Tropical Journal of Nephrology 2020-04-07T18:07:11+00:00 Dr. Samuel Ajayi Open Journal Systems <p>Tropical Journal of Nephrology is the official Journal of the Nigerian Association of Nephrology which aims at providing a medium for the exchange of ideas and promotion&nbsp;of knowledge of nephrology in the tropics through the publication of research works, innovative clinical experiences, authoritative review articles on topical issues.</p> Farewell Message From The Outgoing Editor 2020-04-07T18:06:40+00:00 Olugbenga Awobusuyi 2020-04-07T00:00:00+00:00 Copyright (c) 2020 Tropical Journal of Nephrology Burden, Access and Disparities in Kidney Disease 2020-04-07T18:06:41+00:00 Deidra C. Crews Aminu K. Bello Gam al Saadi <p>Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management.</p> <p>Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies.</p> <p>Achieving universal health coverage worldwide by 2030 is one of the World Health Organization’s Sustainable Development Goals. While universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.</p> 2020-04-07T00:00:00+00:00 Copyright (c) 2020 Tropical Journal of Nephrology Community focused primary prevention of risk factors of Chronic kidney diseases(CKD) : an unmet need in reducing the burden of ESRD in Low and middle income countries(LIMC) countries- a review and proposition 2020-04-07T18:06:45+00:00 Pedro Emem-Chioma Friday Wokoma Manda David-West <p>Chronic kidney disease, is assuming the status of global pandemic, afflicting over 500 million people worldwide, of all ages, gender and racial groups. ESRD accounts for the 19<sup>th</sup> commonest cause of death worldwide. The predominant modifiable risk factors being overweight &amp;obesity, hypertension, diabetes mellitus, chronic glomerulopathies, toxic nephropathies and HIV,etc. The latter two especially in Low- and middle-income countries (LIMC).</p> <p>Tremendous &nbsp;&nbsp;amount of knowledge and developments have taken place in the past 150 years. In spite of these gigantic endeavours, which have indeed ameliorated the sufferings and prolonged survival of patients with CKD and ESRD, especially in the developed countries, CKD and ESRD seem to defile all measures at their containment in the communities globally.</p> <p>While CKD and ESRD management processes have led to improved longevity and health related quality of life (HrQoL) in patients in the developed countries, the story is different for majority of patients in LIMC.</p> <p>To reduce the burden of CKD and ESRD in the present circumstances therefore, focus should be on measures to reduce the burden of risk factors of CKD and an ERSD in the community.</p> <p>A public health approach&nbsp;&nbsp; for the Primary prevention of overweight/obesity, hypertension, type 2 diabetes, nephrotoxin exposures and HIV infection becomes inevitable and advocated.</p> <p><strong>Preventive nephrology</strong> as a body of knowledge and practice have not been given a place of prominence in contemporary nephrology practice and is an unmet need in the global management of CKD, especially in LIMC.</p> <p>The Framingham heart and cardiovascular preventive studies in the United states of America in the 1950s is a classic example and pioneer in the application of primary preventive approach to prevention and control of heart and cardiovascular disease worldwide.</p> <p>We therefor propose a <strong>Preventive nephrology program</strong> for LIMC jurisdiction modelled along the Framingham model for CKD prevention in LIMC jurisdictions. Incorporating the program into the WHO 2013-2018 NCD control program will be cost saving.</p> <p>Keywords:<strong><em> &nbsp;Chronic kidney disease, Risk factors, prevention, unmet need, LIMC</em></strong>&nbsp;</p> 2020-04-07T00:00:00+00:00 Copyright (c) 2020 Tropical Journal of Nephrology Histological pattern of bladder cancer at the Lagos State University Teaching Hospital Ikeja 2020-04-07T18:06:51+00:00 Olufunmilade Akinfolarin Omisanjo Olaolu Adebayo Olufemi Akinola Stephen Ikuerowo Olufemi Ojewuyi <p><strong>Background: </strong>Bladder cancer is the second most common cancer of the genitourinary tract and the ninth most common cancer worldwide. It accounts for 7% of new cancer cases in men and 2% of new cancer cases in women. There are varied reports locally regarding the most common histological type of bladder cancer in Nigeria.</p> <p><strong>Aim: </strong>The aim of the study was to review the pattern of presentation and histological types of bladder tumours at the Lagos State University Teaching Hospital Ikeja.</p> <p><strong>Patients and Method: </strong>This was a retrospective study in which the clinical records of all patients who presented with bladder tumours to the Lagos State University Teaching Hospital Ikeja over a 5 year period (January 2013 to December 2017) were retrieved and analyzed.</p> <p><strong>Results: </strong>The records of 32 patients were available for review. There were 19 (59.4%) males and 13 (40.6%) females, reflecting a male preponderance. All the patients had a cystoscopy and biopsy of bladder mass done under conscious sedation. The mean age was 56.75 ± 3.16 years and the median age was 59.50 years (range 14 – 84 years). The most common presenting symptom was haematuria in 29 patients (90.6%). Other presenting symptoms were irritative lower urinary tract symptoms in 27 patients (84.4%), necroturia in 7 patients (21.9%), back pain in 8 patients (25%) and weight loss in 13 patients (40.6%) at initial presentation. Most of the patients (n=25, 78.1%) had an abdominopelvic ultrasound done, out of which 20 patients (80%) had a demonstrable mass. A CT Scan was also done in 23 patients (71.9%). Possible risk factors identified were wading in streams in 4 patients (12.5%), cigarette smoking in 3 patients (9.4%) and exposure to petrochemicals in 1 patient (3.1%). Associated comorbidities documented were hypertension in 12 patients (37.5%) and diabetes mellitus in 3 patients (9.4%). The most common histological type of bladder tumour was papillary urothelial carcinoma in 23 patients (71.8%), with about half of these (n=12, 52.2 %) being high grade tumours.</p> <p><strong>Conclusion: </strong>Papillary urothelial carcinoma is the most common histological type of bladder cancer presenting at the Lagos State University Teaching Hospital Ikeja with more males being diagnosed than females.</p> <p><strong>Keywords:</strong> bladder cancer, urothelial carcinoma, squamous cell carcinoma&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> 2020-04-07T00:00:00+00:00 Copyright (c) 2020 Tropical Journal of Nephrology PREVALENCE AND SOCIO-DEMOGRAPHIC PROFILE OF HYPERTENSIVE INDIVIDUALS-REPORT OF A 3YR- MMM HYPERTENSION SURVEILLANCE AT LASUTH, IKEJA. 2020-04-07T18:07:02+00:00 Alaba Phillips Adebola SO OGUNDELE FA DANIEL AO AJIBARE M AMISU EO OKOGUN O AISIEN KW WAHAB <p>BACKGROUND.</p> <p>Hypertension is the most common cardiovascular disease worldwide and is responsible for most cardiovascular disease-related deaths globally. As part of a yearly MAY MEASUREMENT MONTH (MMM) hypertension awareness programme organised globally by the WHO in conjunction with the International Society of Hypertension and the Nigerian chapter, we carried out hypertension awareness programme within and outside the immediate environs of LASUTH, in the months of MAY 2017, 2018, and 2019 respectively. The study was aimed at evaluating the prevalence, awareness and socio-demographic risk profile among the participants</p> <p>&nbsp;METHODS</p> <p>A total of 541 subjects consisting of 260 males and 281 females participated in the programme. 146 individuals were involved in 2017, 183 in 2018 and 212 in 2019. Standardized Questionnaires that was prepared by the ISH for the MMM programme globally, was administered to each participant. Hypertension was defined as blood pressure (BP) ≥140/90 mmHg or regular use of BP-lowering medication. Prevalence was represented in both discrete numbers and percentages and subjected to chi-square analyses were applicable. The significant P value was set at &lt;0.05.</p> <p>RESULTS</p> <p>A total of 541 individuals consisting of 260 males and 281 females with a mean age of 45.96±11.1 participated in the programme. Two hundred and forty-five (45.3%) out of the 541 participants were found to be hypertensive. One hundred and ten of the 245 hypertensive subjects (44.9%) had been on antihypertensive medication out of which 44 (40%), were controlled on medication. Hypertensive subjects were more likely to be known Diabetic and obese compared to their non-hypertensive counterparts (p=0.057 and p=0.001 respectively). However, there was no significant difference in the prevalence of alcohol intake and cigarette smoking in the hypertensive compared to non-hypertensive individuals.</p> <p>CONCLUSION</p> <p>THE study reported a relatively high prevalence of hypertension among the participants out of which, only 44-9% were on anti-hypertensive medication, of which 40% were controlled on their antihypertensive medications. There was no significant difference in the prevalence of alcohol intake or cigarette smoking in the hypertensive compared to the non-hypertensive individuals.</p> 2020-04-07T00:00:00+00:00 Copyright (c) 2020 Tropical Journal of Nephrology Localization of Urinary Tract Infection In Catheterized Adults Patients: Experience With The Bladder Washout Technique 2020-04-07T18:07:07+00:00 Mumuni Amisu W B Mutiu M Ojongbede J O Awobusuyi <p>Catheter-associated urinary tract infection is a nosocomial infection acquired by patients admitted into hospitals who are catheterized for various reasons. The prevalence of CAUTI varies between 10.5 to 35% in previous studies done in Europe.&nbsp; Although perceived to be one of the commonest nosocomial infections in our hospitals, local studies on its prevalence and site of infection are sparse in Nigeria., Catheterization is a common procedure in the hospital environment and many in-patients are routinely catheterized for a number of reasons, the general impression is that most of CAUTI are localized to the bladder as patients tend to have few classical symptoms of upper urinary tract infection.</p> <p>This study aims at determining the prevalence of CAUTI in patients admitted to our Hospital and to localize the sites of infection using the Bladder Wash Out technique.</p> <p><strong>Methodology</strong></p> <p>A cross-sectional descriptive study of 226 catheterized subjects recruited over 6 months Bladder washout technique was used to localize the site of infection, and cultures of the collected urine were performed using standard laboratory techniques.</p> <p><strong>Results</strong></p> <p>A total of 226 catheterized patients were studied. There were 144 (64%) males and 80 (36%). 118 (52.2%) had CAUTI. Prevalence in males was 81.4% while it was 18.6% in females who had CAUTI. The prevalence of Upper UTI was 42.4%., this prevalence was seen more commonly in males with (88%) and (12%) in female respectively.</p> <p><strong>Conclusion</strong></p> <p>The study showed a higher prevalence of CAUTI in Hospitalized patients in LASUTH. Contrary to previously held opinion, majority of the infections were upper Urinary Tract infections. Increased duration of an indwelling catheter is a major risk factor for catheter-associated urinary tract infections.</p> 2020-04-07T00:00:00+00:00 Copyright (c) 2020 Tropical Journal of Nephrology