Pediatrics and Child Health
At the Pediatrics And Child Health department office
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Topic: Cardiovascular Dysfunction And Its Determinants In Children With Nephrotic Syndrome
There are various cardiac and vascular dysfunctions associated with nephrotic syndrome. The increased incidence of heart disease in patients with chronic NS has been mainly attributed to coronary disease induced by dyslipidaemia and hypercoagulability
In our environment, little is known about the association of nephrotic syndrome with cardiac abnormalities and routine echocardiography is not standard practice in the routine care of children with nephrotic syndrome. Few reports have been documented in other countries including India. There is paucity of studies on cardiac abnormalities in children with nephrotic syndrome in Nigeria and Africa at large.
Objectives of the Research
To determine the prevalence, pattern, severity and determinants of cardiovascular abnormalities in children with nephrotic syndrome using clinical assessment, electrocardiography, echocardiography and BNP levels
1. To estimate left and right ventricular functions (shortening and ejection fractions) in NS using echocardiography
2. To determine the prevalence of congestive heart failure based on clinical data and B-type natriuretic peptide (BNP) blood level estimation.
3. To ascertain cardiac rhythm abnormalities associated with NS.
4. To determine the predictors of cardiac structural and functional abnormalities in NS (age, sex, BP, duration of disease, steroid responsiveness, anthropometric indices, urine albumin to creatinine ratio, PCV, serum albumin, K+, Na+, Ca2+, creatinine levels, lipid profile).
Prospective and analytical
• Age less than 18 years
• A diagnosis of Nephrotic syndrome according to ISKDC guidelines 
• Apparently healthy age and sex-matched controls.
• Previously diagnosed congenital or acquired structural or functional heart disease
• Presence of rash, haematuria and hypertension that can suggest other extra-renal abnormalities like systemic lupus nephritis, microangiopathic hemolytic anaemia.
• Prior renal transplantation
• Pulmonary, hematologic, malignancy, or immune-related disease.
The spectrum of the cardiac abnormalities in children with NS using echocardiography will be documented including the left and right ventricular functions and rhythm abnormalities. The prevalence of congestive heart failure based on clinical data and B-type natriuretic peptide (BNP) blood level estimation will also be determined. The predictors of cardiac abnormalities in NS (age, sex, BP, duration of disease, steroid responsiveness, anthropometric indices, urine albumin to creatinine ratio, PCV, serum albumin, K+, Na+, Ca2+, creatinine levels, lipid profile) will be determined.
The proposed study will have the facility to record detailed reports of specialized investigations and procedures. We hope to not only improve diagnostic yield but facilitate better use of available resources in patient with nephrotic syndrome. The proposed study will be a pioneer study in Nigeria assessing the cardiac function of patients with nephrotic syndrome
|1.||M. Phil. (Paediatric Nephrology)||University of Cape Town||2017|
Health related quality of life of children with Sickle cell anaemia in Lagos Nigeria
INTRODUCION: Sickle cell disorder (SCD) is a chronic genetic disorder characterized by chronic multisystemic dysfunction. It is the commonest haematologic disorder in the world. Nigeria has the highest burden of children with homozygous sickle cell disorder in the world.
This study was conducted to determine the health-related quality of life in children with SCD and their caregivers in Lagos state using the Paediatric quality of life inventory.
METHODS: A questionnaire based prospective study done at the Sickle Cell Foundation Centre (SCFN), Idi-Araba, Lagos between September to November 2018. The Paediatric quality of life inventory (PedsQL™)16 SCD Module was used to assess the quality of life of the children with SCD after its authorization by Mapi Research Institute.
The Module Scales comprises of parallel child self-report and parent proxy-report formats for children ages 5-18 years, and a parent proxy-report format for children ages 2-4 years.
RESULTS: 240 children and their primary caregiver were recruited. Majority of the subjects had sickle cell anemia (94.8%). No difference was observed in the scores between parents and their children across all the domains. Teenagers have a lesser quality of life in communication domain (H = 11.619, p = 0.003). A lower quality of life was observed in the male sex in the pain and hurt domain, pain impact domain, and the pain and control domain (U = 2937.0, P = 0.014), (U = 2819.0, p = 0.004) and (U = 2895.5, p = 0.011), respectively. Complications such as cerebrovascular accident and chronic leg ulcer did not show any impact on the quality of life of the study participants.
CONCLUSION: Adolescents have a poorer quality of psychosocial life compared to the younger counterpart. Parent and child’s self-report scoring are similar which shows comparable view in life quality as expressed by parents and children with SCD.
SOLARIN ADAOBI is a Lecturer I at the Department of Pediatrics and Child Health
SOLARIN has a M. Phil. in Paediatric Nephrology from University of Cape Town