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Background: Lupus nephritis (LN) is an immune complex glomerulonephritis that complicates up to 40% of SLE patients. A kidney biopsy is required for diagnosis and staging of the disease. Case report: We report a cohort of five patients with LN from a tertiary health facility in northeastern Nigeria. The five patients were all women with age ranging from 26 to 55 years, and eGFR of between 6 to 154ml/minute. Four patients had normal kidney size and were biopsied whereas 1 patient had contracted kidney. Diffuse proliferative LN (Class IV) was seen in two patients while the other two patients had glomerular sclerosis (Class VI). Patients were given induction with methylprednisolone and mycophenolate mofetil (MMF). At one year follow up 2(40%) patients were in remission, 1(20%) was on maintenance hemodialysis and 2(40%) patients had died. Conclusion: Lupus nephritis is a common complication of SLE in northeastern Nigeria. Patients have features of advanced kidney disease at presentation.

Background: Renal allograft recipients develop several complications such as infections and neoplasms. New onset diabetes mellitus is a common transplant complication but rarely coexist with Kaposi sarcoma. Case report: We report the case of a 42-year-old banker who presented with polyuria, polydipsia, polyphagia, weight loss and dark spots in the lower limbs 8 months after he had received a live-related kidney transplant in India. He is not a known diabetic and had no family history of diabetes mellitus. His post-transplant immunosuppressive drugs included Myfortic® (mycophenolate), tacrolimus and prednisolone. At presentation he was wasted, dehydrated and afebrile, with multiple hyperpigmented nodules and plaques in both his lower limbs. Random blood glucose was 38mmol/l, had 2+ glucosuria and no ketones. Biopsy of skin lesions showed features of Kaposi sarcoma. A diagnosis of post-transplant diabetes mellitus and Kaposi sarcoma was made. His treatment included soluble insulin and antibiotics. Tacrolimus was changed to sirolimus and mycophenolate was reduced to 360mg twice daily. Conclusion: Coexistence of diabetes mellitus and Kaposi sarcoma occurs rarely among kidney transplant recipients. Evaluation of transplant recipient who developed diabetes for malignancies such as Kaposi sarcoma will improve patient and graft survival.

Background: Renal tuberculosis constitutes 14% to 41% of cases of extrapulmonary TB and with HIV pandemic; its prevalence is expected to increase. Case report: We report a case of a 51-year-old diabetic/hypertensive female admitted via the A and E with complaints of vomiting and generalized malaise. She had hyponatraemia of 119mmol/l, creatinine 687µmol/L, and urea 28mmol/L. Her kidneys were normal sized and echogenic on ultrasound examination. She was treated for hyponatraemia with normal saline and discharged. She reported at the clinic 2 weeks later with complaints of fever, back pain and right sided neck swelling. Neck ultrasound revealed cystic mass in the lower part of the sternomastoid muscle, Xrays were normal, Urinary AFB done on four urine specimen collected over days was negative and Mantoux test was reactive. Spinal examination was unremarkable except for presence of tenderness at the T6 to T7 vertebrae. A diagnosis of extra pulmonary TB involving the cervical lymph nodes and spine was made and she was commenced on quadruple anti TB drugs which resulted in improvement of her renal function. Conclusion: The diagnosis of renal tuberculosis is usually difficult due to low yield of laboratory tests such as urine microscopy for AFB. High index of suspicion is often required in most patients

Introduction: Gout is considered uncommon among Black Africans. It is commoner in men and associated with obesity, hypertension, and chronic kidney disease (CKD). This study aims to determine the pattern and frequency of gout and its associated factors in Maiduguri, north-eastern Nigeria., Method: A retrospective study of gout patients managed at the rheumatology clinic of the University of Maiduguri Teaching Hospital (UMTH), Nigeria, from January 2014 to December 2021. Diagnosis of gout was made using the Netherlands 2010 criteria, and CKD was defined as an estimated glomerular filtration rate (eGFR) of < 60 ml/min/1.73m 2 using the 2021 CKD-epidemiology collaboration (CKD-EPI) creatinine equation. A P-value of < 0.05 was considered statistically significant., Results: Out of 1409 patients seen during the study period, 150 (10.7%) had gout. They comprised 57.0% males, mostly presented with mono-articular disease (47.7%) with the ankle predominantly involved (52.3%). First metatarsophalangeal and knee joint involvement were commoner among males than females (59% vs 39%, p = 0.052 and 55.7% vs 34.8%, p = 0.05 respectively). The mean serum uric acid (SUA) level was 557.6 ± 176.2 mmol/l, and the levels did not differ between gender (p = 0.118, CI [- 126.6 to 14.5]). Ninety (84.1%) had CKD with 20.6% in end-stage renal disease (eGFR < 15 ml/min/1.73m 2 ). Polyarticular involvement and tophi were commoner among patients with CKD (21.1% versus 11.8% p = 0.652 and χ = 4.364, p = 0.022 respectively) Serum uric acid levels positively correlated with serum creatinine (p = 0.006) and negatively correlated with eGFR (p = 0.001). The best predictor of SUA level was the eGFR (B =  - 2.598, p < 0.001)., Conclusion: Gout in north-eastern Nigeria constitutes about 11% of all rheumatic diseases and is typically monoarticular; however, polyarticular form and tophi were commonly seen in patients with CKD. Further studies will be needed to evaluate the relationship between the pattern of gout and CKD in the region. Key Points • Gout in Maiduguri is commonly monoarticular; however, polyarticular presentations and tophi are commoner among gout patients with chronic kidney disease (CKD). • The increase in the burden of CKD might have resulted in the increase in the number of females with gout. • The use of the validated and simple Netherlands criteria for the diagnosis of gout is useful in developing countries to overcome the challenges associated with the use of polarized microscope and thereby allowing further research on gout. • There is a need for further research on the pattern and prevalence of gout and its relationship with CKD in Maiduguri, Nigeria., (© 2023. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Background: Left ventricular hypertrophy (LVH) is a common complication in patients with sickle cell anaemia (SCA), and it has been associated with systolic and diastolic dysfunction, and sudden death. There is a wide variation in the reported prevalence of LVH in patients with SCA, partly due to the varying criteria applied, and the impact of small weight and body surface area (BSA) in SCA patients. We used four different criteria to determine echocardiographic LVH and geometric patterns in patients with steady-state SCA. Left ventricular hypertrophy was defined by LVM, LVM indexed to BSA, LVM indexed to height and LVM indexed to height2.7 using gender-specific reference values. Left ventricular geometry was determined using LVH and relative wall thickness., Results: Eighty-two patients with steady-state SCA, aged 18years and above were studied from January 2018 to April 2018. The median [IQR] age of the patients was 23 [10] years. Forty-seven (57.3%) were females. The prevalence of LVH was highest when LVM was indexed to BSA (80.5%), followed by LVM indexed to height (73.2%). Comparable prevalences of 68.3% and 69.5% were observed using LVM and LVM indexed to height2.7, respectively. The prevalence of LVH was similar in males and females for all the criteria., Conclusion: The prevalence of LVH is high among patients with steady-state SCA irrespective of the criteria applied. The most prevalent geometric pattern was eccentric LVH. Indexing to BSA might result in over-estimation of LVH given the relatively small BSA in patients with SCA. Indexing to height 2.7 might give a more accurate estimate of LVH., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2023 by West African Journal of Medicine.)

Background: Dental practitioners and dental students are classified as high-risk exposure to COVID-19 due to the nature of dental treatments, but evidence of their acceptance towards COVID-19 vaccination is still scarce. Hence, this systemic review aims to critically appraise and analyse the acceptability of COVID-19 vaccination among dental students and dental practitioners., Materials and Methods: This review was registered in the PROSPERO database (CRD42021286108) based on PRISMA guidelines. Cross-sectional articles on the dental students' and dental practitioners' acceptance towards COVID-19 vaccine published between March 2020 to October 2021 were searched in eight online databases. The Joanna Briggs Institute critical appraisal tool was employed to analyse the risk of bias (RoB) of each article, whereas the Oxford Centre for Evidence-Based Medicine recommendation tool was used to evaluate the level of evidence. Data were analysed using the DerSimonian-Laird random effect model based on a single-arm approach., Results: Ten studies were included of which three studies focused on dental students and seven studies focused on dental practitioners. Four studies were deemed to exhibit moderate RoB and the remaining showed low RoB. All the studies demonstrated Level 3 evidence. Single-arm meta-analysis revealed that dental practitioners had a high level of vaccination acceptance (81.1%) than dental students (60.5%). A substantial data heterogeneity was observed with the overall I2 ranging from 73.65% and 96.86%. Furthermore, subgroup analysis indicated that dental practitioners from the Middle East and high-income countries showed greater (p < 0.05) acceptance levels, while meta-regression showed that the sample size of each study had no bearing on the degree of data heterogeneity., Conclusions: Despite the high degree of acceptance of COVID-19 vaccination among dental practitioners, dental students still demonstrated poor acceptance. These findings highlighted that evidence-based planning with effective approaches is warranted to enhance the knowledge and eradicate vaccination hesitancy, particularly among dental students., Competing Interests: The authors have declared that no competing interests exist.

Infection of the kidneys by human immunodeficiency virus (HIV) is known to cause kidney disease. HIV-associated nephropathy occurs with variable prevalence rates in various communities and is found to be higher among sub-Saharan Africans. The disease has not been studied in Northeastern Nigeria. This study was aimed at comparing the prevalence, clinical and histo-pathologic features of kidney disease among highly active antiretroviral therapy (HAART)-experienced and HAART-naive patients in northeastern Nigeria. Four hundred HIV-infected (200 HAART-experienced and 200 HAART-naïve) patients were recruited consecutively from the ART clinic. Their socio-demographic and laboratory data including CD4+ cell counts and viral loads were obtained and documented. Out of the 200 study participants in the HAART-experienced arm, 21 (10.5%) had kidney disease whereas 61 (30.5%) participants in the HAART-naïve group had kidney disease. Their mean ages were 41.43 ± 11.04 years and 37.42 ± 9.96 years in the HAART-experienced and HAART-naïve groups, respectively. The mean serum creatinine (SCr), CD4 + cell counts, and viral load were 185.67 ± 221.80 μmol/L, 493.26 ± 241.97/mm 3 , and 8,856.79 ± 19,747.11/mL in the HAART-experienced group, respectively. In the HAART-naïve group, the mean SCr, CD4 + cell count, and viral load were 141.88 ± 130.56 μmol/L, 270.00 ± 154.65 cells/mm 3 , and 139,217.70 ± 12,598.50/mL. Focal segmental glomerulosclerosis (FSGS) was the most common histologic diagnosis in 64.7% of kidney biopsies. Risk factors for chronic kidney disease among the study population included age, low weight and body mass index, high human immunodeficiency virus (HIV)-1 viral load, low CD4+ cell counts, low hemoglobin (Hb), and proteinuria. The prevalence of kidney disease is higher among HAART-naïve HIV-infected patients than in patients who are HAART-experienced patients. Factors associated with development of kidney disease included advanced age, low CD4 + cell counts, high viral load, proteinuria, and HAART-naivety. FSGS is the most common histologic diagnosis in our study population., Competing Interests: None

Objective/background: Individuals with sickle cell anaemia (SCA) may manifest various forms of renal abnormalities. Proteinuria is an early marker of renal dysfunction and a strong risk factor for chronic kidney disease (CKD) progression in both patients with SCA and non-SCA population. Currently, the degree of attention given to proteinuric CKD far exceeds that of nonproteinuric CKD, and risk factors that might trigger a progressive decline of the glomerular filtration rate (GFR) in the absence of proteinuria have not been well evaluated in SCA. The aim of this study was to compare the clinical and laboratory parameters among SCA patients with proteinuric and nonproteinuric CKD., Methods: This was a cross-sectional study conducted at the University of Maiduguri Teaching Hospital in north-eastern Nigeria between January 2013 and April 2018. Clinical variables including age of diagnosis of SCA, frequency of vaso-occlusive crises, number of hospitalizations per annum and transfusion therapy were collected. Laboratory data including haematological profile and renal function test were obtained from routine blood sampling., Results: A total of 257 patients with SCA (HbSS) were enrolled during the study period of which 42 had proteinuric CKD, and 48 had nonproteinuric CKD. The two groups were matched for the number of hospital admission (p = .063) and blood transfusion per year (p = .450), frequency of painful crisis (p = .210), systolic blood pressure (p = .084) and diastolic blood pressure (p = .400). In the proteinuric CKD group, the mean serum creatinine was higher (332.17 µmol/L, p = .001) and the estimated GFR was lower (31.88 mL/min, p = .046). The serum alkaline phosphatase was higher in the nonproteinuric CKD group (81.81 IU/L, p = .012)., Conclusion: Nonproteinuric CKD was more frequent than proteinuric CKD in our study population; however, the proteinuric group presented with more advanced disease., Competing Interests: Declaration of Competing Interest The authors have declared no conflict of interest, (Copyright © 2020 King Faisal Specialist Hospital & Research Centre. Published by Elsevier Ltd. All rights reserved.)

Chronic kidney disease (CKD) and stroke share many common risk factors, and the presence of CKD confers added risk factors for stroke. With increasing interest and understanding of the close relationship between the kidney and the brain, this study aims to assess the prevalence and impact of renal dysfunction on outcomes acute stroke patients. This is a prospective hospital-based study carried out in the neurology unit of University of Maiduguri Teaching Hospital, Maiduguri, northeastern Nigeria. The study population consisted of adult patients (>18 years) admitted in the medical wards with a diagnosis of acute stroke. Sociodemographic variables and biochemical parameters were obtained from each patient. Patients' functional status assessment by modified Rankin scale, Barthel index, and National Institutes of Health Stroke Scale score were obtained at admission and discharge. Glomerular filtration rate (GFR) was calculated using the modification of diet in renal disease equation. Patients who have estimated GFR (eGFR) <60 mL/min/1.73 m 2 were considered to have CKD. Patients were grouped into A: with GFR <60 mL/min and B: GFR >60 mL/min. Out of a total of 501 patients admitted during the study period, 448 patients had complete data and were recruited, out of which 275 (61.4%) were male and 173 (38.6%) were female. Their ages ranged from 38 to 89 years, with a mean age ± standard deviation of 53.85 ± 18.13 years. The mean eGFR of the study population was 66.55 ± 30.49 mL/min. Two hundred and twenty-five (50.2%) had renal dysfunction with GFR <60 mL/min. The mean GFR of patients with renal dysfunction was 32.84 ± 27.59 mL/min, and patients without renal dysfunction had a mean GFR of 73.68 ± 35.61 mL/min. Patients with renal dysfunction on admission had Barthel stroke score of 20.74 ± 18.74 as compared to patients without renal dysfunction (25.49 ± 20.34), P = 0.017. At discharge, the Barthel scores for the two groups were 53.87 ± 30.17 and 41.71 ± 30.29 (P = 0.000), respectively. Patients with renal dysfunction had longer hospital stay with a mean duration on admission of 45.66 ± 39.90 days and severe residual disability at discharge. Acute stroke patients who have associated renal dysfunction have severe disability on admission and discharge. Renal dysfunction is common among acute stroke patients.

Background: Involvement of the kidneys in patients with sickle cell anaemia is a well recognised chronic complication. This study seeks to determine the prevalence of chronic kidney disease in patients with homozygous sickle cell disease (HbSS) and to identify risk factors associated with its development., Methodology: The subjects consisted of adolescents and adults with HbSS recruited sequentially from the adult haematology outpatient clinic and Daycare ward of the unit. Clinical variables including age at diagnosis of SCA, the frequency of vaso-occlusive crisis and transfusion therapy, as well as laboratory data including haematological profile and renal function tests were obtained. The glomerular filtration rate was estimated (eGFR) using the 'modification of diet in renal disease' (MDRD) formula., Results: Two hundred and eighty-four HbSS patients were recruited. The prevalence of CKD amongst them was 38.9%. Further stratification of the patients based on eGFR showed that sixty-nine (26.8%) had hyperfiltration; 35 (13.6%) stage 1 CKD; 53 (20.6%) stage 2 CKD; 33 (12.8%) stage 3a CKD; 28 (10.9%) stage 3b CKD; 30 (11.7%) stage 4 CKD and 9 (3.5%) had end stage renal disease. There was significant association between eGFR and clinical parameters such as age (r -0.353, p=0.000), SBP (r -0.148, p= 0.021), DBP (r -0.213, p=0.001) and total number of blood received (r -0.276, p=0.000); and laboratory parameters such as PCV (r 0.371, p=0.000); urea ( r 0.527, p=000); creatinine (r 0.625, p=0.000) and uric acid ( r -0.419, p=0.000)., Conclusions: The present study has revealed a high prevalence of CKD amongst patients with SCA in our region. Clinical and laboratory predictors of CKD using eGFR were identified to include age, SBP, number of units of blood transfusion, PCV, urea, creatinine and uric acid levels., Competing Interests: Competing interests: The authors have declared that no competing interests exist.