A 31 year old female presented with a one-year history of burning sensations, numbness and tingling feelings in her hands and feet. There was also excessive sweatiness of her hands and feet while experiencing these symptoms. Her symptoms were worse at night and during hot weather conditions and aggravated by contact with light clothing. She could not tolerate her shoes. She also complained of weakness in her distal lower limbs. Examination revealed prominent wasting of the thenar and hypothenar eminences, marked bilateral weakness of hand grip, palmar, and dorsal interossei. There was also the significant weakness of the dorsiflexor of the feet with allodynia. Vibration and joint position sense were impaired in the distal lower limbs. Ankle reflexes were diminished. Nerve conduction studies showed nerve conduction block in three nerves. She also had abnormalities from motor and sensory nerve conduction studies involving multiple nerves. She showed remarkable improvements in her symptoms after a course of pulsed oral dexamethasone therapy.
Background: Adult nephrotic syndrome is a common cause of chronic kidney disease globally and in Sub-Saharan Africa. In Nigeria there are only few studies on adult nephrotic syndrome, mostly from the south-western Nigeria and rarely from the Niger delta sub-region of Nigeria. This study aims at contributing to the National data on adult nephrotic syndrome, from the perspective of the Niger delta sub-region.Methods: Retrospective analysis of five-year clinical data (January 2007 to December 2011) of adult nephrotic syndrome patients in the University of Port Harcourt teaching hospital was conducted.Results: Forty-four patients, representing 1% of medical admissions and 7.3% of adult renal cases were seen during the period, with mean age of 27.7±8.5 years. There were 32 males (72.7%). Mean duration of illness was 25.3±30.3months. Peak age group was the 20-29 year age group, accounting for 52.3% of cases. Hypertension was seen in 45.5%. Mean e-GFR was 73.5±33.8 ml/min/1.73m2 with CKD 1-3 constituting 93.2% of cases. Mean 24-hour urinary protein excretion was 13.6±8.4 grams/day. Protein excretion >10grams/day was observed in 65.8% of the patients. Mean total serum protein, albumin and total cholesterol were 51.4±11.7g/dl, 22.5±9.9 g/dl and 8.1±3.0 mmol/L, respectively. Anemia was common (68%) and histology showed MCGN (52.6%), MCD (21.1%), membranous (15.8%) and FSGS (10.5%). Though response to therapy was generally poor, immunosuppressive therapy showed better outcomes.Conclusions: The prevalence and pattern of adult nephrotic syndrome in the Niger delta sub-region is similar to that in other parts of Nigeria. It is predominantly a disease of young adult males with high prevalence of hypertension, and poor histologic categories.
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