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The incidence of CKD (Chronic kidney disease) in Nigeria has been shown by various studies to range between 1.6 and 12.4%. We have shown that the burden of renal disease in Nigeria is probably significantly higher than any previous study on end-stage renal disease (ESRD) has documented, as most studies are hospital-based and fail to include the many patients who do not have access to hospital care. The increased prevalence of ESRD among blacks in the United States and South Africa compared with other races also suggests that ESRD may be more prevalent in Africa than in the United States and other developed nations. Common causes of CKD in Nigerian adults are glomerulonephritis and hypertension, while common causes in children are glomerulonephritis and posterior urethral valves. In the United States, diabetes and hypertension are the commonest causes of CKD and glomerulonephritis plays a less important role. Access to renal replacement therapy (RRT) in Nigeria is limited, and mortality rates are very high, ranging between 40 and 50%. Important steps towards improving the situation are the development of prevention programmes and increased funding to ensure increased availability of RRT. To achieve this, health policies concerning CKD must be formulated, and the lack of a renal registry makes it difficult for this to be done. There is need for the development of a functional organizational structure for the reporting of CKD in Nigeria, the Nigerian Renal Registry.

A characteristic feature of nasal allergy is local accumulation of inflammatory cells, particularly mast cells and eosinophils, and their mediators, which have been implicated to be responsible for symptoms and signs of allergies. This prospective study tested the hypothesis that severity of nasal symptoms at presentation was related to the presence of nasal eosinophilia, using consecutive patients with allergic rhinitis attending the outpatient Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria, between March and December 2008. Excluded were those who had commenced antihistamine and similar antiallergy drugs. Nasal eosinophilia, skin sensitivity, sinus radiograph, and clinical features were graded using standard classification. The study was composed of 49 subjects (28 males and 21 females). The subjects’ age ranged from 7 to 53 years (mean ± SD: 28 ± 4 years). Nasal eosinophilia and abnormal skin sensitivity response were seen in 41 (83.8%) and 37 (75.5%) subjects, respectively. Rhinorrhea, sneezing, and nasal obstruction constituted 42 (85.7%), 31 (63.3%), and 21 (42.9%), respectively, while inferior turbinate enlargement and radiological involvement were seen in 29 (59.2%) and 36 (73.5%) patients. The Spearman correlation test revealed a significant association between nasal smear eosinophilia and rhinorrhea (P = .008) and sneezing (P = .04), although there was no significant association with other variables. The authors conclude that the degree of nasal eosinophilia may be useful in predicting the severity of rhinorrhea and sneezing among the clinical features of nasal allergy.

This is a case of idiopathic pulmonary calcification and ossification in a 70 year old with long-standing diabetes and hypertension. Thirteen years prior to her demise, she was first noticed to have multiple calcific deposits in her lungs on a chest X-ray film. She had no risk factors for soft tissue calcification and ossification. Histology of tissue from autopsy showed intraparenchymal pulmonary calcification and ossification with marrow elements. Idiopathic pulmonary calcification and ossification is rare. At autopsy, she was also found to have had bilateral subarachnoid haemorrhage (SAH), a diagnosis missed during clinical evaluation. We highlight the pertinent details in our patient's management that could have helped to prevent a missed diagnosis of SAH. Even though SAH occurs most commonly following head trauma, the more familiar medical use of SAH is for non-traumatic SAH occurring following a ruptured cerebral aneurysm. This patient had notable risk factors for cerebral aneurysm formation but an aneurysm was not identified at autopsy. The location of the blood high on the cerebral convexities further suggests a traumatic origin rather than a ruptured aneurysm. Heterotopic calcification and ossification (HO) is known to occur in the setting of severe neurologic disorders such as traumatic brain injury but the fact that the lung calcification in our patient predated the brain injury by over 10 years makes it unlikely for the HO to have been due to the brain trauma. Other organ pathologies found at autopsy include chromophobe renal cell carcinoma, renal papillary necrosis, lymphocytic thyroiditis, and seborrheic keratosis.

There has been a paucity of Nigerian studies on renal cell carcinomas (RCC). This retrospective review analyzes cases of RCC diagnosed in the University College Hospital, Ibadan from January 1960 to June 2007. Cases were typed using the 2004 World Health Organization classification of renal tumours. Papillary RCC were further grouped into Type 1 or 2 and Fuhrman's nuclear grade was determined for clear cell and papillary RCC. There were 159 cases, 108 being females, with a male to female ratio of 1:2.1. Peak age of occurrence was in the fourth decade. The right kidney was more commonly affected (58.6%). Papillary RCC was the most common variant accounting for 27 of the 62 cases that were available for review. Six (22.2%) of the 27 papillary RCC had the distinctive histological features that have been associated with Xp 11 translocation carcinoma. All 27 cases of papillary RCC were Type 2. Twenty-one (61.8%) RCC were Fuhrman's nuclear grade 1 and 2. Renal cell carcinoma in Ibadan occurs two decades earlier than in Caucasians. Papillary RCC is the most common histological sub type of RCC in Ibadan, and Xp translocation carcinomas may be more common in this environment than earlier described in America. This is in contrast to the observation that clear cell carcinomas is the most common histological sub type of RCC in Caucasians series.