Objectives: Serum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C. Methods: This prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5–14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL. Results: Mean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively). Conclusion: Diagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria. Keywords: Biomarkers; Acute Kidney Injury; Renal Failure; Glomerular Filtration Rate; Cystatin C; Creatinine; Malaria; Nigeria.
Dilated cardiomyopathy (DCM) may be associated with formation of intracardiac thrombi which may embolize and result in life-threatening complications. We present a 19-month-old female child with DCM who presented with a right hemispheric cerebrovascular accident. Urgent echocardiography revealed poor left ventricular systolic function and a thrombus attached to the interventricular septum along the left ventricular outflow tract. There was resolution of the thrombus following the use of warfarin.
Background Estimated baseline serum creatinine (bSCr) affects the incidence and outcomes of childhood severe malaria. Herein, we estimated baseline serum creatinine (bSCr) levels of 541 children with severe malaria using Pottel and Scwartz formulas for AKI incidence, hospitalization outcomes, and evaluated risk factors for death. Methods This was a retrospective review of malaria cases from January 2019 to December 2020 at a tertiary health facility in northern Nigeria. We extracted relevant data from the electronic health record. AKI definition and staging was based on the 2012 Kidney Disease Improving Global Outcomes (KDIGO). Results The estimated bSCr using Pottel’s method was lower with a mean (standard deviation) bias of -0.039 (0.013) mg/dl, an upper limit of agreement (-0.014 mg/dl), and the lower limit of agreement (-0.063 mg/dl). All (100%) of the estimated bSCr using Pottel’s method fell within 30% of the Schwartz method's estimated bSCr. The incidence of AKI from Pottel’s method was higher than the Schwartz’s method (43.3% vs. 38.4%, p < 0.001). The incidence of AKI derived from Pottel’s method was highest among those under 5 years old (p < 0.001). The mortality rate was 6.1% (33 deaths out of 541 admissions). Pottel’s method detected more deaths (57.6%; 19 out of 33) vs. Schwartz’s method (48.5%; 16 out of 33), p < 0.001. Factors that were associated with malaria AKI death included acidosis with an adjusted odds ratio (AOR) of 9.2 (95% CI 1.671 to 50.097), the first 72 h [AOR 7.0 (95% CI 1.358, 35.840)], and KDIGO stage 3 of AKI [AOR 14.4 (95% CI 3.073, 66.969)]. Conclusion Among Nigerian children with severe malaria, bSCr back-calculated from Pottel’s equation showed a minimal bias, narrow limit of agreement, and high degree of accuracy. Also, Pottel’s method detected more AKI and deaths.
Background: In children, bloodstream infection (BSI) causes significant morbidity and mortality. Most studies in Nigeria focused on the aetiology of childhood BSI with little or no appraisal of burden.Objectives: To determine the direct cost of childhood BSI, length of hospital stay, and deaths in a tertiary health facility in northcentral Nigeria.Method: This prospective observational study was conducted in a tertiary hospital in Nigeria. We recruited children aged 0-14 years with the diagnosis of sepsis. Blood samples were collected and processed following standard microbiological techniques. The culture was performed using BacT/Alert machine. The direct costs of caregivers were obtained daily using receipts of all rendered services till outcome (discharged/death). This study's length of stay (LOS) was defined as the number of days the children stayed after admission prior to discharge/death. Results:Of the 179 blood samples obtained, 91 (50.8%) had bacterial BSI. Gram-positive organisms were the commonest isolated pathogens (70.3%). The mean length of hospitalisation was significantly higher among children with BSI than those without BSI (10.24 ± 8.88 vs. 7.640 ± 5.825 days, p=0.034). Similarly, the mean cost was higher among those with BSI than those without BSI _________________________________________
Background Acute kidney injury (AKI) is an underrecognized complication of severe malaria and an independent risk factor for mortality among children. Objective To determine the incidence and factors predictive of AKI as defined by the pediatric risk, injury, failure, loss, and end-stage (pRIFLE) criteria in children with severe malaria and to assess in-hospital mortality rates in malarial AKI (MAKI). Methods This was a prospective cohort study in 170 children aged 0.5 to 14 years with confirmed Plasmodium falciparum on peripheral blood smears and clinical and/or laboratory features of severe malaria. Serum creatinine was determined using the Jaffe method and glomerular filtration rate (eGFR) was estimated using the Schwartz equation. The primary outcome was the incidence of AKI as defined by the pRIFLE criteria. Secondary outcomes included in-hospital mortality comparison between AKI and non-AKI groups, as well as factors predictive of AKI. Results The incidence of MAKI was 61.2% (104/170) and was comparable between males (66.7%) and females (70.6%). Mean eGFR was lower among children with AKI than those without [42.00 (SD 22) vs. 98.7 (SD 3.9) mL/min/1.73m2, respectively; P=0.005]. Children with MAKI were categorized as having risk (47/104; 45.2%), injury (33/104; 31.7%), or failure (24/104; 23.1%). Mortality rates in AKI and non-AKI subjects were comparable (4.8% vs. 4.6%; P=0.888). Predictors of MAKI were hemoglobinuria [adjusted OR (aOR) 3.948; 95%CI 1.138 to 8.030], deep acidotic breathing (aOR 2.991; 95%CI 3.549 to 66.898), and longer hospital stay (aOR 2.042; 95%CI 3.617 to 12.156). Children with MAKI were more likely to have a longer hospital stay by a mean of 2.5 days. Conclusion AKI is a common complication in children with severe malaria. MAKI has a low mortality rate comparable to those with severe malaria but without AKI. Hemoglobinuria, deep acidotic breathing, and longer hospital stay were predictive of MAKI.
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