Browsing by Author "Asinobi, A. O."

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Acute kidney injury among paediatric emergency room admissions in a tertiary hospital in South West Nigeria: a cohort study
(Oxford University Press, 2019) Ademola, A. D.; Asinobi, A. O.; Ekpe-Adewuyi, E.; Ayede, A. I.; Ajayi, S. O.; Raji, Y. R.; Salako, B. L.; James, M.; Zappitelli, M.; Samuel, S. M.
Background. Epidemiological data on paediatric acute kidney injury (AKI) in sub-Saharan Africa are limited and largely retrospective. We performed a prospective study of AKI among patients admitted through the emergency room. Methods. Children admitted to the post-neonatal emergency room of the University College Hospital, Ibadan, Nigeria between February 2016 and January 2017 were studied. AKI was defined by Kidney Disease: Improving Global Outcomes serum creatinine criteria. AKI ascertainment relied on serum creatinine measurements carried out in routine care by post admission Day 1. We compared in-hospital mortality by post-admission Day 7 for patients with and without AKI (no-AKI). Results. Of the 1344 children admitted to the emergency room, 331 were included in the study. AKI occurred in 112 patients (33.8%) with a median age of 3.1 years [interquartile range (IQR) 0.9–9.4] and was Stage 3 in 50.5% of the cases. The no-AKI group had a median age of 1.8 (IQR 0.7–5.8) years. The underlying diagnoses in patients with AKI were sepsis (33.0%), malaria (12.5%) and primary renal disorders (13.4%). Twenty-four of the patients with AKI underwent dialysis: haemodialysis in 20 and peritoneal dialysis in 4. By Day 7 of admission, 7 of 98 (7.1%) patients in the AKI group had died compared with 5 of 175 (2.9%) patients in the no-AKI group [odds ratio 2.6 (95% confidence interval 0.8–8.5)]. Outcome data were not available for 58 (17.5%) patients. Conclusions. AKI is common among paediatric emergency room admissions in a tertiary care hospital in sub-Saharan Africa. It is associated with high mortality risk that may be worse in settings without dialysis.
An Audit of the Use of Renal Function Tests among Paediatric Mortalities
(Sciencedomain International, 2016) Asinobi, A. O.; Ademola, A. D.; Ogunku, O. O.
Background: Acute kidney injury is a frequent and serious complication encountered in critically ill children and is an independent risk factor for mortality. Major causes of childhood mortality in our environment are conditions frequently complicated by kidney failure, yet kidney failure is conspicuously absent in many of the reports. The actual proportion of these critically ill children subjected to renal function tests is not known. In view of the low representation of kidney failure as a cause of mortality in our environment, we sought to know what proportion of critically ill/dying patients had renal functions tests done and to identify any cases of missed diagnosis. Methods: This was a descriptive study of the mortalities in the Department of Paediatrics, University College Hospital, Ibadan, between August 2004 and May 2006, particularly those due to kidney failure. Data from the departmental mortality database collected on a weekly basis were analyzed. Results: Out of 4,941 admissions, there were 542 mortalities (age 1day -13 years) giving a mortality rate of 11%. Low birth weight, malaria, severe perinatal asphyxia, meningitis and neonatal tetanus were the leading five causes of death. Over 80% of the mortalities were under-fives
Childhood acute glomerulonephritis in Ibadan Nigeria
(Paediatric Association of Nigeria, 2020) Asinobi, A. O.; Ademola, A. D.; Nwankwo, A. F.
Childhood nephrotic syndrome in Africa: Epidemiology, treatment trends, and outcomes
(Elsevier Inc., 2022) Ademola, A. D.; Asinobi, A. O.; Alao, M. A.; Olowu, W. A.
Nephrotic syndrome is a common childhood glomerular disease that is associated with massive proteinuria and edema. Children with nephrotic syndrome are at risk of chronic kidney disease, disease-related complications, and treatment-related complications. Patients with frequently relapsing disease or steroid toxicity may require newer immunosuppressive medications. However, access to these medications is limited in many African countries owing to prohibitive cost, the need for frequent therapeutic drug monitoring, and a lack of appropriate facilities. This narrative review examines the epidemiology of childhood nephrotic syndrome in Africa, including trends in treatment and patient outcomes. In most of North Africa, as well as among White and Indian populations in South Africa, the epidemiology and treatment of childhood nephrotic syndrome closely resembles that of European and North American populations. Historically, secondary causes of nephrotic syndrome (eg, quartan malaria nephropathy and hepatitis B−associated nephropathy) were predominant among Blacks in Africa. Over time, the proportion of secondary cases has decreased, along with rates of steroid resistance. However, focal segmental glomerulosclerosis increasingly has been reported among patients with steroid resistance. There is a need for consensus guidelines for the management of childhood nephrotic syndrome in Africa. Furthermore, establishing an African nephrotic syndrome registry could facilitate monitoring of disease and treatment trends, and provide opportunities for advocacy and research to improve patient outcomes.
Diagnosing renal failure due to diethylene glycol in children in a resource-constrained setting
(Springer International Publishing, 2012) "Akuse, R. M.; Anyiam, J.; Eke, F. U.; Ademola, A. D.; Fajolu, I. B.; Gbelee, H. O.; Ihejiahi, U.; Bugaje, M. A.; Anochie, I. C.; Asinobi, A. O.; Okafor, H. U.; Adeleke, S. I.; Audu, L. I.; Otuneye, A.; Disu, E.; Idris, H.; Aikhonbare, H.; Yakubu, A.; Ogala, W.; Ogunrinde, O.; Wammanda, R.; Orogade, A.; Eseigbe, E.; Umar, L.; Musa, H.; Onalo, R.; West, B.; Paul, N.; Lesi, F.; Ladapo, T.; Boyede, O.; Okeowo, R.; Mustapha, A.; Akinola, I.; Chima-Oduko, O.; Awobusuyi O.
Background In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource constrained countries, this study investigated whether AKI associated with DEG could be identified by other means. Methods: This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children withAKI over a 6-month period were reviewed. Results Sixty (50.4%) of 119 children ingested “My pikin” teething syrup. Compared to children who had not ingested it, they were significantly (p<0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management. Conclusions Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.
Factors associated with mortality and long-term outcomes of pediatric acute kidney injury in a resource limited setting
(Karger AG, Basel, 2023) Alao, M. A.; Ibrahim, O. R.; Ademola, A. D.; Asinobi, A. O.
Introduction: Despite being a leading cause of morbidity and mortality globally, acute kidney injury (AKI) is worse in resource-limited areas. This study explores AKI incidence, in-hospital mortality, and long-term outcomes in resource limited settings. Methods: This was a prospective study of children with AKI from2014 to 2019. KDIGO 2012 defined AKI. We assessed the etiology, in-hospital mortality, and long-term outcome of AKI in a mission hospital. Results: Only 169 of 201 AKI patients had complete data. The ages ranged from 1.08 months to 17.5 years; 65.7% were male and 65.1% were from lower socioeconomic class. The incidence of AKI was 59.6 cases per 1,000 persons (95%CI: 5.42, 47.1). Most patients had stage 1 KDIGO AKI (91; 53.8%). 1–5 years old had the highest incidence of AKI (65; 38.5%); sepsis (26.6%), severe malaria (15.4%), and nephrotic syndrome (14.8%) were common AKI causes. Fever (72.8%), pallor (52.1%), and vomiting (45.6%) were the most common symptoms. Thirty two (27.8%) patients had high blood pressure. In-hospital mortality was 14.8% (95% CI: 9.8, 21.1). The cumulative incidence of AKI-related mortality was 93.2 per 1,000 person years. Poor outcome was associated with breathlessness, hyponatremia, and leukocytosis. Kaplan-Meier survival curve showed 81% (CI: 74–87%) survival after 5 years of AKI. On Cox proportional-hazards analysis, the absence of breathlessness (HR: 2.537, 95%: CI 1.210–5.317) and hyponatremia (HR: 2.914, 95% CI: 1.343–6.324) were associated with increased survival. Conclusion: In resource-limited settings, infectious diseases and nephrotic syndrome are common causes of AKI. Factors associated with mortality include breathlessness and hyponatremia
Haemodialysis for paediatric acute kidney injury in a low resource setting: experience from a tertiary hospital in South West Nigeria
(Oxford University Press, 2016) Asinobi, A. O.; Ademola, A. D.; Alao, M. A.
Background: Acute kidney injury (AKI) is an important cause of preventable mortality among children. Management of AKI may require renal replacement therapy (RRT) but access to RRT for children in low resource settings is limited. Our study explored the role of haemodialysis in the management of children with AKI in a low resource setting in terms of aetiology and outcomes. Methods: A review of patients managed in the Paediatric Nephrology Unit, University College Hospital Ibadan, South-West Nigeria, who underwent haemodialysis for AKI from January 2006 to December 2014. Results: Sixty-eight patients (55.9% males), aged 3–16 (mean ± standard deviation, 9.0 ± 3.4) years were studied. The causes of AKI were sepsis (22.1%), malaria (17.6%) and glomerulonephritis (17.6%), intravascular haemolysis—cause unknown (16.2%), G6PDH deficiency (7.4%), malignancy (8.8%) and haemoglobinopathy (5.9%). The number of sessions of haemodialysis ranged from 1 to 10 (mode = 2 sessions) over a period of 1–55 days. Mortality was 27.9% (n = 19) and was related to the aetiology of AKI (P = 0.000): no deaths among patients with intravascular haemolysis or malaria, six deaths among patients with sepsis (40%), six (50%) among the patients with glomerulonephritis, while all the patients with malignancies died. Conclusions: The outcome of haemodialysis for AKI in Nigeria is relatively good and is related to the underlying aetiology of AKI. In addition to peritoneal dialysis, intermittent haemodialysis may have a role in the management of paediatric AKI in low resource settings and should be supported.
Kidney disease in hepatitis B surface antigen-positive children: experience from a centre in south-west Nigeria and a review of the Nigerian literature
(Taylor and Francis, 2017) Asinobi, A. O.; Ademola, A. D.; Okolo, C. A.; Adepoju, A. A.; Samuel, S. M.; Hoy, W. E.
Background: Kidney disease is an important extra-hepatic manifestation of hepatitis B virus (HBV) infection. However, there is paucity of recent literature on kidney disease in children and adolescents with HBV infection from several parts of sub-Saharan Africa including Nigeria. Objective: To review the pattern of kidney disease in hepatitis B surface antigen (HBsAg)-positive children and adolescents seen at a tertiary hospital in south-west Nigeria. Methods: A retrospective study was undertaken of HBsAg-seropositive children with kidney disease managed at University College Hospital, Ibadan, from January 2004 to December 2015. Patients were identified from the paediatric nephrology unit admissions and the renal histology registers. Results: 24 children and adolescents were studied, 17 of whom were male (70.8%), and the median age was 10.0 years (range 3–15). Ten (41.7%) had nephrotic syndrome, five (20.8%) had non-nephrotic glomerulonephritis, five (20.8%) were in end-stage renal disease (ESRD), including a patient with posterior urethral valves, and four had acute kidney injury secondary to acute tubular necrosis. Renal histology was available for 10 patients: nine had nephrotic syndrome associated with minimal change disease in six, focal segmental glomerulosclerosis in two and one had membanoproliferative glomerulonephritis. The patient with non-nephrotic glomerulonephritis had diffuse global sclerosis. Conclusion: The pattern of kidney disease in HBV-positive children demonstrated a predominance of nephrotic syndrome, followed by non-nephrotic glomerulonephritis, ESRD and acute kidney injury. Better diagnostic facilities and treatment are required. Prevention of HBV infection by universal childhood immunisation is the ultimate goal.
Nephrotic syndrome complicating cyanotic congenital heart disease: A report of two cases
(West African College of Physicians/ West African College of Surgeons., 2008) Ogunkunle, O. O.; Asinobi, A. O.; Omokhodion, S. I.; Ademola, A. D.
BACKGROUND: Renal complications are said to be common in cyanotic congenital heart disease (CCHD), but have not been documented frequently in Nigerian children. Nephrotic syndrome (NS) is an uncommon complication of CCHD. OBJECTIVES: To report two cases of NS complicating CCHD who presented within months of each other, in order to draw attention to the problem. METHODS: The details of the clinical presentation, course and outcome of two children with CCHD, presenting with features of NS within months of each other, were reviewed. The patients were fully assessed clinically and were further investigated with chest X-ray, ECG ad echocardiography. RESULTS: A 12-year old girl with Fallot’s tetralogy underwent a Blalock-Taussig shunt at the age of 2 years, but subsequently defaulted from follow-up. She reappeared 10 years later with features of NS. Echocardiography revealed impaired myocardial function. Despite initial clinical improvement following three plasma exchanges and Enalapril therapy, she suddenly died on the 15th day of admission. The second patient was a 7-year old boy with tricuspid atresia, diagnosed at the age of 10 months, and similarly defaulted, reappearing six years later with features of NS. Oedema regressed with similar treatment, but his renal function deteriorated. He was stable enough to be discharged after six weeks on admission. CONCLUSION: Proteinuria is likely to be more common in Nigerian children with CCHD than has been previously appreciated. Early intervention in patients with CCHD is desirable in order to prevent development of complications which worsen the prognosis. Patients with CCHD should be screened regularly for proteinuria in order to detect and address renal complications early.
Paediatric dialysis at a tertiary hospital in South-West Nigeria: A 4-year report
(Karger AG, Basel, 2022) Ademola, A. D.; Asinobi, A. O.; Alao, M. A.; Wade, A. W.
Introduction: Dialysis is potentially lifesaving in children with acute kidney injury (AKI) or chronic kidney disease (CKD), but availability is limited in low-income countries and lower-middle-income countries (LMICs). Methods: In the present study, we perform a 4-year study of patients who received peritoneal dialysis (PD) or haemodialysis (HD) at the Paediatric Nephrology Unit of the University College Hospital Ibadan, Nigeria. Subgroup analysis was performed on patients with sepsis or malaria AKI who underwent HD or PD for predictors of in-hospital mortality. Results: A total of 167 children aged 7 days to 18 years, median 7 (interquartile range 3–12) years, (60.5% males) were studied. In total, 129 (77.2%) had AKI, while 38 had CKD. Regarding AKI, 83 children (64.3%) received HD only, 42 underwent PD only, while 4 underwent both HD and PD. Malaria AKI was treated with HD in 43 (51.8%) or PD in 8 (10.5%), while sepsis AKI was treated with HD in 20 (21.4%) or PD in 33 (78.6%). Mortality in AKI was 16.3% overall, 10.8% in children on HD only, and 26.2% in children on PD only. Patients with sepsis AKI had higher mortality compared to patients with malaria AKI (RR 7.96) [1.70–37.37]). Subgroup analysis showed that age, diagnosis, and dialysis modality were not independent risk factors for mortality. The aetiology of CKD was glomerulonephritis in 26 (68.4%): treatment was HD in 36 and PD in 2 with mortality being 26.3%. Conclusions: PD for AKI showed relatively good outcomes in a LMIC. However, funding and support for a formal dialysis program for the management of AKI and CKD are needed.
Paediatric end-stage renal disease in a tertiary hospital in South West Nigeria
(Asian Pacific Society of Nephrology, 2014) Asinobi, A. O.; Ademola, A. D.; Ogunkunle, O. O.; Mott S. A.
Background: Children and adolescents with end-stage renal disease (ESRD) in sub-Saharan Africa may have the worst outcomes globally. Barriers to management include late presentation, poor socioeconomic conditions, absence of medical insurance, limited diagnostic facilities and non-availability of chronic renal replacement therapy (RRT). Our study was to determine the incidence, aetiology, management and outcomes of paediatric ESRD in a tertiary hospital in Nigeria. Methods: A retrospective case review of paediatric ESRD at the University College Hospital Ibadan, Nigeria, over 8 years, from January 2005 to December 2012. Results: 53 patients (56.6% male), median age 11 (inter quartile range 8.5-12) years were studied. Mean annual incidence of ESRD in Ibadan for children aged 14 years and below was 4 per million age related population (PMARP) while for those aged 5-14 years it was 6.0 PMARP. Glomerulonephritis was the cause in 41 (77.4%) patients amongst whom, 29 had chronic glomerulonephritis and 12 had nephrotic syndrome. Congenital anomalies of the kidneys and urinary tract (CAKUT) accounted for 11 (21.2%) cases, posterior urethral valves being the most common. Acute haemodialysis, acute peritoneal dialysis or a combination of these were performed in 33 (62.3%), 6 (11.3%) and 4 (7.5%) patients respectively. Median survival was 47 days and in-hospital mortality was 59%. Conclusions: Incidence of paediatric ESRD in Ibadan is higher than previous reports from sub-Saharan Africa. Glomerulonephritis, and then CAKUT are the most common causes. Mortality is high, primarily due to lack of resources. Preventive nephrology and chronic RRT programmes are urgently needed.
Paediatric peritoneal dialysis in a developing country: practice, challenges and opportunities
(African Paediatric Nephrology Association, 2019) Asinobi, A. O.; Ademola, A. D.; Akuse, R. M.
Background: The practice and challenges of peritoneal dialysis (PD) in a developing country may be uniquely different from what obtains in developed countries. Method: A review of the practice and challenges of PD in Nigeria as a case study and documentation of opportunities for improvement Review: There has been renewed interest in the provision of PD to children in acute kidney injury in Nigeria and this has led to adaptations such as use of nasogastric tubes as PD catheters and use of constituted PD fluid. The use of adaptations is lifesaving but complication rates may be higher than with the use of standard gadgets. Other challenges include limited availability and high cost of PD catheters and PD fluid. There are also challenges with the availability of expertise for the insertion of PD catheters and the PD procedure. Opportunities to advance paediatric PD include sustained efforts to provide PD with the use of adaptations, collection of data on outcomes of PD, advocacy for more support from government, non- governmental organisations and industry in the forms of insurance coverage, access to consumables and/or training in paediatric PD. Conclusion: Sustained provision of PD with adaptations, documentation of outcomes, and advocacy may lead to improvement in paediatric PD services.
Peritoneal dialysis in childhood acute kidney injury: experience in Southwest Nigeria
(International Society for Peritoneal Dialysis, 2012) Ademola, A. D.; Asinobi, A. O.; Ogunkunle, O. O.; Yusuf, B. N.; Ojo, O. E.
Background: The choices for renal replacement therapy (RRT) in childhood acute kidney injury (AKI) are lim¬ited in low-resource settings. Peritoneal dialysis (PD) appears to be the most practical modality for RRT in young children with AKI in such settings. Data from sub-Saharan Africa on the use of PD in childhood AKI are few. Methods: We performed a retrospective study of chil¬dren who underwent PD for AKI at a tertiary-care hospital in southwest Nigeria from February 2004 to March 2011 (85 months). Results: The study included 27 children (55.6% female). Mean age was 3.1 ± 2.6years, with the youngest being 7 days, and the oldest, 9 years. The causes of AKI were in¬travascular hemolysis (n = 11), septicemia (n = 8), acute glomerulonephritis (n = 3), gastroenteritis (n = 3), and hemolytic uremic syndrome (n = 2). Peritoneal dialysis was performed manually using percutaneous or adapted catheters. Duration of PD ranged from 6 hours to 12 days (mean: 5.0 ± 3.3 days). The main complications were peri¬tonitis (n = 10), pericatheter leakage (n = 9), and catheter outflow obstruction (n = 5). Of the 27 patients, 19 (70%) survived till discharge. Conclusions: In low-resource settings, PD can be suc¬cessfully performed for the management of childhood AKI. In our hospital, the use of adapted catheters may have contributed to the high complication rates. Peritoneal di¬alysis should be promoted for the management of childhood AKI in low-resource settings, and access to percutaneous or Tenckhoff catheters, dialysis fluid, and automated PD should be increased.
Predictors and outcome of acute kidney injury after non-cardiac paediatric surgery
(Springer Science+Business Media, 2019) Lawal, T. A.; Raji, Y. R.; Ajayi, S. O.; Ademola, A. D.; Ademola, A. F.; Ayandipo, O. O.; Adigun, T.; Ogundoyin, O. O.; Olulana, D. I.; Asinobi, A. O.; Salako, B. L.
Background: It is necessary to define the problem of acute kidney injury (AKI) after non-cardiac surgery in order to design interventions to prevent AKI. The study aimed to evaluate the occurrence, determinants and outcome of AKI among children undergoing general (non-cardiac) surgery. Methods: This was a prospective cohort study of patients aged ≤ 15 years who had general surgery over 18 months period at a tertiary hospital in Nigeria. AKI was evaluated at 6 and 24 h and within 7 days of surgery. Data were analysed using SPSS version 21. Results: A total of 93 patients were studied with age ranging from 3 days to 15 years (median = 4 years). AKI occurred within 24 h of surgery in 32 (34.4%) and cumulatively over 7 days in 33 (35.5%). Patients who had sepsis were nearly four times as likely as others to develop perioperative AKI (OR = 3.52, 95% CI 1.21, 10.20, p = 0.021). Crude mortality rate was 12.1% (4/33); no mortality was recorded among those without AKI, p = 0.014. Conclusion: Perioperative AKI occurred in 35.5% of children who underwent general (non-cardiac) surgery. Patients who had sepsis were four times more likely than others to develop AKI. Mortality was documented only in patients who had AKI.
Spectrum of childhood obstructive uropathy in Ibadan, Nigeria
(MedPrime, 2019) Asinobi, A. O.; Ademola, A. D.; Lawal, T. A.; Takure, A. O.; Shittu, O. B.
Background and Objectives: Obstructive uropathy (OU) is an important cause of morbidity and mortality in childhood with congenital OU being among the top three aetiologies of paediatric end-stage kidney disease (ESKD). With paucity of data on the impact of childhood OU in a setting of largely unaffordable facilities for ESKD management, further studies are needed. The aim of the study was to appraise the aetiological pattern and short- term outcome of childhood OU. Methods: A descriptive cross-sectional study was conducted on consecutively presenting children aged 15 years and below with features of urinary tract obstruction at the University College Hospital, Ibadan between January 2009 and December 2012. Their biodata, clinical presentation, aetiology, treatment, and short- term outcome were analysed in addition to the prevalence of OU in relation to other childhood renal disorders. Results: Eighty-six children aged one day to 15 years with a median age of 2.5 years and a modal age of 6 years were recruited over a 4-year period. The male to female ratio was 4.7:1. Congenital OU occurred in 81% of cases, with the lower urinary tract more frequently affected (78%). Posterior urethral valves (PUV) was the most common cause of OU (59.3%) followed by pelvi-ureteric junction (PUJ) obstruction in 17.4%; 73.3% of all PUJ obstructions occurred in females. Only 3.5% of cases were detected prenatally. Of all incident admissions into the Paediatric Nephrology Unit, OU accounted for 20.7%. An in-hospital mortality rate of 5% occurred. Conclusion: Childhood OU is a significant cause of renal disease in Ibadan accounting for one-fifth of new paediatric renal admissions. It was majorly congenital with a male preponderance and PUV was the most common cause. Contrary to expectations, PUJ obstruction occurred more often in females. Prenatal diagnosis rate was very low.
Steroid response in primary childhood nephrotic syndrome in a tropical African environment
(Medical and Dental Consultants' Association of Nigeria, 2020) Asinobi, A. O.; Ademola, A. D.; Ogunkunle, O. O.
Background: Earlier studies on childhood nephrotic syndrome (NS) in tropical Africa showed steroid resistance in the majority. More recent studies show a variable picture, necessitating a re‑evaluation. This study was aimed at determining the current pattern of steroid response in childhood NS, in an environment known to be dominated by steroid resistance. Patients and Methods: This prospective study of consecutive children who received steroid therapy for primary NS was carried out at the University College Hospital, Ibadan, Nigeria between 2006 and 2013. The outcomes of interest were steroid sensitivity and death. The recruited patients received a 4-6 weeks’ course of prednisolone at 60 mg/m2/day followed by alternate day doses of 40 mg/m2 up to total steroid therapy duration of 6 months in steroid sensitive patients. Statistical analysis was carried out using STATA version 12.0. P value <0.05 was considered significant. Results: Of 109 children that received steroids for at least 8 weeks, whose mean (SD) age was 7.9 (3.7) years, 69 (63.3%) were steroid sensitive. Those aged ≥6 years responded as well as those aged <6 years (P = 0.78). Boys were more likely to be steroid‑sensitive than girls, 65.2% versus 34.8% (P = 0.039). There was zero mortality among the patients studied. Conclusion: This study has shown a better steroid sensitivity of 63.3% in children with primary NS compared with the previously reported 36.8-42.9% in patients with highly selective proteinuria. This improved steroid response and zero mortality show a remarkable departure from the past.
The use of an improvised Nasogastric Tube as a Peritoneal Dialysis Catheter and challenges of adaptation-A case report
(African Paediatric Nephrology Association, 2019) Ademola, A. D.; Asinobi, A. O.; Akuse, R. M.
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.
Trends in the epidemiology of childhood nephrotic syndrome in Africa: A systematic review
(Pediatric Nephrology, 2021) Wine, R.; Vasilevska-Ristovska, J.; Banh, T.; Knott, J.; Noone, D.; Gbadegesin, R.; Ilori, T. O.; Okafor, H. U.; Adetunjil, A. E.; Boima, V.; Amira, O.; Osafo, C.; Guemkam, G.; Ajayiq,, S.; Makusidi, M. A.; Anigilaje, E. A.; Ruggajo, P.; Asinobi, A. O.; Ademola, A. D.; Parekh, R. S.
Background: Childhood nephrotic syndrome, if left untreated, leads to progressive kidney disease or death. We quantified the prevalence of steroid-sensitive nephrotic syndrome, steroid-resistant nephrotic syndrome, and histological types as the epidemiology of nephrotic syndrome in Africa remains unknown, yet impacts outcomes. Methods: We searched MEDLINE, Embase, African Journals Online, and WHO Global Health Library for articles in any language reporting on childhood nephrotic syndrome in Africa from January 1, 1946 to July 1, 2020. Primary outcomes included steroid response, biopsy defined minimal change disease, and focal segmental glomerulosclerosis (FSGS) by both pooled and individual proportions across regions and overall. Findings: There were 81 papers from 17 countries included. Majority of 8131 children were steroid-sensitive (64% [95% CI: 63–66%]) and the remaining were steroid-resistant (34% [95% CI: 33–35%]). Of children biopsied, pathological findings were 38% [95% CI: 36–40%] minimal change, 24% [95% CI: 22–25%] FSGS, and 38% [95% CI: 36–40%] secondary causes of nephrotic syndrome. Interpretation: Few African countries reported on the prevalence of childhood nephrotic syndrome. Steroid-sensitive disease is more common than steroid-resistant disease although prevalence of steroid-resistant nephrotic syndrome is higher than reported globally. Pathology findings suggest minimal change and secondary causes are common. Scarcity of data in Africa prevents appropriate healthcare resource allocation to diagnose and treat this treatable childhood kidney disease to prevent poor health outcomes. Funding: Funding was provided by the Canadian Institute for Health Research (CIHR) and the National Institute of Health (NIH) for the H3 Africa Kidney Disease Research Network. This research was undertaken, in part, from the Canada Research Chairs program.
Trends in the epidemiology of severe pediatric non-surgical renal disorders in Ibadan Nigeria: A marked increase in the incidence of acute kidney injury
(Sciencedomain International, 2016) Asinobi, A. O.; Ademola, A. D.; Ogunkunle, O. O.; Yaria, J.
Background: Renal disorders are increasingly being recognized as major contributors to morbidity and mortality. Variability in their pattern in different populations and regions of the world and changes occurring with time have been demonstrated. We aimed to determine the current trends in the pattern of severe non-surgical childhood renal disorders at our Centre and compare the findings with previous studies. Methodology: A descriptive analytical study was carried out on consecutive incident cases of nonsurgical renal disorders aged 14 years and below, managed in the Pediatric Nephrology Unit of the University College Hospital, Ibadan, Nigeria. Two separate time periods were studied. Results: A total of 869 incident cases of severe non-surgical disorders were admitted during the study periods. There was an increase in the hospital incidence from 1.5 to 2.2 per 100 pediatric admissions and in the average yearly admission from 43 to 103. The crude annual incidence increased from 42 per million age-related population (PMARP) to 86 (PMARP) at the end of the two study periods. The most remarkable increase occurred with Acute Kidney Injury, which showed a 6.5-fold rise and was the most common cause of renal morbidity and mortality in children encountered in the study. Interventional measures resulted in early detection, prompt treatment and reduced mortality. Conclusion: The study has shown an increase in the incidence of severe childhood renal disorders in Ibadan, with Acute Kidney Injury being the leading non-surgical renal disorder. A significant decline in case fatality rates was demonstrated in recent years.
Trends in the histopathology of childhood nephrotic syndrome in Ibadan Nigeria: preponderance of idiopathic focal segmental glomerulosclerosis
(BioMed Central, 2015) Asinobi, A. O.; Ademola, A. D.; Okolo, C. A.; Yaria, J. O.
Background: Reports on the histopathology of childhood nephrotic syndrome (NS) had emanated from our Centre since the 1960s and by the late 1980s and early 1990s, a change was observed and reported. Taking into consideration the worldwide changing trend in the histopathology of the NS and our Unit policy change in the indications for renal biopsy, a change was envisaged. We therefore evaluated the current histologic pattern of childhood NS in Ibadan with the view to highlighting any variations from the past and comparing the findings with regional and global trends. Methodology: We reviewed our database and analyzed the renal biopsy findings in patients who were biopsied before treatment was administered between 1997 and 2001 and those with mostly idiopathic steroid resistant NS (SRNS) and secondary NS, managed between 2006 and 2013. A comparative analysis of the findings from the present study was carried out with two previous reports from our Unit in the 1970s and early 1990s and also with reports from other Centres. Results: A total of 78 patients had successful biopsies done during the study period in children aged between 2 ½ and 16 years. In both pre-treatment biopsy era (1997–2001) and post-treatment biopsy era (2006–2013), focal segmental glomerulosclerosis (FSGS) predominated. 75 % of the patients had idiopathic NS and among the patients that had idiopathic steroid resistant NS, FSGS was the most common followed by MPGN. For secondary NS, MCD was the most common but could be the early stages of either membranous nephropathy (MN) or FSGS. Chronic pyelonephritis and chronic interstitial nephritis occurred in 25 % of the study population but they were more prevalent in secondary nephrotic syndrome. Conclusion: FSGS is the most common histopathology in children requiring renal biopsy in Ibadan presently. FSGS is also the most common histopathology in idiopathic SRNS, which is in keeping with reports from most parts of the world. There has been a transition from the preponderance of Quartan Malarial Nephropathy (QMN) in the 1960s to MPGN in the 1980s to FSGS presently. This has great implications with regards to searching for new aetiologic factors, providing more efficacious treatment modalities and ensuring facilities for immunofluorescence, electron microscopic and genetic studies.