Tropical Journal of Nephrology <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> Nigerian Association of Nephrology en-US Tropical Journal of Nephrology <p>The Nigerian Association of Nephrology owns the Tropical Journal of Nephrology. All right reserved. No part of this may be reproduced or translated fully or part without prior permission from the Association, which holds the copyright on all articles published in the Tropical Journal of Nephrology</p> IMPORTANT TIPS ON ACUTE KIDNEY INJURY FOR PRIMARY CARE PHYSICIANS IN SUB-SAHARA AFRICA <p>The number of Nephrology Specialists continue to lag desperately behind the standard requirements for the Nigerian populace, a situation that is replicated in most sub-Saharan countries in Africa. This has resulted in unfavourable impact on clinical outcomes among patients who present with life-threatening renal diseases that require early recognition and prompt intervention such as acute kidney injury, nephrogenic pulmonary oedema and acute dyselelctrolaemia.</p> <p>It has been shown that early intervention by primary care physicians portends better outcomes for patients with acute kidney injury through early recognition of the disease, prompt intervention and (where necessary) referral to the Nephrologist.</p> <p>However, recent studies indicate that majority of primary care physicians are inadequately equipped with knowledge of the disease thus defeating the purpose of primary care physicians having early contact with such patients. In this article, we aimed to present primary care physicians working in sub-Sahara Africa and other third world countries some simplified but current and practical tips on early recognition of acute kidney injury and the necessary first steps to take during interventions.</p> <p>One of the take home points in this article is the relevance of focused history taking in identifying the aetiological agent(s) of acute kidney injury across the major sub-specialties in contemporary times in sub-Sahara African hospitals as most patients cannot afford hi-tech, sophisticated investigations when and where they are available.</p> Akinwumi Akinbodewa Oluyomi Okunola Copyright (c) 2021 2021-07-01 2021-07-01 15 1 17 24 Reference Interval for Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) for diagnosing Kidney Injury <p>Aim: Neutrophil gelatinase-associated lipocalin<br />(NGAL) is emerging, as a promising biomarker for<br />diagnosing acute kidney injury, yet its reference<br />interval is not established in many populations. This<br />report documents serum NGAL reference intervals<br />in apparently healthy population in the Caribbean in<br />relation to age, sex, body mass index (BMI) and blood<br />pressure.<br />Methods: The blood pressure (BP), height and<br />weight of 90 (37 males, 53 females) apparently<br />healthy subjects aged between 17 and 83 years were<br />measured. Fasting blood samples were collected and<br />serum NGAL levels were measured with manual<br />ELISA technique and 95% reference intervals for<br />NGAL stratified by age and sex was established. The<br />Statistical Package for the Social Sciences (SPSS)<br />was used for statistical analysis.<br />Results: The results are expressed as mean ±2 SD.<br />The age, BP and BMI were similar in male and female<br />subjects studied (p &gt; 0.05). NGAL levels showed a<br />normal Gaussian frequency distribution and were<br />similar in male and female subjects (p &gt; 0.05). The<br />overall unisex reference interval for the population<br />(n = 90; age 17 – 83yrs.) was 73.3-85.6 ng/mL, while<br />the gender reference intervals was 68.3-92.6 ng/mL<br />for male and 73.2- 84.1 ng/mL for female and for<br />age category &lt; 60yrs (n = 82; age 17 – 59yrs) was<br />73.3 – 84.1 ng/mL.<br />Conclusion: This study showed that apparently<br />healthy male and female subjects with similar mean<br />age, body mass index and blood pressure had similar serum NGAL levels. The gender- and age-specific<br />reference intervals determined in this study could<br />therefore provide a suitable template for further<br />studies in relation to establishing reference intervals<br />for serum NGAL for this and other populations.</p> <p> </p> Saleh Idris Chidum Ezenwaka Gershwin Davis Copyright (c) 2021 2021-07-01 2021-07-01 15 1 25 32 Prevalence of Traditional Risk Factors of Chronic Kidney Disease in an Agrarian Community in Edo State, Nigeria: Report of a Health Screening Survey <p>Introduction: Chronic Kidney Disease (CKD) is a<br>public health threat with negative impact on affected<br>individuals, families and communities worldwide<br>because of the prohibitive cost of care especially in<br>those with endstage renal disease (ESRD). It is more<br>cost-effective to identify risk factors of CKD with a<br>view to mitigating them than to treat ESRD. The aim<br>of the study was to determine the prevalence of risk<br>factors of CKD in a semi-urban agrarian community<br>in Edo State.<br>Materials and Methods: This was a cross-sectional<br>study of adults who partook in a health screening<br>exercise done in South Ibie Kingdom, an agrarian<br>community in Edo State, Nigeria between February<br>to May 2015 A structured interviewer- administered<br>questionnaire was used to obtain data from<br>respondents. History, clinical examination (including<br>blood pressure and anthropometric measurement) and<br>collection of urine sample for urinalysis, as well as<br>blood for glucose and creatinine was undertaken.<br>Data was analyzed with IBM SPSS statistics version<br>20.0.<br>Results: One hundred and sixty three respondents<br>(70 males, 93 females) completed the study. The<br>males were older with a mean age of 52.1 + 18 yrs<br>compared with 45.1 + 17.3 yrs for females (p= 0.02).<br>Thirty three (20.2%) had a previous diagnosis of<br>hypertension, 6.1 % diabetes, DM and 1.2 % kidney<br>disease. A family history of hypertension, DM and<br>Tropical Journal of Nephrology Vol.15 No. 1, June, 2020 33 - 42<br>Prevalence of Traditional Risk Factors of Chronic Kidney Disease<br>in an Agrarian Community in Edo State, Nigeria:<br>Report of a Health Screening Survey<br>1Oghenekaro Godwin Egbi and 2Sulaiman Dazumi Ahmed<br>1Department of Internal Medicine, Niger Delta University Teaching Hospital, Bayelsa State, Nigeria<br>2Department of Internal Medicine, Irrua Specialist Teaching Hospital, Edo State, Nigeria<br>33<br>kidney disease was found in 16.0%, 11.7% and 1.8%<br>respectively. There was no difference in the<br>proportion of these risk factors between males and<br>females except for proteinuria which was more in<br>females(p &gt;0.05). The prevalence of elevated blood<br>pressure, hyperglycemia and generalized obesity<br>were 24.5%, 2.5% and 35.0% respectively. While<br>19.6% had proteinuria, 2.7% had hematuria. Thirty<br>(18.4 %) participants had eGFR &lt;90 mls/min. eGFR<br>was significantly negatively correlated with age (p<br>&lt;0.001), BMI (p = 0.029), SBP (p &lt;0.001) and DBP.<br>(p &lt;0.001).<br>Conclusion: The prevalence of risk factors for CKD<br>was high. To help reduce the scourge of CKD, there<br>is need for regular screening of communities at the<br>primary level for these risk factors followed by prompt<br>intervention.</p> Oghenekaro Godwin Egbi Sulaiman Dazumi Ahmed Copyright (c) 2021 2021-07-01 2021-07-01 15 1 33 42 Evaluation of iron status amongst multiply transfused chronic kidney disease patients at the Lagos State University Teaching Hospital, (LASUTH) Ikeja/ Gbagada General Hospital. <p>Anaemia is defined by the World Health Organization (WHO) as a haemoglobin (Hb) concentration of less than 13g/dl in adult males and non-menstruating women and less than 12g/dl in menstruating women. Most end stage renal disease (ESRD) patients in our facility present with severe anaemia requiring multiple blood transfusions. In the course of treatment, especially when on dialysis, these patients are also placed on iron therapy and erythropoietin. Iron studies are not conducted routinely in Nigeria mainly due to high cost of the tests. It is hypothesized that these patients may be iron overloaded and may require chelation therapy.</p> <p>There is paucity of literature on iron status evaluation amongst chronic kidney disease (CKD) patients in Nigeria. This research determined the iron profile of this group of patients in our facility and the findings may provide recommendations on their management.</p> Jane Chiemeka Bakare Jacob Awobusuyi Theophilus Umeizudike Copyright (c) 2021 2021-07-01 2021-07-01 15 1 43 52 The Prevalence of Elevated Serum Troponin T and its Association with Left Ventriular Hypertrophy in Patients with Chronic Kidney Disease in Ilorin <p>Background: Left ventricular hypertrophy is the<br>most frequent cardiac alteration in chronic kidney<br>disease patients and it is associated with poor<br>outcome. Troponin T, a contractile protein has been<br>found to be elevated in chronic kidney disease patients<br>who have no ongoing myocardial necrosis. This study<br>assessed the clinical relationship between serum<br>elevated troponins T in patients with chronic kidney<br>disease and LVH in our patient population.<br>Methods: This was an hospital- based study crosssectional<br>study of 110 patients with CKD who were<br>seen in the nephrology clinic, the renal ward and the<br>general medical ward at the University of Ilorin<br>Teaching Hospital and 110 age and sex matched<br>controls who had no CKD. Informed consent and<br>relevant information were obtained using a study<br>proforma. Biochemical parameters (Troponin T,<br>serum creatinine, lipid profile) of both patients and<br>controls were analyzed. Electrocardiogram and<br>Echocardiogram were carried out on all patients.<br>Troponin T assay was done using ELISA third<br>generation kit while electrocardiogram was done<br>using the GE MAC 1200 ST Electrocardiogram.<br>Echocardiogram was done using the Sonoscope 2D<br>model machine. Data was analysed using descriptive<br>and inferential statistics on an SPSS software version<br>23. Level of statistical significance was set at p &lt;<br>0.05.</p> <p>Results: The mean age of the patients with CKD<br>was 55±14 years while that of the control was 52±14<br>years. The median value of creatinine in the cases<br>category was 160(121-224) μmol/l while the median<br>value in the control participants was 74(51-84)μmol/<br>l. The median eGFR was 39(26-52)ml/min/1.73m2 in<br>the cases, while in the control participants, it was<br>118(87-143) ml/min/1.73m2. The median value for<br>serum troponin T was 0.78(0.15-1.25) μg/l in the case<br>participants. This was significantly higher than the<br>control participants who had a median value of<br>0.09(0.07-0.09) μg/L. P&lt;0.001. Eighty-one (91.4%)<br>of the eighty-six participants with CKD who had<br>elevated troponin T had LVH.<br>Conclusion: Cardiac Troponin T is elevated in<br>chronic kidney disease patients particularly dialysis<br>patients. Cardiac troponin T should be incorporated<br>as a screening tool in patients with CKD.</p> Adegboyega Faponle Timothy Olanrewaju Adindu Chijioke Philip Manma Kolo Oladapo Oyedepo Kudirat Ajoke Busari Idris Yusuf Copyright (c) 2021 2021-07-01 2021-07-01 15 1 53 64 Sixteen Years of Tropical Journal of Nephrology Samuel Oluwole Ajayi Copyright (c) 2021 2021-07-01 2021-07-01 15 1 6 6 Living Well with Kidney Disease by Patient and Care-Partner Empowerment: Kidney Health for Everyone Everywhere <p>Living with chronic kidney disease (CKD) is associated with hardships for patients and their care-partners. Empowering patients and their care-partners, including family members or friends involved in their care, may help minimize the burden and consequences of CKD related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including an emphasis on patients being in control. The World Kidney Day (WKD) Joint Steering Committee has declared 2021 the year of “Living Well with Kidney Disease” in an effort to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labelling claims for medicines and devices. Funding agencies could establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the overall wellness program for kidney disease patients, the need for prevention should be reiterated. Early detection with a prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programs, should be promoted.&nbsp;WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals, and policy makers, applicable to both developed and developing countries.</p> Kamyar Kalantar-Zadeh Philip Li Ekamol Tantisattamo Latha Kumaraswami Vassilios Liakopoulos Siu-Fai Lui Ifeoma Ulasi Sharon Andreoli Alessandro Balducci Sophie Dupuis Tess Harris Anne Hradsky Richard Knight Sajay Kumar Maggie Ng Alice Poidevin Gamal Saadi Allison Tong Copyright (c) 2021 2021-07-01 2021-07-01 15 1 7 16 Guidelines for the Management of Hypertension in Nigeria 2020 <p>Background<br>Hypertension, defined as blood pressure &gt; 140/90<br>mmHg, has assumed greater public health importance<br>in Nigeria in the last 2 decades. Many reports put the<br>adult prevalence rates at 20-40%, with some major<br>ones specifically reporting 27.8% and 28.9%. Low<br>detection and reporting rates, inadequate investigation<br>and treatment rates all combine to increase the burden.<br>The guidelines provide updated information.<br>Recommendations<br>The traditional risk factors, with the addition of high<br>income and education status, are highlighted.<br>Recommendations regarding the use of devices and<br>the setting, including home and ambulatory, in the<br>measurement of the blood pressure, are updated. The<br>importance of total cardiovascular risk assessment<br>and risk stratification, employed in initiating and guiding<br>therapy, is emphasized.<br>Lifestyle modifications are prescribed for all;<br>they are described with estimates of BP responses<br>and with a greater reference to local conditions.<br>Attention is drawn to the early use of medicine<br>therapy in those with high CV risk and multi-medicine<br>therapy in those with BP &gt; 160/100 mmHg. The use<br>of single pill combinations, wherever feasible, is<br>recommended, and the prediction is made of most<br>patients eventually requiring multi-medicine therapy.</p> <p>Considerations of cost, availability, tolerance<br>and patient-specific factors influence the choice of<br>medicines, and although any of the several medicine<br>classes could be used for initial therapy, thiazide and<br>thiazide-like diuretics and calcium channel blockers<br>are recommended for single or dual-medicine therapy.<br>Alternatively, any of these and any of angiotensin<br>converting enzyme inhibitor, angiotensin receptor<br>blocker, centrally acting agent, beta-blocker or alphablocker<br>could be used for combination therapy.<br>Effective and recommended combinations and a list<br>of the commonly available medicines in Nigeria are<br>listed. Aspirin for secondary prevention and statin<br>therapy should be used as required. The goal of<br>treatment is commonly &lt;140/90 mmHg, but could be<br>lower in patients with diabetes, chronic kidney<br>disease. Patient counselling, follow-up and treatment<br>monitoring are emphasised.<br>Outlines of treatment in special groups or<br>situations including diabetes, chronic kidney disease,<br>haemoglobinopathies, HIV-infection, paediatric<br>patients, patients with sexual dysfunction, resistant<br>hypertension, hypertension emergency, community<br>control and prevention are provided.</p> Solomon Kadiri Fatiu Arogundade Ayodeji Arije Ayodele Omotoso Basden Onwubere Ademola Aderibigbe Ambrose Isah Amam Mbakwem Babatunde Salako Simeon Isezuo Shamsudeen Ogun Mahmoud Sani Ifeoma Ulasi Oluranti Familoni Anthonia Ogbera Okechukwu Ogah Adebowale Ademola Abimbola Opadeyi Adanze Asinobi Copyright (c) 2021 2021-07-01 2021-07-01 15 1 65 84