Background: Determination of abnormal blood pressure (BP) in children is dependent on comparison with normal percentile values. The commonly used National Institute of Health (NIH) standard is generated from children outside of Africa. Objective: To develop BP percentile values for Nigerian children based on BP cuff width 40% to 50% of arm circumference. Methods: Subjects were pupils from nine primary schools in Midwestern Nigeria recruited using a multi-stage sampling technique. Their BP was measured using a cuff width of 40 to 50% of arm circumference and cuff length of at least 80% of arm circumference respectively. The mean of two BP readings were taken. Hypertension was defined as systolic and or diastolic BP >95 th percentile of the study population. Results: There were 1549 subjects, aged 5 to 15 years, of which 757 (48.9%) were males. Prevalence of hypertension was 2.6%. Only age and weight were independent predictors of both elevated systolic and diastolic BP. The 5 th , 10 th , 50 th , 90 th and 95 th percentiles of Systolic and diastolic BP were generated for both males and females pupils. Conclusion: BP Percentiles have been generated using BP cuff width 40 to 50% of the arm circumference for Nigerian children.
Background: Kidney diseases are emerging as important contributors to noncommunicable diseases in children worldwide and they impact negatively on the socioeconomic wellbeing of families and nations. Unlike rich economies of the world there is dearth of facilities and manpower needed for the practice and training in Paediatric Nephrology in resource challenged nations like Nigeria. There are however no data to support this assertion.Objectives: The study sought to provide information on facilities and manpower available for paediatrics nephrology practice and education in the country.Methods: We deployed an indirect, unobtrusive and introspective method to gather needed data using semi structured selfadministered questionnaire on resident doctors who fitted well as key informants. Subjects were attendees at the annual Update Course in Paediatrics organisedby the National Postgraduate Medical College of Nigeria in 2019.Results: Of the 154 attendees 93 (31 males and 62 females) participated in the study. Fifty four, 34 and 5 respectively were from Federal Teaching Hospitals, Federal Medical Centres and State Teaching Hospitals. Seventeen (31.5%), 14(25.9%) and 12(22.2%) of the residents working in federal teaching hospitals were from the South-south, Northwest and Southeast zones respectively while majority of the residents employed in state facilities were from the Southwest. Northeast and North-central zones had few residents. Facilities for haemodialysis (X2 = 9.58; p= 0.008), renalbiopsy (X2 = 27.98; p= 0.000) and tissue handling (X2 = 9.97; p= 0.007) were significantly more in state and Federal Teaching Hospitals compared to Federal Medical Centres. Haemodialysis is not done in a quarter of the hospitals and in places where it was carried out, facilities are not dedicated to children and are not regularly done. One in 4 and two in 5 respondents came from centres where peritoneal dialysis (PD) is carried out with improvised materials. Among a quarter and half of the respondents, PD is respectively not done or seldom carried out. The views of 55.9% and 60.2% of the respondents on practice of Paediatric Nephrology was “fair” and “basic” respectively. Supplementary local and overseas trainingrespectively could be accessed by only 23.7% and 12.9% of the respondents. Dedicated training in nephrology was available in centres hosting only 29% of the respondents. Where available the training was assessed as fair and good by 37.0% and 55.6% of the residents respectively. In the opinionof about half the respondents factors militating against training and practice were manpower/ infrastructural deficits, and lack of commitment of stakeholders.Conclusion and Recommendations: Practice and training in Paediatrics Nephrology in Nigeria is at best basic and limited in scope and depth. They are hamstrung by multiplicity of factors. Advancing their cause in the country would require commitment of all stakeholders through improved funding and programs re-orientation. Key words: Paediatrics, nephrology, facilities, training, practice, Nigeria
In this report, we described the case of a 14-year-old boy with steroid-sensitive nephrotic syndrome who developed hyperglycaemia and ultimately, diabetic ketoacidosis, following high-dose steroid therapy for a primary renal disease. The nephrotic syndrome was diagnosed based on generalized oedema, massive proteinuria, hypoalbuminaemia and hypercholesterolaemia. Serum creatinine and random blood glucose levels were normal and there was no glycosuria. He was commenced on high dose prednisolone 40 mg 12 hourly and by the 8th day on prednisolone, he achieved remission and was discharged. However, four weeks later, he developed features of diabetic ketoacidosis (DKA) which was confirmed by the presence of hyperglycaemia (random blood glucose19.4 mmol/L), acidosis (serum bicarbonate 10 mmol/L) and ketonuria (2+). The DKA was managed with intravenous fluid (0.9% sodium chloride), continuous insulin infusion and antibiotics. After resolution of the DKA, he was switched to subcutaneous soluble insulin and thereafter, premixed insulin twice daily with a reduction in the dose of prednisolone and was discharged home after 30 days on admission. Blood glucose level has remained within normal range one year after discontinuing insulin and he is still in remission with regard to the nephrotic syndrome at follow up.Conclusion: The risk of diabetic ketoacidosis should be considered in the course of steroid therapy for nephrotic syndrome. To avoid missing of cases of steroid-induced diabetes mellitus, and ultimately DKA, both fasting and postprandial blood glucose values should be monitored.Key words: Adolescence, diabetes, ketoacidosis, nephrotic syndrome, steroid therapy.
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