African Journal of Paediatric Nephrology

Challenges of peritoneal dialysis in the management of acute kidney injury in South-south Nigeria

E.E. Ekpenyong — 2020-09-01

Background: Peritoneal dialysis (PD) remains a more practical modality for renal replacement therapy (RRT) in young children with Acute Kidney Injury (AKI) especially in resource poor settings. However, its utilization is limited by challenges such as low number of qualified health workers, cost of PD fluid and socio-demographic issues like poor housing, electricity and water supply.

Methods: In a retrospective study, the case notes of all children that had prescription for PD as a RRT for AKI over a 10-year period from February 2009 to March 2019 were reviewed.

Results: Peritoneal dialysis was prescribed for 16 patients, 11 males and 5 females who were diagnosed with AKI. The main causes of AKI were gastroenteritis, malaria, sepsis and posterior urethral valve (PUV). The ages of these patients ranged from 3 days to 5 years (mean 3.00 + 1.59 years). However, PD was performed in 7 (44%) of these patients. Three (19%) patients had contraindications to PD such as peritonitis, recent abdominal surgery and intra-abdominal mass. Peritoneal Dialysis was performed manually with PD catheters inserted in the operating theatre by a paediatric surgeon. Size 16 urinary silicon catheter was used as an improvised PD catheter in 6 patients (86%). PD was delayed for more than 24 hours after prescription in all patients. Time before onset of PD ranged from 2 to 7 days with a mean time before PD as 1.78 ± 0.85 days. Duration of PD ranged from 2 hours to 10 days (mean 4.15 ± 1.00 days). Four (57%) of patients had full recovery of renal function while the remaining three (43%) patients died. All mortalities occurred within 48 hours of commencement of PD. The main challenges were unavailability of dialysis fluid in 100%, delay in obtaining parental consent for PD due to ignorance in 81% , financial constraint in 75% and cultural beliefs in 56% of patients.

Conclusion: The utilization of PD was found to be low in resource poor settings like ours. Contributory factors were financial constraints, non-availability of PD catheters and dialysis fluid, delay in obtaining parental consent and cultural beliefs.

Keywords: Acute Kidney Injury, Peritoneal dialysis, Challenges, poor resource setting.

Urinary abnormalities in asymptomatic school age children in public primary schools in abuja

A.I. Dike — 2020-09-01

Background: Nitrituria and leucocyturia are indicative of urinary tract infection and a commonly missed condition in asymptomatic children. When left untreated could lead to long term consequences such as renal scaring, hypertension, altered renal function, and end stage renal disease. We conducted this study to determine the prevalence and risk factors for silent urinary tract infection among primary school children from public school in Abuja.

Materials and Methods: A descriptive cross sectional school-based study was conducted among apparently healthy, children from public primary schools in Gwagwalada Area Council of Federal Capital Territory, Abuja using a multi-staged sampling technique. Early morning urine was collected for presence of nitrites and leucocytes using urinary dipsticks. Urine microscopy was done for all subjects with positive results (nitrites and leucocytes) to confirm the presence of white blood cell count (pyuria), and urinalysis repeated 2 weeks later for persistent urinary abnormality. Bio-data was collected and socio economic class determined using Oyedeji et al classification.

Results: Of the 861 urine samples analysed, 215(25%)were from urban schools, and 646(75%) from rural schools. Three hundred and ninety-seven(46.1%)of the subjects were males, while 464(53.9%) were females, given a male to female ratio of 1:1.2. Their mean age was 9.5±2.1 years with a range of 6-12 years, and most 315(36.6%) were between 11-12 years. Nitrituria, leucocyturia, pyuria, nitrituria+leucocyturia, and nitrituria+leucocyturia+pyuria was seen in 23(2.7%), 29(3.4%), 26(3.0%), 18 (2.1%), and 5(0.6%) of the subjects respectively. Statistically significant association was seen between nitrituria with location of the school (x2=6.589, p=0.010), and social class (x2=9.065, p=0.011), and between leucocyturia, and nitrituria+leucocyturia with gender (x2=7.804, p= 0.005) and (x2=3.603, p=0.042) respectively.

Conclusion: There is high prevalence of nitrituria and leucocyturia among primary school pupils in this study, necessitating the need for regular routine urinary screening for early detection and treatment to prevent long term complications

Keywords: Nitrituria, leucocyturia, pyuria, primary school, children.

Risk factors of urinary tract infection in children In Khartoum State, Sudan

Nahla Allam — 2020-09-01

Background: Urinary Tract Infection (UTI) is common in children with a great burden of morbidities. Many factors such as age, gender, race, chronic constipation and circumcision status are believed to increase the risk of recurrent UTI in children.

Objectives: To study the pattern of risk factors of Urinary Tract Infection (UTI) in Sudanese children aged 2-12year in Khartoum state.

Methodology: This was a descriptive cross sectional study. Study population composed of 136 children aged 2-12 years with history of UTI attended to teaching hospitals in Khartoum state. Data was collected by the researcher using an interview questionnaire.

Results: In 136 children diagnosed with UTI, 89(65.4%) were above 5 years of age and the majority were females 75(55.1%). For the majority of the children the source of water was pipe line, 120(88.2%) and 16(11.8%) by carts, and majority 134(98.5%) drink non boiled water. The source of waste disposal in 88(64.7%) was pit latrine and 48(35.3%) used flushing toilet. Un circumcision was more prevalent among 37 (60.7%) male children with UTI. History of chronic constipation was reported in 2.9% of the children. The commonest presentations of UTI were fever 118(86.8%) and painful micturition 115(84.6%)

The common risk factors for UTI were neurological disease (neurogenic bladder) 11% and nephrotic syndrome treated with steroid therapy 16(11.3%) . Escherichia coli was the most commonly isolated pathogen in 57.4% , Klebsiella in 18.4% and Pseudomonas in 11.8%.

Conclusions: The risk factors of UTI varies depending on socioeconomic state and cultural habits.

The use of an improvised nasogastric tube as a peritoneal dialysis catheter and challenges of adaptation-a case report

A.D. Ademola — 2020-09-01

Background: Paediatric dialysis for acute kidney injury (AKI) in developing countries may be a challenge because of limited access to standard gadgets. Adapted gadgets such as nasogastric tubes have been used to provide peritoneal dialysis (PD)in such settings. The nasogastric tube is usually inserted by the trocar or surgical technique which is cumbersome. We describe passage of the nasogastric tube for PD at the bedside by a technique that is considered easier than the trocar or surgical method.

Case report and Treatment: A two-and-a-half-year-old girl presented with oliguric AKI secondary to malaria and intravascular haemolysis with suspected uraemic encephalopathy. Her serum creatinine on admission was 9.4mg/dl. A nasogastric tube was adapted as PD catheter, and was inserted by the modified Seldinger technique on post-admission day 1.

Results: She received 39 cycles of PD over 5 days. Complications of PD included catheter outflow obstruction on post admission day 2 on account of which the catheter was replaced. She also developed Klebsiella pneumoniae peritonitis and on account of which the procedure was discontinued on post admission day 6. She regained normal urine output on post admission day 7. She was managed with iv meropenem based on the antibiotic sensitivity pattern with resolution of peritonitis. She showed significant improvement and her serum creatinine on post admission day 15 was 0.5 mg/dl.She was discharged home on post admission day 18.

Conclusion: Nasogastric tube, adapted as PD catheter and inserted by modified Seldinger technique may be life-saving in patients with AKI in developing countries.

Keywords: Peritoneal dialysis, acute kidney injury, nasogastric tube, developing countries, children

COL4A5 gene mutation associated Alport's syndrome in a two-year old boy: a case report

B. Admani — 2020-09-01

Background: Alport's disease is an inherited disorder which may lead to End Stage Renal Disease, hearing loss and ocular abnormalities. It is as a result of mutations in COL4A3, COL4A4 and COL4A5 genes leading to collagen type 4 abnormalities in the basement membrane. Different mutations may have different outcomes and course of disease. There is very little data on the genetic mutations in Alport's disease in Sub Saharan Africa.

Case Report: A 17-month-old child was referred from Kampala with a three-month history of persistent hematuria after a febrile illness. There was a family history of maternal uncles having had renal diseases. On examination, was normotensive, had no oedema, no pallor and systemic examination was essentially normal. Laboratory examination showed microscopic hematuria, normal creatinine. Renal biopsy showed minimal change on light microscopy and no abnormality on immunofluorescence. Genetic studies showed mutation in COL4A5 genec.576dup p.(Pro193Alafs*23).

Conclusion: Alport disease is prevalent in Sub-Saharan Africa and the gene mutation in this case was in COL4A5. We need to more genetic studies on our patients with suspected Alport's disease to understand the pattern of presentation and outcomes.

Keywords: Alport's syndrome, COL4A5 mutation, hematuria, end stage renal disease, chronic kidney disease.

Nephrotic syndrome in an urban south african paediatric population: a fifteen-year retrospective study of clinical, histopathologic pattern and treatment outcomes

A.U. Solarin — 2020-09-01

Background: Nephrotic syndrome (NS) is the commonest mode of presentation of glomerular disease in Africa. There is no single histological entity that underlies NS in Africa.

Objectives: To determine the clinicopathological patterns, and the outcome of nephrotic syndrome

Methods: Medical records of children with NS were reviewed.

Results: There were 147 children studied and 112(76.2%) were males. The mean age at presentation was 5.73±3.69 years. 134(91.2%) had idiopathic nephrotic syndrome. Majority were of the mixed race 124(84.4%). 119(83.8%) were steroid sensitive and 23(16.2%) were primary steroid resistant. Secondary steroid resistance was seen in 20(17.7%).The black race had higher rates of steroid resistance 8(66.7%) whereas the white 10(90.9%) and the mixed race 104 (88%) were more steroid sensitive. Minimal change disease (MCD) was commonest histological presentation 33(34.0%).The whites (4/8,50%) and the mixed race(28/84,33.3%) had high rates of minimal change. The black children had the highest proportions of mesangioproliferative GN (MesPGN) (5/7(57.1%) and similar rates of MCD and focal segmental glomerulosclerosis (FSGS) 14.3%. The mixed race had the highest proportion of FSGS 17/84(20.2%) Overall mortality was 3.4% and 6.3% had undergone transplantation.

Conclusion: MCD is the predominant pattern among the white and mixed race. FSGS is seen across all the races. Steroid resistance remains high among the black population

Keywords: Nephrotic syndrome, steroid sensitive, steroid resistant, children