Discussion: Outcomes of this study are in keeping with
data and data on CNCDs and their risk factors. Physical reports from literature, however, it is limited by fact it is measurements were taken, and biological samples were a single-center retrospective noncomparative study with a collected for serum creatinine, cholesterol, and urine small sample size.
protein/creatinine ratio (UPCR).
Results: The average age of participants was 46.4±8.5years,
with 70.3% being female and 70% of mixed ethnicity. Prevalence of CKD was 8.9%. Proteinuria was present in 5.3% while 3.8% had an eGFR <60mls/min/1.73m2. RiSK FACTORS OF ChRONiC KiDNEY DiSEASE
BMI was 31.8 ± 7.6 kg/m2 and waist circumference 95.9 iN GENERAl MEDiCiNE iN CONAKRY.
± 14.1 cm. Systolic BP, diastolic BP and mean arterial Kaba ML1, Camara M1, Béavogui M2, Bah AO1, Diakité F1, pressure was 135.6 ± 18.8 mmHg, 79.8 ± 11.1 mmHg and Baldé MS1, Traoré 98.4 ± 12.7 mmHg respectively. Mean serum cholesterol M1, Kourouma ML1, Diallo AAS3, Touré YI1 was 5.6 mmol/L, serum creatinine 74.2 μmol/L, eGFR 1Néphrologie Donka, Conakry, Guinea, 2Cardiologie I Deen, 89.2 mls/min/1.73m2 and UPCR 0.10 mg/mg. CKD was Conakry, Guinea, 3Médecine Interne Donka, Conakry, Guinea associated with higher BMI, waist circumference, blood The aim of our study was to detect chronic kidney glucose, diabetes and metabolic syndrome. Multiple logistic disease. This was a prospective study conducted over the regression analysis demonstrated increased risk of CKD period from 1 November 2011 to 31 January 2012. It with increasing blood glucose concentrations.
involved patients at risk of chronic kidney disease (CKD) Conclusion: In our study population CKD is common
hospitalized in the internal medicine at Donka National and associated with cardiovascular risk factors. The long- Hospital. The renal risk was defined by the presence of term complications are serious and expensive to manage abnormal markers of kidney damage and/or a decrease in and this therefore constitutes an important public health the glomerular filtration rate (GFR ≤ 60ml/ min). Patients problem in South Africa.
with no abnormal markers of kidney damage and kidney failure of stage 4 were excluded. The frequency of chronic kidney disease in internal medicine was 33%. Of 185 hospitalized patients, 61 (33%) had CKD, among them 35 (57%) were male (p ns). The mean age of patients was 56 TElMiSARTAN uSE lED TO REGRESSiON
± 19 years [16 years-95 years]. The main risk factors faced OF PROTEiNuRiA AND iMPROVEMENT iN
were: HBP (52%), age>60 years (41%), edema syndrome GlOMERulAR FilTRATiON RATE (GFR)
(26%), diabetes mellitus (18%), anemia (11%) , smoking iN SiCKlE CEll DiSEASE PATiENTS WiTh
(8%) and heart disease (7%). The average serum creatinine was 144 ± 80μmol / l [66-428], i.e a clearance (MDRD) of Fatiu Arogundade1, Abubakr Sanusi1, Muzamil Hassan1, A creatinine equal to 62 ± 29 ml / min [16-127]. Proteinuria Akinbodewa1, BO Omotosho1, NO Akinola0 ,2, MA Durosinmi0 ,2, A Akinsola1 cases and <1g / l in 32%. The clinical type of renal damage 1Department of Medicine, Obafemi Awolowo University, Teaching was vascular nephropathy (43%), glomerular (26%), Hospitals Complex, PMB 5538, Ile-Ife, Osun State, Nigeria., Ile- diabetic (10%) and interstitial (8%). Chronic renal failure Ife, Osun State., Nigeria, 2Department of Haematolog y, Obafemi African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) Awolowo University, Teaching Hospitals Complex, PMB 5538,., Ile- in 11(18%) and difficulties with access and blood flow in Ife, Osun State., Nigeria 11(18%) sessions. Complications varied from mild and transient to severe. They led to discontinuation of 13(21.3%) Kidney disease is a common cause of morbidity and dialysis sessions. One 1(2.7%) patient died. Complications mortality in Sickle Cell Disease patients with up to 5% of which occurred in the other sessions were successfully them developing end stage renal disease. Whereas as high as managed but improvement in renal function was dependent 38% of SCD patients have covert nephropathy which could on length of dialysis.
be retarded by drugs. We set out to assess the usefulness or Conclusion: Complications occurred commonly during
otherwise of Angiotensin Receptor Blocker (Telmisatan) paediatric haemodialysis and affected the duration and Therapy in SCD patients with microalbuminuria, overt efficiency of the procedure. Continued research is needed proteinuria and/or reduction in GFR.
to prevent, anticipate, and manage these complications. Methodology: Forty SCD patients were given Telmisartan
Preventive measures must include encouraging patients to (40 - 80 mg) daily and biochemical parameters were assessed present earlier to hospitals.
at 6 weeks and after 12 weeks. They were then repeated after 6 months of stopping Telmisartan therapy.
Results: Thirty nine (97.5%) completed the study with age
range of 18-56 years with a median of 27 years. The mean arterial blood pressure was 79.5±, 97.5 and 98.0 mmHg ANEMiA iN PATiENTS ON ChRONiC
at 0, 6 and 12 weeks respectively (p<0.0001). The median hEMODiAlYSiS: PREVAlENCE,
microalbuminuria level for 27 patients with microalbuminuria ChARACTERiSTiCS AND MANAGEMENT iN A
regressed from 15 to 10 and 5.0 mg/g at 0, 6 and 12 weeks lOW RESOuRCES SETTiNG.
respectively (p<0.0001) while the mean 24-hour urinary Francois Kaze Folefack1 ,2, Andre Pascal Kengne3, Alex Mambap protein level for 12 patients with overt proteinuria was 1.03± tatang1, Marcel 0.49, 0.57±0.16 and 0.45±0.10 g/day at 0, 6 and 12 weeks Monny Lobe1, Gloria Ashuntantang1 ,2, Dora Mbanya1 respectively (p<0.0001). The median glomerular filtration 1Faculty of Medicine and Biomedical Sciences of the University of rate (GFR) for 38 patients progressively increased from Yaoundé 1, Yaounde, Cameroon, 2Yaoundé General Hospital, 54.75 to 70.25 and 72.5 mls/ min/1.73m2 Body Surface Yaounde, Cameroon, 3South African Medical Research Council & Area at 0, 6 and 12 weeks respectively (p<0.0001).
University of Cape Town, Cape Town, South Africa Conclusion: Telmisartan therapy led to a reduction
Aim: We investigated the prevalence, characteristics and
in proteinuria and microalbuminuria and also improve management of anemia in patients on chronic hemodialysis glomerular filtration rate (GFR) in SCD patients.
and assess the response to blood transfusion based management in Cameroon.
Method: This was a cohort study of five months duration
(August-December 2008) conducted at the Yaounde General Hospital hemodialysis center, involving 95 patients (67 men, COMPliCATiONS ASSOCiATED WiTh
70.5%) on chronic hemodialysis by a native arterio- venous hAEMODiAlYSiS OF ChilDREN DiAlYZED
fistula. A monthly evaluation included full blood count, AT AhMADu BEllO uNiVERSiTY TEAChiNG
number of pints of packed cell and vital status.
Results: At baseline, 75 (79%) patients had anemia which
Rosamund Akuse, Mohammed Hassana, Eno Helen was microcytic and hypochromic in 32 (43%) patients. Ahmadu Bello University Teaching Hospital, Zaria, Nigeria Anemia was corrected in 67 (70.5%) patients using blood Background: Haemodialysis is the commonest form of
transfusion only while 28 (29.5%) patients were receiving renal replacement therapy used in Nigerian adults but is erythropoietin (11 regularly, 39%). Only 77.2% of 342 pints much less often used in children. Not much is known about (range 0-7 per patients, median 3.8) of packed cell prescribed complications associated with paediatric haemodialysis in were effectively received by patients during the follow-up at Nigeria. The aim of this study was to review complications an unacceptably high cost to patients and families. Mean associated with haemodialysis in paediatric patients at hemoglobin and mean corpuscular hemoglobin levels Ahmadu Bello University Teaching Hospital, (ABUTH) remained within the same range during follow-up, while mean Zaria, Nigeria.
globular volume increased. Being on erythropoietin was the Method: Retrospective audit of dialysis records and case
main determinant of favorable trajectories of hematological notes of children dialyzed at ABUTH.
markers. In all, 18 patients died during follow-up, with Results: Seventeen children (3 to 15 years) had a total of
neither anemia, nor baseline hematological parameters being 61 haemodialysis sessions (range 1-9 sessions per child) associated with mortality risk.
over a four year period. Indications for dialysis were severe Conclusion: Patients on chronic hemodialysis in this
Acute kidney Injury (AKI) 9(52.9%), Chronic kidney disease setting have a high prevalence of predominantly microcytic 3(17.6%), and acute on chronic renal failure in 5(29.4%) cases. hypochromic anemia, with limited capacity for correction Most patients presented to hospital late and were severely using blood transfusion only. Strategies to reduce the burden ill – 9(52.9%) had multiorgan dysfunction. Complications of anemia should include improved access other means for occurred in 6(35.3%) children during 38(62.3%) of the correcting anemia in dialysis and the creation of a national dialysis sessions and included problems with blood pressure (hypotension/hypertension) in 15(24.6%) sessions, seizures African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) Our study investigates this possible explanation for the high incidence of hypertension in Africans, in a Ghanaian ChilDhOOD iDiOPAThiC STEROiD
RESiSTANT NEPhROTiC SYNDROME iN
Materials & Method: DNA samples were obtained from
PORT-hARCOuRT, SOuThERN NiGERiA
957 of a cohort of 1,013 apparently healthy individuals, Ifeoma Anochie, Augustina Okpere, Felicia Eke who in 2001/02 had been recruited to an epidemiological University of Port Harcourt Teaching Hospital, Port Harcourt, study of hypertension and salt intake. They were residents Rivers State, Nigeria of 12 villages in the Ashanti region of Ghana. The Background: Childhood idiopathic steroid resistant extracted DNA was, in 898 individuals, of sufficient quality
nephrotic syndrome (iSRNS) is an important cause of end to allow genotyping at the CYP3A5*3 and CYP3A5*6 stage renal disease (ESRD). We undertook this study to SNPs by real-time polymerase chain reaction. Blood determine the prevalence, clinicopathologic characteristics, pressure was measured using an OMRON HEM705CP treatment and outcome of children with iSRNS in Port sphygmomanometer. The participants had sat for at least 5 Harcourt, Nigeria.
min before three pressures were obtained one minute apart; Materials & Method: A prospective study of patients with
the first reading was discarded and the mean of the second Idiopathic Nephrotic Syndrome (iNS) over a 6-year period and third calculated for analysis. Hypertension was defined (June 2006 to December 2012). Patients who were resistant as systolic BP ≥140 mmHg.
to steroid therapy for at least 4 weeks were further analysed.
Results: 244 (27.2%) of the 898 individuals were
Results: Of the 89 patients with iNS, 77(86.5%) and 12
hypertensive. Although there was a possible relationship (13.5%) were steroid sensitive nephrotic syndrome (SSNS) between blood pressure and degree of CYP3A5 expression, and iSRNS respectively. Patients with iSRNS were aged 3 - 16 there was no statistically significant relationship between years, with a higher mean age of 10.3 ± 4.8 years compared either systolic or diastolic pressure and CYP3A5*3 or to 7.4 ± 4.2 years among those with SSNS. There were more CYP3A5*6 genotypes and their haplotypes.
females with iSRNS (M:F =1:2). Three (25.0%) patients had Conclusion: We conclude that there is either no association
hypertension at presentation. Microscopic haematuria was between CYP3A5 expression and blood pressure or, if there commoner in patients with iSRNS (69.2%) compared to is a relationship, an association that is very weak.
those with SSNS (30.8%) [p = 0.000]. Renal biopsy of ten patients revealed focal segmental glomerulosclerosis (FSGS) in 80.0%; membraneous glomerulonephritis (10.0%) and membranoproliferative glomerulonephritis (10.0%). Alternative treatments given were cyclophosphamide OuTCOMES OF ChRONiC DiAlYSiS iN hiV-
(3 patients) and cyclosporine A (5 patients). Complete remission was achieved in only one patient after 6 months Fikile Zako, Benjamin Wambugu, Matey Radev, Saraladevi Naicker of regular treatment with cyclosporine A. Two (16.7%) University of Witwatersrand, Johannesburg, South Africa patients developed ESRD and died.
South Africa carries the highest burden of HIV infection Conclusion: The prevalence of iSRNS remains low in our
worldwide with about 5.6 million people living with the environment with the commonest histologic lesion being virus. There is a paucity of studies on outcomes of HIV- FSGS. We had few alternative therapies and cyclosporine A infected chronic dialysis patients in Africa.
was expensive and unaffordable resulting in poor outcome To determine outcomes of chronic dialysis in HIV-infected in these patients.
patients and predictors of survival, records of HIV-infected patients on dialysis for 3 months or longer between January 2001 and September 2012 were reviewed for demographic and clinical data.
Results: 59 patients were included, 55.9% female, 93.2%
lACK OF RElATiONShiP BETWEEN CYP3A5
black, 6.8% of mixed race. Mean age at dialysis initiation ExPRESSiON AND BlOOD PRESSuRE iN
was 37.16 ± 8.19 years. Mean follow up was 30.45 months hEAlThY ADulTS iN AShANTi, GhANA
(3.1-132.2 months). Cause of ESRD was unknown in David Fisher1 ,2, Jacob Plange-Rhule3, Michelle Moreton1, John 57.6%, 18.6% had hypertension, 11% had diabetes. Biopsies Eastwood4, Sally Kerry2, Frank Micah3, Francesco Cappuccio5, were done in 7 patients, 4 had HIVAN, 1 had HIVICK. Atholl Johnston1,2, Iain MacPhee4 62.7% were on peritoneal dialysis, 37.3% on hemodialysis. 1Analytical Services International, St George's, University of London, Median CD4 count was 230.5 cells/mm3 (3.0-499). HIV London, UK, 2Queen Mary University of London, London, UK, viral load was undetectable in 23 patients. 18 patients were 3Komfo Anokye Teaching Hospital, Kumasi, Ghana, 4St. George's, on HAART at dialysis initiation. Most hospital admissions University of London, London, UK, 5University of Warwick, were due to peritonitis (30.5%) and fluid overload (27.1%). Warwick, UK 30 patients died, 1 was transplanted. The commonest causes introduction: CYP3A5 protein substantially increases
of death were fluid overload (37.95) and peritonitis (31.0%). 6β-hydroxylase activity, which in turn stimulates the There was no correlation between dialysis modality and sodium-retaining actions of the mineralocorticoid receptor, outcome (p=0.922). Factors associated with mortality were potentially causing high blood pressure. Most Africans are low albumin (p=0.039) and low hemoglobin (p=0.049).
functional CYP3A5 expressers so one would expect to Conclusion: Peritonitis and fluid overload are important
find a relationship between CYP3A5 and blood pressure. causes of morbidity and mortality in HIV-infected patients African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) on dialysis. CD4 counts and viral load at dialysis initiation did median age was 47 ± 13 years with a male/female ratio of not impact on survival in our group. Dialysis modality did 1.21. Nephrosclerosis and diabetic nephropathy were the not impact on mortality.
main causes of ESRD. Forty five peritonitis episodes were diagnosed in 36 patients (58%) for a peritonitis rate of 1 episode/20 patient months. Staphylococcus aureus and Pseudomonas aeruginosa were the most commonly identified organisms. Touch contamination has been implicated in 26 ChRONiC KiDNEY DiSEASE iN GhANA
cases (57.7%). In 23 episodes (51%), bacteria cultures were Vincent Boima1, Charlotte Osafo2 ,1, Michael Matekole1 ,2, Adu negative. Catheter removal was necessary in 12 cases (26.6%) Dwomoa1 ,2 secondary to mechanical dysfunction, fungal or refractory 1Korle-Bu Teaching Hospita, Accra/Greater Accra, Ghana, infection. Sixteen patients 2University of Ghana died during the study.
Medical School, Accra/Greater Accra, Ghana Conclusion: Peritoneal dialysis is suitable therapy which
Background: The prevalence of chronic kidney disease is
may widely use for ESRD treatment in western sub-Saharan increasing rapidly in Africa and other parts of the world. Africa. A good peritonitis rate can be achieved despite the Previous data from Korle-Bu Teaching Hospital in Ghana, difficult living conditions of patients. Challenges to the show that 15% of all medical admissions have kidney development of PD programs include training health care disease. In addition 10% of all deaths on the medical ward providers, developing an infrastructure to support the are due to chronic kidney disease. Most patients with chronic program, and developing a cost structure which permits kidney disease in Ghana are aged between 20 and 50 years. expansion of PD program.
There are few recent data on the causes for chronic Kidney Disease (CKD) from Africa. Previous studies reported that glomerulonephritis and hypertension were the major causes of CKD in Africa. We reviewed data on 100 new admissions with CKD in 2012. The information extracted CONTRiBuTiON TO ThE STuDY OF
from patients' records included; demographic factors, renal POSTPARTuM ACuTE RENAl FAiluRE
diagnosis, cause of renal failure, presenting serum creatinine, (CONNECTiON OF 146 CASES COllECTED iN
and sonographic measurements of kidney sizes.
Results: 82% of the patients with CKD were aged between
Ahmed Tall LEMR ABOTT, El hadji Fary K A, Mouhamadou 20 to 69 years with a slight male preponderance (male to Moustapha CISSE, Maria FAYE, Sidy Mohamed SECK, Khodia female ratio of 1.1:1). The commonest cause of CKD was FALL , Abdou NIANG, Boucar DIOUF cheikh anta diop Hypertension (33%) followed by chronic glomerulonephritis university, dakar, Senegal (28%). Diabetes alone was a cause in 11% of patients. 12% Aim: The aim of this study was to determine epidemiological,
of the patients had both hypertension and diabetes. Kidney clinical, biological, etiological and therapeutic profiles of sizes: Right- between 9 t0 10.9cm for 62.5% of the patients ARF - pp, and to assess the materno- fetal prognosis.
and less than 8.0 cm in 25% of patients. Left- between 8 to Method: This is a retrospective study in the Department of
10.9cm in 67.3% of the patients and less than 8cm in 20.8% Nephrology at Aristide Le Dantec Hospital in Dakar over of patients.
a period of 10 years (2000-2009). Patients with pre-existed Conclusion: Most of the patients with CKD were young
impaired renal function before pregnancy were not included. and the commonest causes of CKD were hypertension and 146 patients with ARF – PP were surveyed. Prognosis factors were determined by comparing two groups of patients according to the favourable or unfavourable renal function Results: The hospital prevalence was 4.65%. The average
age was 31,01±6,63 years. The perinatal mortality was PERiTONEAl DiAlYSiS iN ESRD TREATMENT,
87.7%. The oligo-anuria was found in 82.2% of cases. The PilOT ExPERiENCE iN WEST AFRiCA
average blood creatinine and urea were 1.5 g/l and 96,08 Abdou Niang, Ahmed T. Ould Lemrabott, Mouhamadou M. Cisse, mg/l, respectively. The acute tubular necrosis was found Mamadou S. Balde, ElHadji Fary Ka, Boucar Diouf in 145 cases. This was always due to a childbirth bleeding Nephrolog y Department, CHU A. Le Dantec, Dakar, Senegal result of a retro-placental Hematoma in 60,27% of cases. introduction: Peritoneal Dialysis (PD) is rarely used in the
Hemolytic uremic syndrome was found in one case. The western sub-Saharan Africa to treat patients with end-stage hemodialysis treatment was used in 57.5% of the cases. The renal disease (ESRD). The present study is a retrospective recovery of renal function was complete in 45.9% of cases. review of the initial 6 years experience with PD in Senegal Poor prognosis factors were: The time limit of taking care, for ESRD therapy.
the rural origin of the patient, the hemorrhagic or septic Materials & Method: Single centre retrospective cohort
abortion, oliguria, serious renal impairment, the non-use of study of patients treated with PD between March 2004 to December 2010. Basic demographic data was collected on Conclusion: The Africa and specially the Senegal should be
all patients. Peritonitis rates, causes of death and reasons for implemented all our resources to combat the ARF-PP .The transfer to HD were determined in all patients.
most efficient tool of prevention is still a rigorous follow-up Results: Sixty two patients were included in the study. The
of pregnancies.
African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) the body, stored under the skin.
The excess sodium under the skin is bound to proteins RENAl BiOPSY iN ChilDREN AGED 2-15 YEARS
called proteoglycans and glycosaminoglycans. This iN ThE TEAChiNG hOSPiTAl OF DAKAR
makes the sodium osmotically inactive. This extra- Younoussa Keita, Cherif Dial, Assane Sylla, Mouhamadou renal mechanism of sodium handling was not Moustapha Cisse, Ahmed Tall Lemrabott, Maria Faye, El Hadji known before and is a new concept being presented Fary Ka, Aliou Ndongo, Claude Moreira, Abdou Niang, Boucar Diouf, Mohamadou Guélaye Sall, Mamadou Sarr Cheikh Anta The lymphatic vasculature forms a network that Diop University, Dakar, Senegal drains interstitial fluid from tissues and returns introduction: We report the results of a series of 31
it to venous system. Excess sodium in the biopsies kidneys for children, inteeching hospital Aristide interstitium leads to interstitial hypertonic sodium, Le Dantec between January 2010 and May 2011.
stimulates lymphatic growth through the activity of Materials & Method: This is a retrospective study a
macrophages. This sponges away the sodium making series of 31 renal biopsies with ultrasonography using it inert, and prevents excess fluid accumulation.
Silverman needle between January 2010 and May 2011. The sheet contained clinical information.we are using optic microscopy for the lecture.
Results: Thirthy one patients were collected. Mean age
was 9.19 years with a sex ratio of 1.8.
OuTCOME OF TREATMENT OF ChilDhOOD
The indications were dominated by nephrotic syndrome STEROiD RESiSTANT NEPhROTiC
corticoresistant, corticosteroid or multiple relapses in 24 SYNDROME WiTh COMBiNED PulSE
cases, followed modification of renal function (5 cases), CYClOPhOSPhAMiDE, PREDNiSOlONE AND
one case of tubulointerstitial nephropathy and proteinuria ACE iNhiBiTOR - A PREliMiNARY REPORT
in a lupus. We diagnosed in 14 cases of nephrotic syndrome Adanze Asinobi, Adebowale Ademola, Oluwatoyin Ogunkunle , minimal glomerular change (58.30%), 7 cases of focal College of Medicine, University of Ibadan/University College glomerular sclerosis (29.2%), 3 cases of MDS (12.5%), Hospital, Ibadan, Ibadan, Oyo State, Nigeria Other lesions were diffuse glomerulonephritis with introduction: Steroid Resistant Nephrotic Syndrome
crescent in 2 cases, 1 case of reduced nephron (3, 7%), 1 (SRNS) usually associated with a poor outcome, is a case of cortical necrosis, 1 case of acute tubular necrosis common occurrence in South West Nigeria. Unfortunately, and 1 case of lupus glomerulonephritis.
the prevalent high level of poverty in the country places Conclusion: the renal biopsy brings added value to the
the more effective drugs such as calcineurin inhibitors and understanding and treatment of renal diseases in children.
Rituximab out of the reach of the common Nigerian child.
Methodology: Children with SRNS managed at the
University College Hospital, Ibadan who underwent renal biopsy were treated with a combination of 6 doses of monthly intravenous Cyclophosphamide at 600mg/m2 , SAlT uNDER ThE SKiN
oral prednisolone at 40mg/m2 on alternate days and ACE Mohamed Abdullah inhibitor (Lisinopril or Enalapril at 0.2-0.6 mg/kg/day).
Aga Khan University Hospital, Nairobi, Kenya The necessary clinical and laboratory parameters were monitored. They have been followed up for periods ranging Extra-Renal Sodium handling
from 2months to 3years. Their records were reviewed and Sodium is the major cation in the extracellular fluid. The body contains about 200 gm. of sodium chloride.
Results: Eleven patients have so far completed the
Traditionally the kidneys are responsible for handling treatment schedule. Their ages ranged from 3.5 to 11years sodium and adjusting blood volume, In situations of with a male to female ratio of 1.8:1 and 7 had FSGS. Four excess, three mechanisms are brought into play: (36.4%) went into complete remission (CR), 5(45.4%) into ○ A feeling of thirst causing drinking, which dilutes partial remission (PR) and two (18.2%) patients did not respond. One of the non-responders and one of the partial ○ Drinking causes volume increase leading to passing responders lost to follow-up are dead.
urine thus enhan0cing sodium excretion.
Conclusion: This result suggests that in a developing
economy like Nigeria, the above drug combination could ○ The rest of the excess body sodium is tucked under serve as a first line treatment for SRNS in the absence the skin, which acts as a capacitor, till the extra salt of the ideal though more expensive combinations, and is removed. It is this third extra renal mechanism is therefore recommended. Efforts should however be which is the subject of discussion of this paper geared towards making available other immunosuppressive Modern diet gives us overdose of sodium 15-18 agents that could keep patients in remission and prevent grams rather than 5-6 grams that we need per day. progression to End-stage Kidney disease.
The kidneys and skin are the traditional ways to get rid of extra sodium. But kidneys can only get rid of 5 gm/ day and the skin can get rid of upto 3 gm as sweat. The remaining 8-10 gm of sodium is stuck in African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) Method: A retrospective review of 12 patients who
underwent live donor Kidney transplant in Korle Teaching SEROCONVERSiON TO hEPATiTiS B
hospital in Ghana from November 2008 to April AND C POSiTiViTY AMONG PATiENTS
ON MAiNTENANCE hAEMODiAlYSiS iN
Results: The age of the patients ranged between 24 and 57
CAMEROON: A SiNGlE CENTRE STuDY.
years (Median age of 40years. The mean serum creatinine Marie-Patrice Halle1, Henry Luma1, Vanessa Tchamago1, Francois at 9months was 106umol/l .There was no delayed graft Kaze2, Gloria function. Postoperative bleeding was observed in one patient. There was no vascular, thrombotic or urological 1General Hospital, Douala, Cameroon, 2Faculty of Medicine & complication seen. One patient had severe wound infection Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon leading to gaping of his wound and secondary suturing.
Background: Maintenance haemodialysis constitutes a
6 (50%) of the patients developed New Onset Diabetes high risk environment for both Viral Hepatitis B (HBV) and after Transplantation (NODAT). One patient developed hepatitis C (HCV) infections. While some patients enter the graft failure after one year on account of non- compliance. dialysis program with seropositivity for these viruses, most There was no mortality at one year but 2 patients died acquire the infection in the course of therapy. The aim of subsequently. One died from severe gastrointestinal this study was therefore to determine seroconversion rates ulceration with a functioning graft and the other from for HBV and HCV amongst haemodialysis patients in the cardiac arrest after 2 years on haemodialysis.
renal unit of Douala and to identify potential risk factors Conclusion: Although the numbers are too small to make
Materials & Method: This was a cross-sectional study
any definite conclusions, the outcome of the transplants conducted in the haemodialysis centre of the Douala done so far is good.
General Hospital in September 2012. No dialyzer re-use and no isolation policy is practised in the unit. Patients on dialysis for at least 4 months were studied. Relevant patient data was noted. Third and fourth generation ELISA assays were used for HBsAg (BIOREX), and HCV antibodies PREVAlENCE AND EPiDEMiOlOGY OF END
STAGE RENAl FAiluRE iN ChilDREN
Results: Ninety-seven patients were included in the study,
Sampson Antwi (64 M, 33F) Mean age was 50.9 ± 13.9 years. The mean Kwame Nkrumah University Of Science & Technolog y/Komfo dialysis duration was 32,7 ± 27,5 months ( range 5 -127). Anokye Teaching All patients had received blood transfusions on dialysis. Hospital, Kumasi, Ghana The seroprevalences of HBV and HCV were 4, 1%, and introduction: End-Stage-Renal-Failure (ESRF) defines
26, 8% respectively. Seroconversion rates were 1, 1% the stage of chronic kidney disease at which Renal (1 patient) for HBV and 11, 80% (9 patients) for HCV. Replacement Therapy (RRT) becomes necessary. At Only a longer dialysis duration was associated with HCV ESRF, death becomes imminent from severe uraemic complications and pulmonary oedema. In Ghana like Conclusion: The seroconversion rate for HCV is high in
most African countries, chronic RRT for children is non- our center. HBV seroconversion is low despite the absence existent. This may be due partly to under estimation of the of isolation for positive patients. Strict adherence to magnitude of the problem.
universal precautions may reduce these rates.
This study was undertaken to determine the prevalence of ESRF among children admitted with kidney disease and to establish the epidemiological distribution.
Method: Retrospective data review of children with kidney
diseases admitted to the nephrology unit of KATH over REViEW OF OuTCOMES OF KiDNEY
3-year period.
TRANSPlANTATiON iN GhANA
Results: Fifty-four (9%) of 600 children admitted with
Charlotte Osafo1, Bernard Morton1, J. E Mensah1, Michael Mate kidney diseases had ESRF, 28 males and 26 females.
Kole1, Nick Inston2 ,1, Graham Lipkin2, Andrew Ready2, Dwomoa Thirty-one (57.4%) were aged 10 years or more, 19 (35.2%) Adu1, Jennie Jewitt- Harris2 between 5 and 10 years. One (1.8%) was < 1 year.
1Department of Medicine and Therapeutics, University of Ghana Aetiology could not be established in 53.7% of cases. Medical School, Accra, Ghana, 2University Hospital Birmingham, Chronic glomerulonephritis accounted for 33.3%, CAKUT NHS Trust, Birmingham, UK 5%, urinary schistosomiasis 3.7%. Unresolved AKI and Background: Kidney transplantation is the treatment of
HIVAN accounted for 1% each.
choice for patients with end- stage kidney disease and it Discussion: Chronic glomerulonephritis continues to be
is cheaper in the long-term than haemodialysis. Kidney a major cause of ESRF among children in Africa. Most transplantation was started in Ghana in November. of the children had no prior history of overt renal disease Twelve successful transplants have been done so far. All and were presenting for the first time. It presupposes a 12 patients were on dialysis before transplantation. The significant proportion of subclinical disease which could average duration of dialysis was 24months.
have been detected by simple urine test.
Aim: To review the outcomes of live donor kidney
Conclusion: There is significant burden of ESRF in
transplants performed in Ghana children in Ghana. This calls for the establishment of African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) chronic RRT for children. Periodic urinalysis should be une perte accélérée du DFG>70 ml/mn/1,73ml/mn enforced in schools.
.Les patients qui avaient subit une dégradation accélérée de la fonction rénale étaient plus susceptibles d'avoir été hospitalisés et ou une lésion rénale aigue surajoutée à été diagnostiquée. La plupart des patients n'ayant pas reçu des soins en pré dialyse avait un risque plus élevé de décès dans l'ESTiMATiON DES RiSQuES DE
la première année après le début de dialyse.Conclusion :il COMPliCATiONS CARDiO-VASCulAiRES PAR
existe une grande hétérogénéité dans les pertes du débit lE CAlCul Du DFG PAR lA MéThODE DE
de filtration glomérulaire au cours de la période de 3ans menant à l'initiation de la dialyse . Ces résultats suggèrent Liela Azouaou, Mohamed Benabadji une approche plus souple à l'égard de la planification de CHU, alger, Algeria introduction: Le calcul du DFG à l'aide du CKD-EPI
estime le risque des complications cardio-vasculaires chez les malades avec maladies rénales chroniques que l'équation Matériels et méthodes: L'étude cohorte de 226 patients
lE SOMMEil POuRRAiT il êTRE CONSiDéRé
sur la comparaison du risque des complications des COMME uN FACTEuR DE RiSQuE DE
maladies cardio-vasculaires par le calcul du DFG selon 2 MAlADiES RéNAlES ChRONiQuES ?
méthodes : MDRD et CKD EPI Leila Azouaou, Mohamed Adoui, Mohamed Benabadji Résultats: Sur les 226 patients : 45% étaient diabétiques,
CHU, ALGER, Algeria 17% avec des maladies cardio- vasculaires, 20% avec des introduction: De nombreuses études ont montré que la
maladies rénales chroniques au stade 3 et 5 durée du sommeil est considérée comme un facteur de Sur une durée de 3ans, nous avons obtenu: 46 patients
risque prédictif de maladies cardio vasculaires, mais il n'a qui avaient développé une maladie cardio-vasculaire dont 20 pas été rapporté une association entre la durée du sommeil patients avec des maladies coronariennes, 10 cas d'accidents et les maladies rénales chroniques.
vasculaires cérébraux et 16 cas d'insuffisances cardiaques. Matériels et méthodes: Etude cohorte sur 142 patients
La méthode de CKD EPI a permis de reclasser les patients atteints de maladies rénales chroniques stades 3,4 et 5, âgés : les patients avec des DFG ≥90 ml/mn avaient moins de entre 20 et 70 ans risque de développer des maladies cardio-vasculaires Résultats: Durée de sommeil de base est de 6 h 66 % des
Conclusion L'utilisation de l'équation CKD EPI pour le
patients avaient une durée de sommeil < 5h , protéinurie calcul du DFG est meilleure que la méthode de MDRD de 24h ≥2 g /24 H avec MRC stades 4 et 5 en dehors des pour prédire le risque des complications cardio- vasculaires.
néphropathies glomérulaires 27 % des patients avaient une durée de sommeil entre 5 et 6h , protéinurie de 24h entre 1 et 2 g /24h , avec MRC stade 4 7 % des patients avaient une durée de sommeil ≥ 7 h, protéinurie de 24h <1 g /24 lES DiFFéRENTES TRAJECTOiRES DE
Discussion: Nous avons constaté que plus la durée du
lA DE DéGRADATiON DE lA FONCTiON
sommeil est moindre plus la protéinurie s'aggrave, et la RéNAlE ChEZ lES PATiENTS ATTEiNTS DE
fonction rénale s'altère MAlADiES RéNAlES ChRONiQuES
Conclusion: La baisse de la durée du sommeil pourrait
Leila Azouaou, Mustapha Adoui, Mohamed Benabadji être considérée comme un facteur aggravant la protéinurie CHU, Alger, Algeria et un facteur de risque de maladies rénales chroniques L'évaluation du trajet de la progression de la fonction rénale du stade de l'IRC au stade terminal est délicate. Celle-ci passe par une collaboration précoce du médecin généraliste et du néphrologue dont l'histoire de l'IRC est lE SOMMEil POuRRAiT il êTRE CONSiDéRé
variable suivant les patients. Certains évoluent lentement COMME uN FACTEuR DE RiSQuE DE
alors que d'autre rapidement.Objectif :Evaluer le trajet MAlADiES RéNAlES ChRONiQuES ?
de la progression du DFG de la MRC 3ans avant le début The ergamisol in the nephrotic syndrome of the African child: what de la dialyse .Patients et Méthodes :Etude cohorte portée contribution??? Adonis-Koffy Laurence, Diarrassouba Gnenefoly, sur 102 patients atteints de MRC .Résultats :Nous avons Niamien Ekou, Gorgui Jean- dentifié 4 trajectoires différentes du DFG :59,5% des Marc unit of pediatric nephrolog y of teaching hospital of Yopugon, patients présentaient une dégradation faible de la fonction Yopougon/ Abidjan, Cote D'Ivoire rénale avec une perte de DFG <30ml/ mn/1 .73 et une introduction: Nephrotic syndrome represents 0.26% of
pente moyenne de 8,2±3ml/mn. 27.2% présentaient une pediatric hospitalizations in CHU Yopougon. It is steroid- perte progressive du DFG 30-59 ml/mn/1,73 ml/mn et sensitive in 88% of cases, there is 70% of relapses during une pente moyenne de 20±2ml/mn/1,73. 11,2% avaient the decrease or discontinuation of corticosteroid therapy. une perte rapide de la fonction rénale >60 ml/mn/1,73 We describe our experience in the treatment of ergamisol (pente moyenne de 35±10 ml/mn/1,73. 2 ,1% ont subit for sensitive nephrotic syndrome.
African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) Methodology: This is a retrospective study to February
2001 at August 2009. 15 children with steroid-sensitive or steroid- dependent nephrotic syndrome who received SlEEP MAY BE CONSiDERED AS A RiSK
Ergamisol were collected.
FACTOR FOR ChRONiC KiDNEY DiSEASE?
Results: Nephrotic syndrome was pure in 53, 3% and
Leila Azouaou, Mohamed Benabadji 46.67% impure. The average age of patients was 10.12 years HOSPITAL , ALGIERS, Algeria at the time of using ergamisol. The average age of disease introduction: Many studies have demonstrated that the
progression was 5.4 years. The Indications of ergamisol duration of sleep is considered a risk factor predictive of was the frequent relapses (80%), non-observance with cardiovascular disease, but it was not reported an association corticosteroid therapy (7%), partial cortico-sensitivity (7%), between the duration of sleep and chronic kidney disease.
a leuconeutropenia during cyclophosphamide treatment Matériels et méthodes: Study cohort of 142 patients with
(7%). Remission was significantly associated with a lower chronic kidney disease stages 3,4 and 5, aged between 20 and threshold of corticosteroid (86.67%). the ergamisol stopping was justified in only 1 case by the occurrence of leucopenia Results: Sleep duration base is 6 hours 66% of patients had
Conclusion: The ergamisol should be popularized in Africa,
a sleep duration <5h, 24h proteinuria ≥ 2 g / 24 H with ensuring the availability of the drug. The possibility of stages 4 and 5 chronic kidney disease outside of kidney neutropenia requires a monthly biological monitoring.
glomerular 27% of patients had a duration of sleep between 5 and 6 h, 24 H proteinuria between 1 and 2 g / 24 with stage 4 chronic kidney disease %seven patients had sleep duration ≥ 7 h, 24 h proteinuria <1 g / 24 h, with Stage 3 chronic ASSESSMENT OF QuAliTY OF liFE OF
Discussion: We found that the longer the duration of sleep
PATiENTS WiTh END STAGE KiDNEY DiSEASE
is less proteinuria worsens, and kidney function deteriorates RECEiViNG ChRONiC hAEMODiAlYSiS iN
Conclusion: The decline in sleep duration could be
considered as an aggravating factor and proteinuria a risk Bernadette Chimera, Thokozani Chikondi, Martin Kamponda, factor chronic kidney disease Gavin Dreyer Malawi College of Medicine, Blantyre, Malawi introduction: Quality of life (QOL) of patients on
haemodialysis is often overlooked in developed and developing countries. Traditional dialysis outcomes including DiFFERENT TRAJECTORiES DEGRADATiON
haemoglobin, phosphorus and calcium may not be available OF RENAl FuNCTiON iN PATiENTS WiTh
in developing nations. This study assessed QOL of patients ChRONiC KiDNEY DiSEASE
receiving chronic haemodialysis in Malawi.
Leila Azouaou, Djamel Adoui, Djamila Ould Abderhmane, Methods: This was a cross-sectional study and participants
Mohamed Benabadji hospital, algiers, Algeria were recruited based on a convenience sampling approach. introduction: The evaluation of the path of progression
Patients were included if they had been on dialysis for more of renal function stage of CKD to end stage is difficult. than three months in order to ensure their responses were an Even if it is not possible, effective planning of dialysis and accurate reflection of the QOL on haemodialysis. We used transplantation should be sought. Some evolve slowly while the kidney disease quality of life short form 36 (KDOQL- another quickly.Objective: To evaluate the path of progress SF36) questionnaire to collect QOL data.
of GFR of CKD over a period of 3 years before the start Results: Twenty-two out of 25 eligible haemodialysis
of dialysis : estimate the frequency of different trajectories patients were recruited from three dialysis centres in Malawi: of kidney functionPatients and Methods: Cohort study worn 59.1% were males and their median age was 44 years. The on 102 patients with chronic kidney disease 2 most common causes of end stage kidney disease were Results: We dentifié :59.5% of patients had a very low
diabetes and hypertension (45.5% in total). The median degradation of kidney function with loss of GFR <30ml/ duration on dialysis was 20.6 months. From a possible score mn/1 .73 and an average slope of 8.2 ± 3ml/mn; 27.2% of 100, representing optimal QOL, the mean scores for the showed a progressive loss of GFR 30-59 ml/mn/1, 73 ml three main domains of the KDQOL- SF36 were 50.4 (SD / min and an average slope of 20 ± 2ml/mn/1, 73; 11.2% 22.8) for the physical composite summary, 61.3 (23.0) for the had an accelerated loss of kidney function> 60 ml/mn/1, mental composite summary and 67.9 (13.2) for the kidney 73 (average slope of 35 ± 10 ml/mn/1, 73 ; 2, 1% have disease composite summary.
undergone a catastrophic loss of GFR> 70 ml/mn/1, 73ml/ Conclusion: QOL is poor in haemodialysis patients in
mn Patients who had suffered a catastrophic deterioration of Malawi and physical health issues predominate. Possible kidney function were hospitalized or had acute kidney injury explanations include the relatively young age of our cohort superadded to diagnosed .Most patients who did not receive and short time on haemodialysis. Interventions to improve pre dialysis treatment had a higher risk of death in the first QOL for haemodialysis patients in Malawi need to be multi- year after the start of dialysis.Conclusion:We observed a faceted with an emphasis on alleviating physical symptoms.
large heterogeneity in the loss of GFR during the period of 3 years leading to the initiation of long-term dialysis. These results suggest a more flexible approach with regard to planning the management of chronic renal failure.
African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) Conclusion: Calcitriol Oral is commonly used to treat
ThE ESTiMATED RiSK OF CARDiOVASCulAR
secondary hyperparathyroidism in patients with CKD but COMPliCATiONS iN ThE CAlCulATiON OF
the magnitude of the response to PTH TRT is highly variable GFR BY CKD EPi METhOD
Leila Azouaou, Mohamed Benabadji Hospital, Algiers, Algeria introduction: The calculation of GFR using the CKD-
EPI estimates the risk of cardiovascular complications in ChAllENGES OF MANAGiNG KiDNEY
patients with chronic kidney disease than MDRD equation DiSEASES iN RESOuRCE POOR COuNTRY
Materials And Methods: The study cohort of 226 patients
Folashade Adekanmbi, Tinuade Ogunlesi comparing the risk of complications of cardiovascular Olabisi Onabanjo University Teaching Hospital Sagamu Ogun State disease by calculating the GFR using 2 methods: MDRD Nigeria, Sagamu/Ogun,, Nigeria Background: With economic reccession and non availabity
Results: Of the 226 patients 45% had diabetes, 17% with
of established health insurance, cost of care for kidney cardiovascular disease, 20% with chronic kidney diseases Objective: To find out challenges associted with managing
Over A Period Of 3 Years, We Got: 46 patients who
glomerular diseases glomerular di diseases seen between developed cardiovascular disease, including 20 patients Feb 2006 to 6eb 2011. were studied.Information collected with coronary heart disease, 10 cases of cerebrovascular include biodata,laboratory investigation, biopsy and dialysis accidents and 16 cases of heart failure. The method of Results: 110 renal cases were seen during the
CKD EPI has reclassify patients: patients with GFR ≥ 90 period,30(27.3%) had glomerular disease with male :female ml / min were less likely to develop cardiovascular disease 2.3:1.Glomerulonehritis accounted for18/30, 12 of these conclusion Using the CKD EPI equation to calculate GFR were acute and 6 were chronic while nephrotic accounted is better than the MDRD method to predict the risk of for40% of the cases. Only 7 did ultrasound scan,3 did biopsy. Of the 7who needed dialysis one one had it done.4 death were recorded.
DEFiCiENCY OF ViTAMiN D AMONG
ThE TuAREGS WiTh ChRONiC KiDNEY
ThE CliNiCAl PRESENTATiON OF KiDNEY
DiSEASE STAGES 3AND 4 AND EFFiCACY OF
DiSEASE iN ADulTS AT A CENTRAl hOSPiTAl
iN MAlAWi
Leila Azouaou, Mohamed Benabadji Gavin Dreyer Hospital, Algiers, Algeria Malawi College of Medicine, Blantyre, Malawi introduction: The Vitamin D is essential for the
introduction: No studies have examined how kidney
regulation of the synthesis of parathyroid hormone disease in adults presents to health services in Malawi and (PTH). It is recommended measure serum 25 (OH) D and correspondingly, there is no outcome data from admissions supplementing any deficiencies identified matériels and with kidney disease. This study examined the clinical méthods:Cohort study of 54 patients of Algerian origin (29 presentation and outcomes of kidney disease in a central Targuis, 25 non Targuis) with CKD stages 3and 4. hospital in Malawi to enhance service provision, determine Results:median Values: GFR 28- 27 ml / min (25-52 ml
research opportunities and improve outcomes.
/ min),25 (OH) D: 15 (10-30) ng / ml, mean concentration Methods: A new nephrology service at a central hospital
of PTH initial: 199 (150-250) pg / ml,PTH relative change in Malawi has been established. Routine, fully anonymised, 34pg/ml for patients on calcitriol and 20pg/ml for patients demographic, laboratory and clinical data were prospectively started on alfacalcidol .Relationship between PTH and collected over 2 years in adults of 16 years with kidney VITD: There is a relationship between Vitamin D and disease. Clinical and laboratory parameters were analysed by PTH, the higher the concentration of Vit D is low more a nephrologist to determine the likely cause and nature of PTH is inversely proportional.Threshold slope failure of kidney disease.
the PTH value of 18 ng / ml for Targuis and 10ng/ml for Results: 213 patients were referred in the first 2 years of the
non Targuis same région.The base dose of Vit D is smaller service, 118 male (55.4%), mean age 40.3 years, 66 (31.0%) patients Targuis compared to other patients not Targuis. HIV positive. 148 (69.5%) patients presented with evidence The response of patients treated with PTH Calcitriol is of chronic kidney disease, 43 (20.2%) with acute kidney more important than patients treated with Alfa-calcidol.
injury, and 12 (5.6%) with acute on chronic kidney disease. Discussion: The basal Vit D in Tuareg is less important
Glomerular disease was the primary renal disorder in 32.4% than non Tuareg in the same region. PTH rises more quickly of patients. 15/31 (48.4%) patients with acute kidney injury for a comparable concentration of Vit D Calcitriol and and 17/55 (30.9%) of patients with chronic kidney disease alfacalcidol are widely used in the treatment of secondary died during admission irrespective of the underlying cause hyperparathyroidism. PTH response of patients treated or severity of kidney disease.
with calcitriol is more important than patients treated with Conclusions: Patients present with advanced kidney disease,
African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) the inpatient mortality is high and glomerular pathology exists. Studies in Caucasian and Asian (Chinese; Japanese) is the main aetiological factor. Intensification of efforts populations, and one of African Americans, describe to detect kidney damage earlier combined with optimised elevated abnormally degalactosylated IgA1 molecules clinical care and improved laboratory services are required in sera, exposing the GalNAc antigen. There is a lack of to reduce the morbidity and mortality associated with this pathogenetic data on IgAN in Africa.
condition in Malawi.
Aim: To study the O-glycosylation of serum IgA1 molecules
in a multi-ethnic population of IgAN patients in KwaZulu Natal, South Africa.
Materials And Methods: - An ELISA based lectin binding
assay was used to measure and compare the level of IgA1 VERBAl AuTOPSY STuDY iN ADulT
degalactoslyation between IgAN patients and controls. GhANAiANS iN ThE AShANTi REGiON:
Participants included individuals of African, Caucasian, PREliMiNARY FiNDiNGS hiGhliGhTiNG
Coloured, Indian (predominantly) and mixed-race descent. ThE iMPORTANCE OF CARDiOVASCulAR
Nineteen IgAN patients at various stages and 20 healthy controls were recruited between 2005 and 2011. The John Eastwood1, Frank Micah2, Sally Kerry3, Jacob Plange-Rhule4 mean absorbance values were recorded. A non-parametric Wilcoxon matched pairs test was used accordingly. The two- MacPhee1, Francesco Cappuccio5 tailed p value was used to assess for statistical significance 1St George's, University of London, London, UK, 2Komfo Anokye between the groups.
Teaching Hospital, Kumasi, Ghana, 3Queen Mary University of Results: When all the means of the tests were compared,
London, London, UK, 4Kwame Nkrumah University of Science and the average means of the tests of the IgAN patients was Technolog y, Kumasi, Ghana, 5University of Warwick, Warwick, UK 0.3678±0.0790(SEM) which is statistically significantly introduction In 2001/02, 1,013 adults [385 men, 628
greater than the normal controls which was 0.2969±0.0586 women], aged 40-75 living in 12 villages in Ashanti, Ghana (SEM) (p = 0.0076). IgAN patients exhibited abnormal were studied. Overall, 28.7% had a BP ≥140/90. 125 IgA1 O-glycosylation with a greater level of terminal participants had a GFR < 60 mL/min/1.73 m2.
degalactosylation of IgA1 in comparison to normal controls.
Methods The 12 villages were re-visited in 2011/12; 208
Discussion: This finding is consistent with that of other
participants had died. Using the WHO document Verbal populations globally; supporting a universal strategy for autopsy standards [2007], it was possible to identify a therapeutic or curative agents that target this aberrancy.
respondent for 201 of the deceased (96.6% response rate). Each respondent was interviewed, from which it was possible to assign a WHO category for cause of death.
Results Overall death rate at 10 years was 20.5%: men
29.3% [113/385], women 15.1% [95/628]. Diseases of the AN ANAlYSiS OF PERiTONEAl MEMBRANE
circulatory system [VA04] accounted for 54 deaths (25.9%): TRANSPORTERFuNCTiON iN CAPD PATiENTS
28.3% [32] in men and 15.2% [22] in women. Overall, AT iNKOSi AlBERT luThuli hOSPiTAl,
8.3% [32] of the original 385 men, and 3.5% [22] of the DuRBAN, SOuTh AFRiCA.
628 women, died of cardiovascular diseases. 10 deaths were Sudesh Hariparshad1 ,2, Busi Msomi2, L Kalliden1 ,2, Alain classified as VA07 [Renal disorders].
Assounga1 ,2 Conclusions These initial observations show that in a
1Dept of Nephrolog y, University of KwaZulu-Natal, Durban, healthy Ghanaian population cardiovascular disease, as South Africa, 2Inkosi defined by verbal autopsy, is an important cause of death. Albert Luthuli Central Hospital, Durban, South Africa Renal disease, though less common than other cardiovascular Background: Peritoneal dialysis remains a practical and
causes of death, is nevertheless an important underlying risk cost effective form of dialysis especially in resource limited factor, potentially amenable to preventive strategies through countries. It is necessary to determine the membrane risk factor modification.
function in order to tailor the dialysis prescriptions. We analysed the proportion of different membrane types at our facility and compare them with other data from other Method: The Peritoneal equilibration tests of 53
ABNORMAl iGA1 O-GlYCOSYlATiON iN
consecutive patients were interpreted using the Adequest A MulTi-EThNiC POPulATiON OF iGA
2.0 programme from Baxter R based on a standard 4 hour NEPhROPAThY PATiENTS iN KWAZulu
test. The tests were performed from October 2010 until NATAl, SOuTh AFRiCA.
Prishani Nansook1, Alain Assounga1 ,2 Results: There were 30 females and 23 males. The age
1Dept of Nephrolog y, University of KwaZulu-Natal, Durban, range was 21 to 64 years and the mean age was 43.4 years. South Africa, 2Inkosi The PET was done between 4 months to 2 years after Albert Luthuli Central Hospital, Durban, South Africa initiation of chronic ambulatory peritoneal dialysis. High Background: IgA nephrology (IgAN) is a leading cause
transporters accounted for 31% of patients. High average of chronic kidney disease worldwide. The pathogenesis transporters made up 41% of membranes. There were is poorly understood and no curative therapy currently 26% low average transporters and 2% low transporters. African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) The mean KT/V and creatinine clearance were 1.75 and 55.31 L/week, respectively. The average albumin was 34.06 g/l and the mean body surface area was 1.75 square meters. PROTEiNuRiA, GRAFT OuTCOME AND
Black African patients accounted for 47% of patients. Sub- CARDiOVASCulAR RiSK AMONG KiDNEY
analysis of Black African patients showed that 36% were TRANSPlANT RECiPiENTS iN A SOuTh
high transporters and 40% high average transporters. There AFRiCAN PuBliC hOSPiTAl.
was no statistically significant difference compared to the Aminu Muhammad Sakajiki1, Saraladevi Naicker1, Sagren Naidoo1, non-Black group (p=0.6487, using Chi-square test).
Wambugu Benjamin Conclusion: Our study revealed that peritoneal membrane
Maranga1, Russel Britz2, Pravin Manga3, Nazir Muhammad Shehu3 function was similar to those seen in Saudi Arabia, Canada, 1Division of Nephrolog y, University of the Witwatersrand, New Zealand and India. The analysis helped improve Johannesburg, South Africa, 2Division of Vascular Surgery, University prescriptions for CAPD.
of the Witwatersrand, Johannesburg, South Africa, 3Division of Cardiolog y, University of the Witwatersrand, Johannesburg, South introduction And Aim: Protienuria is a marker of poor
graft survival and an independent risk factor for total and CAROTiD iNTiMA MEDiA ThiCKNESS AND
cardiovascular mortality in the transplant population. In this CARDiOVASCulAR RiSK FACTORS iN KiDNEY
study, we aimed to determine the prevalence of proteinuria in our kidney transplant recipients (KTRs) and its relationship Aminu Muhammad Sakajiki1, Saraladevi Naicker1, Sagren Naidoo1, with graft function and cardiovascular risk factors.
Wambugu Benjamin Methodology: Patients aged 18 years and above who received
Maranga1, Russel Britz2, Pravin Manga3, Nazir Muhammad Shehu3 kidney transplant at the Charlotte Maxeke Johannesburg 1Division of Nephrolog y, University of the Witwatersrand, Academic Hospital between January 2005 and December Johannesburg, South Africa, 2Division of Vascular Surgery, University 2009 were recruited. A questionnaire that captured various of the Witwatersrand, Johannesburg, South Africa, 3Division of cardiovascular risk factors was administered. Patients records Cardiolog y, University of the Witwatersrand, Johannesburg, South were assessed for information on their post transplant follow up. Body mass index (BMI) and waist circumference were introduction And Aims: Cardiovascular disease (CVD) is
determined. Echocardiography and carotid doppler were common in kidney transplant recipients (KTRs) and majority done using Philips iE33 machine (Philips Corporation of death following transplantation is due to CVD.
USA). Framingham Risk Score was used to categorize Carotid intima-media thickness (cIMT), is a proven surrogate patients cardiovascular risk. Graft dysfunction was defined of atherosclerosis. In this study we aimed to determine the as estimated GFR of less than 60 ml/min/1.73m2 based on prevalence and predictors of cardiovascular risk among the modification of diet in renal disease equation. Results KTRs at the Charlotte Maxeke Johannesburg Academic were analyzed using statistical package for social sciences Hospital, South Africa and to examine the relationship version 17, p value of 0.05 was considered significant.
between cardiovascular risk factors and cIMT.
Results: Proteinuria was present in 51%, the mean ± SD
Methods: Patients aged 18 years and above who received
urinary protein excretion per day was 1.67 ± 2.00 with a range kidney transplant between Jan 2005 and Dec 2009 of 0.4 to 9.4. Proteinuria correlated with graft dysfunction, were recruited. A questionnaire that captured various increased left ventricular mass index, high CVD risk and cardiovascular risk factors was administered. Patients records anaemia. Graft function correlated with physical exercise.
were assessed for information on their post transplant follow Conclusion: Proteinuria is a marker of graft dysfunction
up. Echocardiography and carotid doppler were done. and is associated with high cardiovascular risk in our KTRs. Framingham Risk Score was used to categorize patients Strategies aimed at reducing proteinuria including blood CVD risk. Results were analyzed using statistical package for pressure control and physical exercise in kidney transplant social sciences version 17, p value of 0.05 was considered recipients are recommended.
Results: 100 patients (63 male, 37 female) were recruited
with a mean age of 42.2+-12.42, range of 19 to 70 years. Thirty six patients (36%) were high cardiovascular risk. Predictors of higher CVD risk were proteinuria (p=0.022), COMPARATiVE EVAluATiON OF ThE
higher cumulative steroid (p=0.028), triglycerides (p=0.04) GlOMERulAR FilTRATiON RATE iN
and plaques in the carotid artery (p=0.012). Mean cIMT of PATiENTS WiTh ChRONiC KiDNEY DiSEASE,
the study population was 0.62+- 0.21 mm with a range of BY ThE FORMulAS OF COCKROFT-GAulT
0.42 to 1.45 mm, 14 (14%) had a carotid artery plaque. Age, AND MDRD AT CONAKRY.
BP, LVMI, presence of plaque, BMI and waist circumference Kaba ML , Nanda OYN, Bah AO, Kourouma ML , Diakité F, showed positive correlation with cIMT.
Baldé MS, Traoré Conclusion: CVD risk was high and correlates with cIMT in
M, Touré YI our KTRs. Routine follow up should include measurement hopital donka, conakry, Guinea of cIMT in KTRs.
Our work had for objective to estimate and to compare the GFR (glomerular filtration rate) calculated by the two formulas, C-G (COCKROFT-GAULT) and MDRD African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) (modification of the Diet in the renal disease) of patients with Tenofovir.Early identification of renal dysfunction with CKD (chronic kidney disease) in Guinean. The or toxicity and withdrawal of the offending drug before survey was retrospective and descriptive, back up to the development of irreversible tubular injury is vital.The 2010 to 2008. 323 cases of CKD were found among the effects of tenofovir are reversible with withdrawal of the 743 hospitalizations registered on that period. Only the stages III, IV and V of the CKD were considered. The clearances have been calculated by the two formulas: C-GS and MDRDS. CKD prevalence was 43, 5%. The average age of the patients was 47[18-90]. They were 174 (54%) men and 149 (46%) women either a sex-ratio of 1, 2. The TREATMENT OF STEROiD-RESiSTANT
average creatininaemia was 672 µmol/L (168-2854). The NEPhROTiC SYNDROME iN ChilDREN iN
average valued GFR was 16,2 mL/min by C-GS and 21,1 mL/min by MDRD. According to age, the patients of less Louise Day1, Hasan Imam1, Martin Christian2 than 50 years old were 202 (63%) by C-G and 210 (65%) by 1L AMB Hospital, Parbatipur, Dinajpur, Bangladesh, 2Nottingham MDRD; those of more than 50 years old were 121(37%) by Children's Hospital, Nottingham, UK C-G against 113(35%) by MDRD. According to the sex and We report two cases of nephrotic syndrome in rural the CKD stage, they were 11% men, 12% women by C-G, Bangladeshi children (a girl of 2 y and a boy of 3 y). In and 5% men, 8% women by MDRD at the stage III. For both cases, the disease did not respond to 4 weeks of high the stage IV they were 14% men and 15% women by C-G dose oral prednisolone. The girl was steroid-resistant from against 11% men and 12% women by MDRD. At stage V the outset whereas the boy had an initial episode which the men were 28% the women 27% by C-G against 29% responded to conventional oral corticosteroids. The girl had and 27% respectively by MDRD.
received several second-line agents from a teaching hospital including ciclosporin, which could not be monitored in a rural hospital setting. Both children had severe episodes of sepsis requiring in-patient treatment for intravenous TENOFOViR iNDuCED RENAl TuBulAR
Both children entered remission 2-9 weeks after DYSFuNCTiON: A CASE REPORT
commencing a regime of intravenous methylprednisolone Patience Sigwadi pulses and oral cyclophosphamide, based on the so-called 1Military Hospital, Thaba Tshwane, Pretoria, South Africa "Mendoza regime". They each received a total of 12 weeks Background: Survival of patients infected with HIV after
of cyclophosphamide at 3 mg/kg/d. Both children remain introduction of HAART has led to discovery of the many in remission with a follow-up of 4-6 months.
side effects of these drugs,Tenofovir is one example and it The management of childhood steroid-resistant nephrotic is a mitochondrial toxin.
syndrome can be challenging in resource-rich countries. In Case Report: A 10 year old girl presented with weight
rural areas in the developing world, additional difficulties loss,weakness of lower limbs,bone pain and skeletal such as limited laboratory facilities and the prohibitive cost deformities over a period of 6 months.She could no of drugs which is usually borne by the family make this longer walk.She has been on her second HAART a particular challenge. Intravenous methylprednisolone regime consisting of Tenofovir,Zidovudine and Kaletra and cyclophosphamide are relatively cheap drugs and may for 3 years.At the time of presentation she had severe be safely given without plasma biochemistry monitoring. muscle wasting,skeletal manifestations of rickets:pectus The use of remote paediatric nephrology advice enabled carinatum,Harrison sulci,splaying of the ends of long families to remain close to home where concordance with bones and a dinner fork deformity of the right wrist. therapy is likely to be enhanced as a result of less economic Urine dipsticks showed proteinuria and glucosuria.Urine family disruption chemistry tests revealed aminoaciduria,u-phosphate 21.7mmol/l,u-protein:creatinine ratio 0.65 g/mmol,u- β2microglobulin:creatinine ratio 34.4.Blood investigations showed hypokalemic metabolic acidosis with serum- phosphate 0.56mmol/ l,TRP 51.8%, s-creatinine 36µmol/ ESTiMATED GlOMERulAR FilTRATiON
l,s-calcium 2.38mmol/l,s-ALP 2191 U/l,PTH 51.9ng/l.S- RATE AT iNiTiATiON OF hAEMODiAlYSiS iN
25(OH)D2,25(OH)D3 and 1.25dihydroxy Vit D levels were A NiGERiAN TERTiARY CENTRE.
normal.The results were in keeping with De Toni Fanconi Ogochukwu Okoye1, Ayo Odonmeta1, Evelyn Unuigbe0 ,2 Syndrome X-rays of the long bones showed widening of 1Delta State University Teaching Hospital, Oghara, Delta State, the growth plate and splaying,fraying and cupping of the metaphysis and Salter Harris V fracture of the right wrist.She 2University Of Benin Teaching Hospital, Benin City, Edo State, was treated with Phosphate Sandoz,one alpha (Alfacalcidol) and sodium bicarbonate.Tenofovir was replaced with Background: Decreasing glomerular filtration rate generally
Abacavir.After 6 months of therapy her skeletal deformities depicts progression of renal disease and renal replacement has largely resolved,height improved:117-124 cm,s-ALP therapy is indicated as patients approaches end stage renal decreased from 2191 to 229U/l. Conclusion:Monitoring disease. The GFR of end stage renal disease patients at of renal tubular function is important in children treated initiation of haemodialysis varies depending on factors African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) including, comorbidities, physicians practice, geographical was a significant negative correlation between haemoglobin region amongst others.
concentration and GFR as well as serum creatinine Aim: To determine the levels of estimated GFR of ESRD
(Pearson's correlation -0.647 and -0.687respectively).
patients at initiation of haemodialysis. To determine the Conclusion: Anaemia is highly prevalent among
association between variables such as sex, age, comorbidities patients seen in the renal outpatient clinic. Haemoglobin on one hand and time of initial dialysis.
concentration is directly proportional to GFR of patients. Method: This is a hospital-based retrospective observational
There is no significant relationship between haemoglobin study. Records of all ESRD patients dialysed over a 6 concentration and age of the patients.
month period were collated. Patients with acute on chronic kidney disease were excluded. GFR was estimated using MDRD formula. Early dialysis was defined as dialysing at an estimated GFR of >10ml/min. Data analysis was done using SPSS version 17.
SCREENiNG FOR hYPERTENSiON AND
Results: Mean age was 45±18 years while male to female
OBESiTY iN A RuRAl POPulATiON iN
ratio was 1.2: 1. Prevalence of hypertension and diabetes among patients was 57.7% and 20.5% respectively. Mean Ogochukwu Okoye, Isoken Idenigbe serum creatinine concentration was 12.6±7.1 mg/dl while Delta State University Teaching Hospital, Oghara, Delta State, mean estimated GFR was 14.3±7.6 ml/min. The early dialysers constituted 65.4% of the patients studied. Background: Obesity, defined as Body mass index
There was no significant association between age, sex, (BMI) >30Kg/m2 and Hypertension are among the hypertension, diabetes on one hand and time of dialyse on commonest risk factors for cardiovascular disease globally. The prevalence rates of both are said to be high even in Conclusion: Majority of ESRD patients in the centre
developing nations and are also contributory to the rising dialysed early and no predictor of the time of dialysis was prevalence of CKD.
identified. Further research geared towards identifying Aim: To determine the prevalence rates of Hypertension
possible predictors of early dialysis among ESRD patients and Obesity in the study population. To determine any is required.
relationship between blood pressure and BMI in the Method: This is a community-based cross-sectional study.
Consenting 350 individuals were recruited consecutively as they presented for voluntary screening during the hAEMOGlOBiN CONCENTRATiON PROFilE
2012 ‘world kidney day' celebration. Blood pressure was OF RENAl PATiENTS SEEN iN DElSuTh
measured using an Accosson sphygmomanometer and an average of 3 readings taken as BP. Weight and Height were Ogochukwu Okoye, Ayo Odonmeta measured using a stadiometer.
Delta State University Teaching Hospital, Oghara, Delta State, Results: Mean age was 37±13 years while sex ratio was
1.3: 1 in favour of females. Prevalence of Obesity and Background: Anaemia is defined as a haemoglobin below
Hypertension were 88.5 per 1000 and 168.5 per 1000 14g/dl in males and <12g/dl in females. It is one of respectively. Mean BMI was 23.15± 4.35 Kg/m2 while commonest features of significant decline in renal function. mean systolic and diastolic blood pressure were 119± 21 Haemoglobin concentration of renal disease patients vary mmHg and 72±13mmHg respectively. Blood pressure and depend on a number of factors, however it is largely increased significantly with age. There was a significant directly proportional to glomerular filtration rate.
association and a positive correlation between BP and BMI Aim: To determine the haemoglobin concentration
(p=0.0001, Pearson's correlation +0.202).
profile of patients referred to the renal outpatient clinic. Conclusion: The prevalence of Obesity and hypertension
To determine the relationship between haemoglobin are high in the population studied and Blood pressure concentration and renal function of patients.
increases significantly with increasing BMI.
Method: This is a hospital-based prospective observational
study. Consenting 74 patients were recruited consecutively as they presented for initial assessment at the renal outpatient clinic. Sociodemographic data was collated using an open ended questionnaire. Haemoglobin concentration A CASE OF SOliTARY MulTilOCulAR CYSTiC
and serum creatinine were measured using the Reflotron® KiDNEY WiTh SEVERE PYONEPhROSiS
analyser and appropriate strips. GFR was estimated using Ogochukwu Okoye, Leslie Akporiaye MDRD formular Anaemia was defined as haemoglobin ≤ Delta state university teaching hospital, Oghara, Delta state, Nigeria 12g/dl. Data analysis was done using SPSS version 17.
A 23year old Nigerian lady, was admitted with a history Results: Mean age was 50±16 years while sex ratio was 1.64:
of recurrent right flank pain for 5 years and right sided 1 in favour of males. Prevalence of anaemia among patients abdominal swelling first noticed 5 months prior to was 76.16%. Mean haemoglobin concentration was 10.0 presentation. A further history of associated fever, ±2.8g/dl. Serum creatinine ranged between 0.5-10.0mg/dl vomiting, passing foul smelling purulent urine and bilateral while mean estimated GFR was 63.2±50.8ml/ min. There leg swelling prompted nephrology referral. Medical history African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) revealed recurrent treatment for urinary tract infection and =-0.255; p=0.04). All recruited patients had markedly reccurrent spontaneous abortions. She had just delivered a elevated fractional excretion of potassium (FEK) while pre-term foetus that eventually died of septic complications. 98.6% had elevated fractional excretion of sodium (FENa). Physical examination revealed a young febrile lady, with Hyposthenuria was present in 85.7%. GFR correlated palor, grade IV digital clubbing and bilateral pitting pedal negatively with percentage sickle cell count(r=-0.616, oedema. Her abdomen was distended with a large tender p<0.0001), FEK(r=-0.448, p<0.0001) and FENa(r=-0.336; mass measuring 20cm by 24cm at the right lumbar region p=0.004). Of the 22 successfully biopsied patients, renal extending to her iliac fossa. Dipstick urinalysis showed histology revealed mesangioproliferative glomerulonephritis turbid urine with blood and leucocytes. Complete blood in 11 (50%), 6 (27.3%) had minimal change disease, 3 (13.6%) count revealed leucocytosis, haemoglobin 6.6g/dl, platelets had focal segmental glomerulosclerosis while interstitial 524,000/mm3. Serum creatinine was 0.5mg/dl while nephritis was diagnosed in 2 (9.1%) patients.
urea was 18mg/dl. Abdominal ultrasound scan revealed Conclusion: Kidney disease is common among SCD
a right multicystic kidney extending into the pelvis with patients and is characterized by a preponderance of tubular debris within the cyst . Abdominal CT scan Revealed large dysfunction and mesangioproliferative glomerulonephritis.
multiseptated cystic mass with lobulated margins in the right kidney extending from the right upper quadrant of the abdomen down to the pelvis with enhancement of the septae of the mass. The left kidney was normal and secreted DEPRESSiON AND QuAliTY OF liFE iN
contrast adequately. She had urological intervention with PATiENTS ON lONG TERM hAEMODiAlYSiS
over 3.5 litres of frank pus aspirated.
AT ThE RENAl AND CARDiOThORACiC uNiT
Conclusion: this case illustrates the importance of
OF ThE KORlE-Bu TEAChiNG hOSPiTAl.
identifying a possible underlying disease in patients with Vincent Boima1, Vincent Ganu1, Charles Matekole1, Charlotte recurrent urinary tract infections.
Osafo0, Michael Matekole0, David Adjei0, Adu Dwomoa0 1University of Ghana Medical School, l, Accra/Greater Accra, Ghana, 2Korle-Bu Teaching Hospita, Accra/Greater Accra, Ghana Background: Depression is not uncommon amongst end
CliNiCO-PAThOlOGiCAl STuDY OF SiCKlE
stage renal disease patients on long term haemodialysis. The CEll NEPhROPAThY iN NiGERiANS.
disease condition itself, dialysis treatment and incidence of Fatiu Arogundade1, Abubakr Sanusi1, Muzamil Hassan1, S depression all contribute to the poor quality of life in these Osasan2, K A Adelusola2, NO Akinola3, MA Durosinmi0 ,3, A patients. In Ghana, there is very little data on the prevalence of depression and the quality of life in patients on long term 1Department of Medicine, Obafemi Awolowo University, Teaching Objectives: To assess the prevalence of depression and to
Complex, PMB 5538, Ile-Ife, Osun State, Nigeria., Ile-Ife, Osun assess the quality of life in long term haemodialysis patients State., Nigeria, 2Department of Morbid Anatomy and Histopatholog Study Design: This study was a cross-sectional study.
y, Obafemi Awolowo University, Teaching Hospitals Complex, PMB Setting: Dialysis units of the medical block and
5538,., Ile-Ife, Osun State., Nigeria, 3Department of Haematolog y, cardiothoracic centre of the Korle-Bu Teaching Hospital.
Obafemi Awolowo University, Teaching Hospitals Complex, PMB Methods: A total of 106 patients (63 males and 43 females)
5538,., Ile-Ife, Osun State., Nigeria aged 18 years and above participated in this study. Depression Background: Sickle cell disesase (SCD), a genetically
was assessed using the Patient Health Questionnaire inherited disease, often presents with disabling acute and (PHQ) and quality of life was assessed using World Health chronic complications which can occasionally be fatal Organization quality of life instrument (WHOQOLBREF).
including kidney disease. This study assessed the relationship Results: The study sampled 106 patients with a mean age
between kidney function, renal histopathology and of 48.7±13.3 years. Majority of the population were males (59.4%). The prevalence of depression was found to be Methodology: The study prospectively screened 70 patients
44.4%. Quite a number of our patients (18.9%) had an with SCD for the presence of proteinuria (microalbuminuria overall poor quality of life. There was a significant association or overt proteinuria), glomerular filtration rate (GFR) between overall quality of life and educational status (p = <60ml/min and tubular dysfunction and renal biopsy was 0.003) and source of income (p = 0.014).
performed in those with indications.
Conclusions: This study found out that depression
Results: The age of the patients ranged between 18
was common amongst ESRD patients on long term and 56 years (Mean±SD; 27.5±8.9years) with a female haemodialysis at the Korle-Bu Teaching Hospital. Quite a preponderance. Of the 70 patients screened, 25 (35.7%) had number of these patients had an overall poor quality of life.
CKD as defined by GFR <60ml/min and/or proteinuria, 23 (32.9%) patients had GFR <60ml/min and 5 (7.1%) had hyperfiltration GFR >120ml/min; overt proteinuria was found in 4 (5.7%) while microalbuminuria was found in 12 (17.1%). GFR correlated positively with haematocrit ESTABliShMENT OF A NATiONAl DiAlYSiS
(r=0.472;p<0.0001) and BMI (r=0.518; p<0.0001) while AND TRANSPlANT REGiSTRY
microalbuminuria correlated negatively with GFR (r M Razeen Davids1 ,2, Nicola Marais2, Julian Jacobs3 ,2 African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) 1Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa, 2South African Renal Society, Johannesburg, South Africa, 3NRC Goodwood Dialysis Unit, Cape Town, South Africa OuTCOME OF NON-TuNNElED NON-
The South African Dialysis and Transplant Registry (the CuFFED CENTRAl VENOuS CAThETERS iN
Registry) is an information database established by the PATiENTS ON ChRONiC hEMODiAlYSiS
South African Renal Society which aims to provide critical Francois Kaze Folefack1,2, Gloria Ashuntantang1 ,2, Andre Pascal information on end-stage renal disease (ESRD) and renal replacement therapy (RRT) in South Africa. Our Registry 1Faculty of Medicine and Biomedical Sciences of the University of Committee is responsible for coordinating the collection, Yaoundé 1, Yaounde, Cameroon, 2Yaoundé General Hospital, analysis and publication of data concerning end-stage renal Yaounde, Cameroon, 3South African Medical Research Council & disease and transplantation in South Africa. The primary University of Cape Town, Cape Town, South Africa output would be an annual report, but may also include other Background: Vascular access is a challenge in end-stage
academic papers and presentations. The Registry allows for renal disease patients requiring emergency dialysis. We the sharing and use of this information for informed decision investigated the adverse outcomes of non-tunneled catheters making and can be used for many purposes including the and determinants in patients on chronic hemodialysis at the planning of health service delivery and research. The Yaounde General Hospital hemodialysis center, Cameroon.
Registry is registered as a long-term observational study Methods: This was a prospective study of eleven months
with ethics approval for country-wide data collection. The duration (February-December 2008) involving 81 non- development and operation of the Registry will be described tunneled catheters (63 femoral, 18 internal jugular) inserted and challenges encountered discussed. Provisional results in 72 adults (47 men, 65.3%) on chronic hemodialysis. based on data collected to date will be presented.
Clinical and laboratory data were used to investigate catheter outcomes during follow-up.
Results: Sixty five (80.2%) catheters were inserted for
emergency dialysis, 11 (13.6%) for a failed native arterio- venous fistula and 5 (6.2%) for a failed prior catheter. The mean CARDiOVASCulAR RiSK FACTORS iN RENAl
time-to-catheter removal was 35±28 days. Elective removals, TRANSPlANT RECiPiENTS ATTENDiNG
catheter related and unrelated complications accounted each NEPhROlOGY CliNiCS iN NAiROBi, KENYA
for a third of catheter removal. The main catheter related James Wagude, Joshua Kayima, Elijah Ogola, Seth Mcligeyo, Anthony complications were infections (17/27, 62.9%) and bleeding Were Department of Clinical Medicine and Therapeutics, College of (6/27, 22.2%), which were associated with unemployment Health Sciences, University of Nairobi, Nairobi, Kenya (p=0.0002) and longer duration of catheter (p=0.004). The OBJECTiVE: To determine the prevalence of established
catheter-related infections were sepsis (11.8%), exit-site cardiovascular risk factors in Renal Transplant Recipients in (29.4%) and both (58.8%); complicated by death in 11/17 Nairobi, Kenya.
(64.7%) cases. Fever (94.1%), pain (88.2%) and pus (70.6%) Design: Cross-sectional clinic based descriptive study
were the main infectious signs with Staphylococcus aureus Subjects: Adult renal allograft recipients attending involved in 70.6%. Unemployment was significantly frequent
nephrology clinics in Nairobi, Kenya in patients with infectious complications (76.5% vs. 26.6%, Results: 91 renal allograft recipients were evaluated with
a male to female ratio of 2.1 to 1 and mean age of 44.2 Conclusions: Non-tunneled hemodialysis catheters are
years (SD12.44). Hypertension, dyslipidemia and abdominal mainly used for emergency dialysis in this setting. Catheter obesity by waist-hip ratio were the highest prevalent risk related infections due to staphylococcus are the leading factors at 95.6%, 73.6% and 68.1% respectively. Significant complications associated with unemployment and longer associations were found between the presence of a second utilization. Efforts are needed to improve early transfer of renal allograft and NODAT (P = 0.011) as well as history patients to nephrologist for better preparation for renal of pre-transplant diabetes mellitus and use of insulin with impaired graft function (P = 0.026 and P = 0.004 respectively). Most allograft recipients were on Prednisolone, Cyclosporine and Mycophenolate mofetil combination therapy with those on Azathioprine having the longest duration of exposure (142.0 months) while those on Everolimus had the shortest BlOOD PRESSuRE AND PulSE PRESSuRE
duration (7.5 months). No significant associations were RElATiONShiPS WiTh KiDNEY FuNCTiON
found between any of the immunosuppressant agents and iN AShANTi, GhANA
the cardiovascular risk factors.
Debasish Banerjee1, Jacob Plange-Rhule1 ,2, Nihil Chitalia1, Conclusions: There is a high burden of CVD risk factors
Kwabena Kumi2, Frank Micah2, Sally Kerry3, Francesco Cappuccio4, among renal transplant recipients and they should be John Eastwood1 prioritized as being at high risk for cardiovascular mortality 1St George's, University of London, London, UK, 2Komfo Anokye with local adaptation of guidelines on cardiovascular risk Teaching Hospital, Kumasi, Ghana, 3Queen Mary University of factors. Larger prospective studies should be carried out to London, London, UK, 4University of Warwick, Warwick, UK characterize post-transplantation anemia, control of diabetes introduction: Hypertension is a major risk factor for
mellitus and associations between immunosuppressive adverse cardiovascular outcomes. However, correlations agents and cardiovascular risk factors.
between individual components of hypertension – pulse African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) pressure (PP), and systolic (SBP) and diastolic blood and pathologists need to coordinate in widening access to pressure (DBP), and kidney function in healthy populations this important service to patients.
Methods: We undertook a cross-sectional study in 944
inhabitants of 12 villages in the Ashanti region of Ghana [men 355, women 589; aged 40-75 years]. Data collected included demographics, height, weight, BP and GFR.
hEPATiTiS B ASSOCiATED NEPhROPAThY
Results: The characteristics of the population were: age
(hBVAN) iN A TERTiARY hOSPiTAl iN SOuTh
55(11) [mean(SD)] years, men 38%, semi-urban village- dwellers 51.7%, diabetes 1∙5%, BMI 21(4)kg ∕m2, 24hour Adanze Asinobi1 ,2, Adebowale Ademola1 ,2, Olufunke Owa2 CrCl 84(23)ml/min/1.73m2. 29% had BP >140/90mmHg; 1Dept. Of Paediatrics, University of Ibadan, Oyo State, Nigeria, SBP and DBP were 125/74(26/14) mmHg, PP was 51(17) 2Dept. Of Paediatrics,University College Hospital, Ibadan. Oyo mmHg. PP increased with age by 0.55(0.46 to 0.64) mmHg/ State, Nigeria year. PP was higher (53(17) v 49(15) mmHg; p<0.001) in the Background: There are few reports on HBVAN in
semi-urban participants. GFR decreased with increasing PP Nigerian children.
[-0.19 (-0.27 to -0.10) ml/min/1.73m2/ mmHg] and SBP Methodology: A retrospective study of HBsAg seropositve
[-0.09 (-0.14 to -0.03) ml/min/1.73m2/mmHg]; there was children managed for kidney disease in our hospital between no significant relationship with DBP [-0.04 (-0.15 to 0.06)]. January 2006 and December 2012 was performed.
After adjusting for SBP the relationship between GFR and Results: 16 children (12 males), aged 3 -13 (mean 9.4 ±
PP became steeper [-0.31 (-0.50 to -0.12) ml/min/1.73m2/ 2.8) years were identified. The clinical presentation were mmHg]. GFR increased, though not significantly, as SBP nephrotic syndrome (NS) in 11 children, glomerulonephritis increased after adjusting for PP [0.09 (-0.03 to 0.21) ml/ (GN) in 4 and acute kidney injury (AKI) in another child. min/1.73m2/mmHg]. Using multivariate regression Among children with GN 2 needed dialysis at presentation, analysis that included PP, age, gender, BMI, only increasing on account of end stage kidney disease (ESKD) or AKI age [-0.75 (-0.88 to -0.62)] and decreasing BMI [0.50 (0.17 each occurring in 1 child. 9 renal biopsies were performed to 0.82)] were significantly associated with decreased kidney and showed minimal change disease (n=4), FSGS (n=3), and MPGN (n=1) in the children with NS; and Focal Global Conclusions: In this cross-sectional study of a Sclerosis in a child with GN. Management of NS included
homogeneous West-African population, PP increased with use of corticosteroids in 9 patients combined with the use age and had a better relationship with declining kidney of lamivudine in 3. 1 child with GN received corticosteroids function than SBP or DBP.
and this was combined with lamivudine. Remission occurred only in 8 children with NS and it followed steroid therapy in 7, and was spontaneous in 1 child. 5 children who were not in ESKD at presentation progressed to ESKD, 3 children with NS and 2 with GN. 2 of the children with NS and RENAl BiOPSY PAThOlOGY SERViCES
progression to ESKD had FSGS and steroid resistance AND SPECTRuM OF RENAl DiSEASES AT A
while the third did not receive corticosteroid therapy.
PRiVATE REFERRAl lABORATORY iN KENYA
Conclusion: In Nigeria the clinical picture of GN, steroid
Ahmed Kalebi resistance and FSGS appear to be poor prognostic factors Lancet Group of Laboratories, Kenya, Nairobi, Kenya Renal biopsy and renal pathology services are generally inadequate in most parts of Africa. In turn, data on diagnosis made on renal biopsies is also scant. The author presents his experience over a period of about two years since introducing renal pathology services at a private ThE ChAllENGES OF ESTABliShiNG A
independent laboratory in Nairobi, with a series of up to KiDNEY TRANSPlANT PROGRAM iN SuB-
100 biopsies evaluated. A small proportion of cases had SAhARAN AFRiCA: ExPERiENCE FROM ThE
immunofluourescence or immunohistochemical studies FiRST CASE iN ilORiN iN ThE NORTh-
done as adjunt. FSGS, MCD, lupus nephritis, acute tubule- CENTRAl ZONE OF NiGERiA
interstitial nephritis, membranous glomerulonephritis Timothy Olusegun Olanrewaju1, Ademola Popoola1, Adindu and MPGN are the commonest diagnoses made. In some Chijioke1, Abdulwahab Ajape1, Tajudeen Adeniran Badmus2, instances, pathological diagnoses led to identification of Fatiu Abiola Arogundade2, Abubakr Abefe Sanusi2, Mikhail systemic conditions previously undiagnosed clinically e.g. Olayinka Buhari1, Ademola Aderibigbe0 paroxysmal nocturnal hemoglobinuria and plasma cell 1University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria, dyscrasia. Transplant biopsies were <10% of cases with 2Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, acute humoural rejection being the commonest diagnosis. Osun State, Nigeria The presentation highlights some of the challenges faced in Backgroung: Kidney transplantation is the best treatment
resource constraint settings where renal biopsies have not for patients with end stage kidney disease. It offers better taken root as a routine in patient evaluation where indicated. quality of life and cost savings compare with dialysis.In There is a need to increase awareness and promote the Nigeria with 160million population and ESKD burden utilization of renal biopsies for patient work-up.Clinicians of 10% of hospital admissions, 161 cases have so far African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) been performed from 7centres. This report highlights the age, fewer comorbidities, less severe physical pain, and challenges from experience of the first case of living related fewer physical or social limitations. QoL could increase by kidney transplantation in Ilorin in the north-central zone improving co-morbidity treatments, giving more effective Methods: The patient is a 28year old junior employee
of a private construction company who had ESKD from chronic glomerulonephritis and his donor is his elder brother, a 30years old teacher. His income was less than 500dollars per month and had declined travelling abroad hOME-BASED EDuCATiON, SCREENiNG
to have kidney tansplant as advised by similar patients. AND KiDNEY CARE iN RuRAl AFRiCAN
His employer and our Hospital financed his treatment. Majority of the pretransplant investigations were done in Philip Zager1 ,2, David Ploth3 our hospital but specialized ones such as renal angiography, 1University of New Mexico, Albuquerque, New Mexico, USA, HLA typing, CMV and EBV serology were done in other 2Dialysis Clinic, Inc., Nashville, Tennessee, USA, 3Medical centres. The results were satisfactory and was 50%HLA University of South Carolina, Charleston, South Carolina, USA match. Results:The surgery was done on the 10th of We will develop home-based kidney education, screening September, 2012. He had delayed graft function due to and treatment programs for implementation in rural African AKI for 20days and later regained full function. He was communities. The program will be modeled on that used maintained on MMF/Tacrolimus/ Prednisolone regimen. in the Zuni Pueblo, a rural American Indian community He had fungal UTI and sepsis which were managed. The in the US, which experienced interrelated epidemics of clinical, biochemical and haematological profiles was obesity, type 2 diabetes, and chronic kidney disease. The satisfactory and was dischaged.
Zuni Kidney Project has been funded by the US National Conclusions: The challenges involved in establishing a
Institutes of Health (NIH) and Dialysis Clinic Inc. (DCI), a transplant program in Nigeria include inadequate facilities, large not for profit dialysis provider, for 15 years.
logistic problems, poverty, lack of political will, transplant In Phase I we will hold focus groups with community tourism and high risk for infections.
members, tribal leaders and health care professionals to identify potential barriers to health education, screening and treatment to ensure widespread community support. In Phase II we will implement population based screening using the household as the sampling unit. We will train and QuAliTY OF liFE OF PATiENTS WiTh END-
certify community health care workers (CHCW) to screen a STAGE RENAl DiSEASE iN GuiNEA
random population sample for diabetes, hypertension and BAH Alpha Oumar¹, NANKEU Nestor¹, K ABA Mohamed kidney disease. CHCW will interview household members, Lamine¹,BALDE Mamadou Cellou², BAH Kadiatou-Hadiatou¹, obtained personal and family medical histories, measured ROSTAING Lionel². ¹ height, weight, and blood pressure; obtained blood (Hb Nephrolog y Unit, Donka National Hospital, BOX 234, Conakry, A1c, glucose, creatinine) and urine (urine albumin:creatinine Republic of Guinea ² Service of Nephrolog y, Haemodialysis ratios) samples. Recognizing the needs of rural African CHVA, BP01 09017, Foix cedex, France. communities will use Point of Care (PoC) determinations Aim This questionnaire-based study included 69 patients
of these analytes. We will develop and implement the with end-stage renal disease (ESRD). Factors that affected appropriate quality control procedures by obtaining their quality of life (QoL) were determined.
randomly selected duplicate samples processed at a reference Methodology This study was conducted over 12 months.
lab. In Phase III follow-up and treatment protocols will be The included patients had ESRD and creatinine clearance of developed in collaboration with ongoing investigations to <15 ml/min. We used the SF36 questionnaire and classified maximize capacity and minimize duplication.
the results into two groups: scores <50/100 as poor QoL and scores ≥50/100 as good QoL. Factors that determined QoL scores were cessation of all activities and additional effort required, severe or mild pain, good or bad health, and reduced or not reduced social and physical activities.
SiCKlE CEll GlOMERulOPAThY iN DAKAR:
Results Of the 69, 32 (46.3%) had a good QoL and 37
STuDY OF 11 CASES OF RENAl BiOPSiES
(53.7%) had a poor QoL. The latter group's average age El hadji Fary K A, Seynabou FALL , Ahmed Tall LEMR was 54±4 years, the good-QoL group's average age was ABOTT, Mouhamadou Moustapha Cisse, Cherif Dial, Fatou of 47.6 ± 4 years (p=0.01). Patients with a good QoL had Samba Ndiaye, Younoussa Keita, Berrada Hakim, Sidy Mohamed better overall health but this was not statistically significant Seck, Maria Faye, Abdou Niang, Boucar Diouf Cheikh Anta Diop (OR=0.42; 95% CI; p=0.14). Patients with a poor QoL University, Dakar, Senegal had more severe pain (p=0.002); however, good QoL did introduction: Few publications are dedicated to the
not protect against mental problems (OR=46.67; 95% practice of Kidney biopsy during the sickle cell nephropathy. CI; p=0.0001). Mental status (p=0.01) and social activities Our purpose was to describe the indications of the kidney (p=0.001) were reduced, and there were more co-morbidities biopsy, histological and evolutif profile of anatompathologic (29.7% with >4, p= 0.01) in the poor-QoL group.
damage of sickle cell nephropathy in Dakar Conclusion Good QoL was associated with younger
Methods: a retrospective (December 2009-Aout 2011), and
African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) multicentric study exploited histological kidney biopsy of kidney disease patients and therefore requires active sickle cell patients followed in Nephrology Departments treatment in the Nigerian CKD population.
of Dantec hospital and Child Fann hospital Albert Royers. Diagnostic, histological, therapeutic and evolutif data are. Results: on 292 kidney biopsies, 11 were made to sickle
cell anemia patients (6SS, 1 SBth+, 4 AS) with 23,1-year-old DiABETES, FiRST CAuSE OF SECONDARY
average [ 13-51 years]. All had impur nephrotic syndrome NEPhROTiC SYNDROME OF ADulTS iN
with hypertension (1case), microscopic hematuria (11cases) and renal insufficiency (6 cases). The focal segmental El Hadji Fary K A, Maria FAYE, Mouhamadou Moustapha glomerulosclerosis (5 cases) dominated, followed by the CISSE, Ahmed Tall LEMR ABOTT, Sidy Mohamed SECK, association specific lesions (hypertrophy glomerular, Younoussa KEITA, Khodia FALL , Abdou NIANG, Boucar peri-tubular) to minimal glomerular damage (3 cases), DIOUF Cheikh Anta Diop University, Dakar, Senegal membranoproliferative glomerulonephritis (2 cases) and introduction: The nephrotic syndrome is the common
the extra-membraneous glomerulonephritis (1cas). Under mode of exposure of chronic glomerulopathies. The treatment, evolution was marked by 7 complete remissions diabetic nephropathy, is the second cause of renal and 1 death. Three patients were lost sight.
failure in Senegal. The aim of this study is to determine Conclusion: practice of kidney biopsy are uncommon, and
epidemiological, clinical, biological and etiological profiles main indication was impur nephrotic syndrom. Histological of secondary nephrotic syndrome.
renal lesions are variable, dominated by focal segmental Methods: The paper is based on a retrospective survey
glomerulosclerosis. Kidney biopsy, keep significatif interest, carried out in the Nephrology service of Aristide Le Dantec in sickle cell nephropathies, where the interest to revised Hospital of Dakar over a 10 year period (2001-2010). A total of 47 patients with secondary nephrotic syndrome were surveyed. Demographic, clinical, biological and etiological data were analysed.
Results: The hospital prevalence of secondary nephrotic
syndrome was 23%. The average age was 42 years with a PATTERN OF DYSliPiDEMiA iN NiGERiAN
sex raio of 2,4. The oedema was found in 44% of cases.The ChRONiC KiDNEY DiSEASE PATiENTS
High blood pressure was found in 38% of cases. The serum Effiong Akpan1, Udeme Ekrikpo1, Emmanuel Effa1, Aniema protein and albumin 48,5g/l and 20g/l respectively. The Udo1, Solomon Kadiri2 1University of Uyo Teaching Hospital, Uyo, average serum creatinine was 12 mg/l, the average blood Akwa Ibom State, Nigeria, 2University College Hospital, Ibadan, urea was 0,36 g/l. An impaired renal function was found Oyo State, Nigeria in 44% of patients with mean serum creatinine clearance Background: Cardiovascular diseases (CVD) are common
of 28,9ml/mn. The average proteinuria was 4,2 g/day. The in patients with chronic kidney disease and they are likely Diabetes was found in 37,5% of cases, Hepatits B in 29,2% to die of cardiovascular complications before developing and Sickle- cell disease in 12,5% of cases.
renal failure. One modifiable risk factor for CVD in CKD Conclusion: The Diabetes is a significant cause of renal
patients is dyslipidemia. Unfortunately dyslipidemia, which failure in our country. The early prevention of diabetic contributes greatly to the cardiovascular risk in CKD nephropathy appears to be mandatory before the appearance patients, is often an underestimated problem.
of nephrotic syndrome because, blood dialysis is hard to get Methods: Patients with CKD stages 1- 5 had samples for
to and renal transplantation is still at the project stage.
serum lipid profile collected after an overnight fast of 8 - 14 hours. Samples were separated within 3 hours of collection and kept in refrigerator at 40C. Total cholesterol and HDL were assayed using enzymatic substrate method, while LDL was estimated using Friedwald formula. The glomerular ANATOMOCliNiCAl, ThERAPEuTiC AND
filtration rate of each patient was estimated from serum EVOluTiONNARY ASPECTS OF PRiMiTiVE
creatinine using Cockcroft and Gault formula.
NEPhROTiC SYNDROM iN DAKAR.
Results: One hundred participants, mean age 38.4±12.6
El Hadji Fary Ka1, Maria Faye1, Mouhamadou Moustapha Cisse1, years, were recruited into the study. Eleven percent were Ahmed Tall Lemrabott1, Sidy Mohamed Seck0 ,2, Younoussa Keita1, diabetic while 82% had hypertension. Eighty four (84%), Khodia Fall1, Abdou Niang1, Boucar Diouf1 1Cheikh Anta Diop 95%CI 76.7 - 91.3%, of the participants had at least one University, Dakar, Senegal, 2Gaston Berger University, Saint Louis, lipid fraction deranged. Total cholesterol and LDL-c was elevated in 29%, high total cholesterol and triglyceride found introduction: The nephrotic syndrom is the most common
in 7%, high total cholesterol and low HDL in 9%, 23% had mode of exposure of chronic glomerulopathies which elevated LDL occurring simultaneously with a low HDL. account for nearly half of chronic kidney failure observed All the participants with stage 1 CKD had dyslipidemia; in Africa. The objective of this piece of research is to 90.0% of stage 2, 85% of stage 3, 74.3% of stage 4 and determine epidemiological, clinical, biological, histological, 89.3% of stage 5 patients had at least one fraction of the therapeutic and evolutionnary profiles of the primitive lipids deranged.
nephrotic syndrom.
Conclusion: Dyslipidemia is common among our chronic
Methods : The paper is based on a retrospective survey
African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) carried out in the Nephrology service of Aristide Le Dantec in Senegalese patients. Many species had been reported in Hospital of Dakar over a 10 year period (2001-2010). A others studies.
total of 156 patients with primitive nephrotic syndrom were surveyed. Anatomoclinical, therapeutic and evolutionnary data of the primitive nephrotic syndrom were analysed.
Results : The hospital prevalence was 77%. The average
age was 26 years with a sex ratio of 2,4 . The oedema was SlEEP DiSORDERS AMONG BlACK AFRiCAN
found in 63% of patients. The hypertension was found in ChRONiC DiAlYSiS PATiENTS: A PilOT STuDY
63% of cases. The mean proteinuria was 6,8g/day. Focal FROM SENEGAl
segmental glomerulosclerosis was found in 45,6 %, Minimal El Hadji Fary K A1, Sidy Mohamed SECK ,2, Zeinabou MAIGA1, change disease in 43,4% and the Extramembranous Mouhamadou Moustapha CISSE1, Ahmed Tall LEMR ABOTT1, glomerulonephritis in 5% of cases. 134 patients had receveid Maria FAYE1, Younoussa KEITA1, Khodia FALL1, Abdou corticosteroid therapy. The cyclophosphamide was used in NIANG1, Boucar DIOUF1 1Cheikh Anta Diop university, Dakar, 7,9 % of cases and Azathioprine in 2,9% of cases. Progress Senegal, 2Gaston Berger university, Saint Louis, Senegal towards was noted for 28,21 % of patients. Poor prognosis Aims: Chronic dialysis patients are highly exposed to diverse
factors were: age from 40 years old, proteinuria from 10g/ sleep disorders (SD) that can impact their daily quality of day, renal failure and non-use of corticosteroids.
life. This study aimed to describe prevalence and risk factors Conclusion : The primitive nephrotic syndrom is the most
of four major SD in Senegalese dialysis patients.
common form of hereditary glomerulopathies. It mostly Methods: We performed a cross-sectional study between
occurs among young patients and ends in chronic renal February 15th and April 30th 2012 in three dialysis centres failure without treatment. Hence the need for effective and including 127 patients dialysed since >6 months. For each patient, we assessed insomnia according to the Ohayon method, obstructive sleep apnea syndrome (OSAS) with the Berlin questionnaire, restless leg syndrome (RLS) using abridged version of Cambridge-Hopkins RLS questionnaire, and excessive daytime sleepiness (EDS) with Epworth ThE hERBAl TOxiNS ASSOCiATED
sleepiness scale. Logistic multivariate regression was used to NEPhROPAThY iN SENEGAl
identify factors associated with different SD.
El Hadji Fary Ka1, Sidy Mohamed Seck ,2, Ahmed Tall Lemrabott1, Results: The overall prevalence of SD was 88% a with
Djibrilla Tondi1, Mouhamadou Moustapha Cisse1, Maria Faye1, predominance of insomnia (64%) followed by OSAS Younoussa Keita1, Khodia Fall1, Abdou Niang1, Boucar Diouf1 (49.6%), RLS (24.4%) and EDS (20.5%). Fourty-two 1Cheikh Anta Diop University, Dakar, Senegal, 2Gaston Berger patients presented at least two disorders. Patients with University, Saint Louis, Senegal insomnia presented lower BMI than patients without Background: The pathological and etiological patterns of
insomnia (respectively 20.7 vs 28.3 kg/m2, p=0.02) and herbal toxins associated nephropathy (HTAN) are not well lower albuminemia (respectively known in Africa. This study aimed to describe histological 3.0 vs 3.7g/dL). Insomnia correlated with anemia (OR=1.31, findings and causes of HTAN in Senegalese patients.
P= 0.03), C-reactive protein (OR=1.29, p= 0.05), and RLS Methods: We conducted a retrospective study between
(OR=1.02, p= 0.02). OSAS was associated with snoring January 1st 2010 and August 31st 2012 at University hospital (OR=2.41, p= 0.01) and neck circumference (OR=1.27, p= Aristide Le Dantec in Dakar. We included all patients with 0.01). RLS correlated with insomnia (OR=1.44, p=0.03), kidney diseases who reported use of traditional plants and anemia (OR=3.32, p= 0.05). The only factor associated for whom renal biopsy was performed. Anamnesis, clinical, with EDS was OSAS (OR=1.15, p= 0.01).
biochemical, histological data were collected.
Conclusions: Nephrologist should be more aware of
Results: Among the 312 patients who had renal histology
these SD in order to detect them early and provide efficient during the study period, 74 presented lesions probably due to herbal toxins (prevalence of 19.7%). Their mean age was 34.7 years (5 – 67 years) and sex-ratio was 3.1. only 20.7% of them had previous history of nephropathy. Clinical presentation was dominated by oedema (78.0%) and high blood pressure (69.8%). Glomerular filtration rate was < 15 iNCiDENCE OF NON TuMOR KiDNEY
ml/mn/1.73 m² in 1/3 of the 39 patients for whom serum DiSEASES iN ChilDREN (A MulTiCENTER
creatinine was available. Main histological findings were SuRVEY iN A PEDiATRiC hOSPiTAl iN
glomerular lesions such as thrombopathy micro-angiopathy, thickening of the Bowman's capsule and presence of Younoussa KEITA, Cherif DIAL , Assane SYLL A, spumous cells in capillaries. Tubulo-interstitial and vascular Mouhamadou Moustapha CISSE, Ahmed Tall LEMR ABOTT, lesions were also found respectively in 55,4 % and 23 % of Aliou NDONGO, Maria FAYE, Clause MOREIR A, Abdou patients. Overall 21 medicinal herbs belonging to 14 families NIANG, Boucar Diouf, Mohamadou Guélaye SALL , Mamadou were mentioned by patients. The most frequently reported SARR Cheikh Anta Diop University, Dakar, Senegal plants: Guiera senegalensi, Ziziphus mauritiana, Combretum introduction The non tumor Kidney diseases in children
are hereditary, congenital or acquired. The main purpose Conclusion: This study shows a high prevalence of HTAN
of our study was to assess the frequency, difficulties of African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) diagnosis and Support of the care Materials And Methods We conducted a retrospective
multicenter study in period from 1 January 2010 to 31 FuTiliTY OF SCREENiNG FOR
December 2010. Patients hospitalized for non-tumor kidney hYPERTENSiON AND uRiNARY
disease were included.
ABNORMAliTiES iN YOuNG NiGERiAN
Results We have recenced 85 patients on 6964 hospitalized,
1.2 % with a 2.14 ratio. Children aged 5 to 10 years accounted Abubakar Ibrahim, Istifanus Bosan, Moses Tuko, Bello Jamoh, for 42.4 % of the sample.
Musa Sunday, Mohammed Abdulrashid Ahmadu Bello University The Pathologies Encountered Were: Acute
Teaching Hospital, Zaria, Nigeria glomerulonephritis in 27 patients, nephrotic syndrome child Background The National Youth Service Corps (NYSC)
in 25 cases, urinary tract infection in 22 cases, the single statutorily obliges Nigerian graduates of tertiary institutions renal cyst and nephrolithiasis in 1 case, acute renal failure below 30 years to work for one year outside their geo-ethnic in 19 children with chronic renal failure in 8 patients. The origins, allowing their periodic gathering at orientation death rate in the CKD was 62.5 %.
camps. These ‘youth corpers' occasionally manifest Discussion The predominance of glomerular pathology
hypertension, kidney disease and diabetes on routine was described in our study, as in the literature. Prevention screening. Therefore, a survey was conducted to determine and first management of this causes could reduce the effectiveness of screening in this population for kidney incidence of chronic kidney disease.
disease and hypertension, to facilitate early intervention.
Conclusion The opening of a pediatric nephrology unit
Methodology Over three weeks, young Nigerian graduates
is the key of management in renal disease in our teaching of tertiary institutions at 2008 Kaduna NYSC orientation camp were evaluated for evidence of kidney disease. Demographic profiles, medical history and blood pressures were recorded, followed by random dipstick urine test for albumin, sugar, blood, and nitrite. SPSS version 16 was used for the analysis.
luPuS NEPhRiTiS ClASSS iV OF iSN/RPS
Results 201 out of 1200 graduates participated in the
iN A GiRl AGED 15 YEARS iN PEDiATRY OF
screening. M: F = 110:91; age ranged from 22-41 +3.5 TEAChiNG hOSPiTAl ARiSTiDE lE DANTEC
years. Ethnic origins: Hausa 20 (10%), Yoruba 41(20.4%), Younoussa KEITA, Cherif DIAL , Assane SYLL A, Ibo 64 (64%) other ethnic tribes 76 (37.8%). Personal Mouhamadou Moustapha CISSE, Ahmed Tall LEMR ABOTT, history of hypertension, diabetes or kidney disease was Aliou NDONGO, Maria FAYE, Claude MOREIR A, Abdou negative. Parental hypertension, diabetes and kidney disease NIANG, Boucar DIOUF, Mohamadou Guélaye SALL , occurred in 38%, 68.2% and 5% respectively. SPB 80-150, Mamadou SARR Cheikh Anta Diop University, Dakar, Senegal mean 97+12 mm Hg, DBP 50-100, mean 63+9 mm Hg. introduction We report a case lupus nephritis class IV of
BP >140/90 mm Hg present in only 2(0.9%). Dipstick WHO in a girl of 15 years.
proteinuria, in only 10%; haematuria in 3%, nitrite test in Observation He is a 15 year old girl, hospitalized for
1.5%. None had glycosuria.
discoid lesions of the scalp, with red hair and alopecia Conclusions Hypertension and urinary abnormalities are
, erythema and cheekbones vespertilio in area exposed rare in this young literate population and may not be cost- to sunlight, stains hyperchromic thorax and abdomen, effective tools for kidney disease screening. The seemingly purpuric spots of palms; infiltration syndrome (oedema, high prevalence of parental hypertension and diabetes has ascites) polyarthralgia knee and hip, a inflammatory been validated in several studies.
micropolyadenopathy localised cervical and axillary, anemic, retard pubertal P1S1; cachexia. In biology, the NFS show a normocytic anemia, VS: 120 H 1 , CRP :6 mg / l, proteinuria of 24 hours: 93.9 mg/kg/24h, serum protein 42 g / l, albumin: 23 g / l, normal renal balance. Anti Sm Ab was PATTERN OF GlOMERulAR DiSEASE iN
positive. Histology showed glomerular lesion class IV of ADulT PATiENTS iN GhANA
WHO, global diffuse proliferative, with complete activity Charlotte Osafo1, Vincent Boima1, Perditer Okyere1, Michael Mate and discreet tubulointerstitial lesion . The IF was not was Kole1, Desley Neil2 ,1, Robert Kumoji1, Dwomoa Adu1 made. Treatment based relay with bolus corticosteroids oral 1University of Ghana Medical School/Korle-Bu Teaching Hospital, bolus of endoxan and hydroxychloroquine. The short-term ACCR A, Ghana, 2University Hospital, NHS Trust, Birmingham, outlook was favorable.
Discussion Our observation exposed the difficulty in
Background : Glomerulonephritis has been reported as
management of the several NL a major cause of end-stage renal disease in tropical Africa but there is little recent information about the types of Conclusion We report our first case of lupus nephritis in
glomerular disease seen there.
children has evolved under treatment.
Methods: A retrospective review of 121 native renal
biopsies performed on patients in Korle-Bu Teaching Hospital Nephrology Unit in Ghana from January 2009 to August 2012. All biopsies were studied by light and African Journal of Nephrology (2013) 16 (1) Abstracts Of The 12th Congress Of The African Association Of Nephrology (Accra, Ghana, 20-23 Febuary, 2013) Results: The mean age of the patients (n=121) was 30.0
121 patients had a nephrotic syndrome. Of these, 29 (43%) ±12.4. There were 62 males and 59 females. 13 out of the 121 had FSGS, 10 (15%) had Minimal change glomerulonephritis, biopsy specimen were inadequate. Out of the 108 specimen 8 (12%) had membranous nephropathy, 5 (7.5%) had analyzed, 36 (33%) had Focal segmental glomerulosclerosis lupus nephritis, 2 (3%) had Membranoproliferative (FSGS), 19 (17.5%) had lupus nephritis, 10 (9%) had glomerulonephritis and 13 (19.5% ) had other diagnoses Membranous nephropathy. Minimal change disease including Amyloidosis, and Diabetic nephropathy.
was found in 10 (9%) of the patients, 6 (5.5%) had a Conclusion: The most prevalent cause of glomerular
Membranoproliferative glomerulonephritis, 5 (5 %) had disease in the adult Ghanaian with nephrotic syndrome is a Tubulointerstitial nephritis and 4 (4%) had vasculitis. FSGS. Systemic lupus Erythematosus with lupus nephritis The remaining 18 (17%) included Diabetic nephropathy, is also common.
Amyloidosis and IgA nephropathy Sixty seven (55%) of the All rights reserved. No part of this book may be reproduced or transmitted in any form or any means, electronic or mechanical, including photocopying, recording or any information storage or retrieval system without permission from the copyright holder.
Published by Reach Publishers, P O Box 1384, Wandsbeck, South Africa, 3631 Tel: +27312672049 Fax: +27866476539 Editor-in-chief: Prof. Alain Assounga African Journal of Nephrology (2013) 16 (1)

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