Background. Sub-Saharan Africa experiences an epidemic surge in hypertension. Studies in African Americans led to the recommendation to initiate antihypertensive treatment in Blacks with a diuretic or a low-dose fi xed combination including a diuretic. We mounted the Newer versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial to compare in native African patients a fi xed combination of newer drugs, not involving a diuretic, with a combination of older drugs including a diuretic. Methods. Patients aged 30 -69 years with uncomplicated hypertension (140 -179/90 -109 mmHg) and two or fewer associated risk factors are eligible. After a 4-week run-in period off treatment, 180 patients will be randomized to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg or amlodipine/valsartan 5/160 mg. To attain and maintain blood pressure below 140/90 mmHg during 6 months of follow-up, the doses of bisoprolol and amlodipine in the combination tablets will be increased to 10 mg/day with the possible addition of α -methyldopa or hydralazine. NOAAH is powered to demonstrate a 5-mmHg between-group difference in sitting systolic pressure with a two-sided p -value of 0.01 and 90% power. NOAAH is investigator-led and complies with the Helsinki declaration. Results. Six centers in four sub-Saharan countries started patient recruitment on September 1, 2010. On December 1, 195 patients were screened, 171 were enrolled, and 51 were randomized and followed up. The trial will be completed in the third quarter of 2011. Conclusions. NOAAH (NCT01030458) is the fi rst randomized multicenter trial of antihypertensive medications in hypertensive patients born and living in sub-Saharan Africa.
Background Chronic kidney disease (CKD) is a growing challenge in low- and middle-income countries, particularly in sub-Saharan Africa. There is insufficient population-based data on CKD in Nigeria that is required to estimate its true burden, and to design prevention and management strategies. The study aims to determine the prevalence of CKD and its risk factors in Nigeria. Methods We studied 8 urban communities in Kwara State, North-Central zone of Nigeria. Blood pressure, fasting blood sugar, urinalysis, weight, height, waist circumference and hip circumference were obtained. Albuminuria and kidney length were measured by ultrasound while estimated glomerular filtration rate (eGFR) was derived from serum creatinine, using chronic disease epidemiology collaboration (CKD-EPI) equation. Associations of risk factors with CKD were determined by multivariate logistic regression and expressed as adjusted odds ratio (aOR) with corresponding 95% confidence intervals. Results One thousand three hundred and fifty-three adults ≥18 years (44% males) with mean age of 44.3 ± 14.4 years, were screened. Mean kidney lengths were: right, 93.5 ± 7.0 cm and left, 93.4 ± 7.5 cm. The age-adjusted prevalence of hypertension was 24%; diabetes 4%; obesity 8.7%; albuminuria of > 30 mg/L 7%; and dipstick proteinuria 13%. The age-adjusted prevalence of CKD by estimated GFR < 60 ml/min/1.73m2 and/or Proteinuria was 12%. Diabetes (aOR 6.41, 95%CI = 3.50–11.73, P = 0.001), obesity (aOR 1.50, 95%CI = 1.10–2.05, P = 0.011), proteinuria (aOR 2.07, 95%CI = 1.05–4.08, P = 0.035); female sex (aOR 1.67, 95%CI = 1.47–1.89, P = 0.001); and age (aOR 1.89, 95%CI = 1.13–3.17, P = 0.015) were the identified predictors of CKD. Conclusions CKD and its risk factors are prevalent among middle-aged urban populations in North-Central Nigeria. It is common among women, fueled by diabetes, ageing, obesity, and albuminuria. These data add to existing regional studies of burden of CKD that may serve as template for a national prevention framework for CKD in Nigeria. One of the limitations of the study is that the participants were voluntary community dwellers and as such not representative for the community. The sample may thus have been subjected to selection bias possibly resulting in overestimation of CKD risk factors.
To determine the correlation of renal ultrasonic parameters and degree of kidney function among chronic kidney disease patients seen at the Nephrology unit of the University of Ilorin Teaching Hospital (UITH) Ilorin, we studied 322 patients. The results were analyzed with specific reference to socio-demography and correlating renal length and volume with estimated glomerular filtration rate. The male to female ratio was 2:1, with an age range from 20 to 80 years and mean age of 45.06 (±13.0) years. The serum creatinine levels ranged from 201 to 1205 μmol/L, with a mean of 388 ± 168 μmol/L, while the estimated glomerular filtration rate (eGFR) ranged from 3.77 to 44.32 mL/min, with a mean of 18.2 ± 7.19 mL/min. The right and left renal lengths ranged from 6.9 to 13.0 cm, with a mean of 9.11 ± 1.06, and 6.5-13.4 cm, with a mean of 9.23 ± 1.07 cm, respectively. The mean volumes of the right and left kidneys were 98.6 ± 41.9 cm 3 and 105 ± 46.2 cm 3 , respectively. The Pearson correlation of the right and left kidneys length to eGFR were -0.197 and -0.137 respectively, while that of the right and left kidney volume to eGFR were -0.122 and -0.043, respectively. Our study showed that there is a positive correlation between ultrasonic renal measurements and degree of kidney function.
Tuberculosis (TB) is a major health problem worldwide , especially in tropical developing countries involving major organs in the body. The kidney is usually affected through haematogenous spread from a primary focus. Renal tuberculosis is the commonest form of extra pulmonary TB particularly among the Caucasians but thought to be rare in Blacks. Due to the paucity of data on the prevalence of renal TB. A prospective study was undertaken to investigate the prevalence of renal TB in cases of active pulmonary TB (PTB) in llorin-Nigeria. Confirmed cases of active PTB patients were consecutively recruited from the Pulmonary Clinic and the PTB Ward over a one year period. The inclusion criteria were sputum acid fast baccili (AFB) positivity on two or more occasions and radiological evidence of PTB. Patients fullfilling the above criteria were investigated by urine analysis for sterile acid pyuria, Z-N stain, plain abdominal x-rays, renal ultrasound, intravenous urogram and renal biopsy. A total of 148 acti ve PTB patients were studied (91 males, 57 females). Male to female ratio was 3:2. The mean age of the males and females with renal TB was 40 and 29 years respectively. The prevalence rates of AFB in urine and sterile acid pyuria were 9.5% and 8.8% respectively. Only 2.7% had both AFB in urine and sterile pyuria. Renal histology was abnormal in 70% of the biopsied kidneys with sterile pyuria. The combination of AFB in urine and histologic evidence of renal TB increased the prevalence of renal TB to 14% in the study.
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