Dr. Ibrahim Rasheed Olayinka

Background Despite the kidney being affected by diphtheria exotoxin, the extent of acute kidney injury (AKI) and its possible impact on outcomes remain unknown. This study examined the incidence, risk factors, and outcomes of AKI in children with diphtheria. Methods This was a prospective cohort study of confirmed diphtheria managed from July 1, 2023, to April 30, 2024, at a health facility in Nigeria. We obtained data on clinical and laboratory features and treatments received. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results We included 237 children with a median [interquartile range] age of 7.0 [4–10] years. Using KDIGO, 139 (58.6%) had AKI [stage 1:88 (37.1%); stage 2: 18 (7.6%); and stage 3: 33 (13.9%)]. Variables associated with AKI included age, sore throat, inability to swallow, difficulty breathing, nasal blockade, hypoxemia, nasal discharge, pallor, abnormal chest findings, hospitalization duration, vaccination status, white blood cells, lymphocytes, platelets, serum bicarbonate, sodium and potassium, and treatments received, p < 0.05. On multivariable logistic regression, predictors of AKI included age ≤ 60 months [AOR 2.75, 95% CI 1.27–5.95], dexamethasone [AOR 2.57, 95% CI 1.11–4.60], oxygen therapy [4.85, 95% CI 1.24–18.99], and ibuprofen [AOR 2.74, 95 CI% 1.16–6.44]. Mortality rate was 24.5% (58/237) and 33.1% (46/139) in AKI. The odds of deaths with AKI were 3.56 (95% CI 1.76–7.14). Conclusion There is a high incidence of AKI among children with diphtheria and increased odds of death. Factors that predicted AKI included younger age, oxygen therapy, and medications (ibuprofen and dexamethasone).

Background Despite recurrent outbreaks of diphtheria in Nigeria, there is a lack of in-depth analysis of hospitalization outcomes. Herein, we describe the sociodemographic, clinical, and laboratory features associated with hospitalization outcomes (defined as death or discharge) during the recent diphtheria outbreak in Nigeria. Methods This prospective observational study included 246 confirmed diphtheria cases managed in a dedicated isolation ward of a health facility in northwestern Nigeria from July 1, 2023, to April 30, 2024. We analyzed clinical and laboratory features, immunization status, and socio-demographics in relation to hospitalization deaths using SPSS version 29. Results The median age (interquartile range) was 7.00 (4–10) years and 49.6% (122) were aged 5–10 years. Common clinical features were fever (95.9%), sore throat (91.9%), painful swallowing (90.7%), pseudomembrane (93.1%), and cervical-submandibular lymphadenopathy (91.5%). Most children were unvaccinated (158; 64.2%), 199 (80.9%) received diphtheria antitoxin, and both were related to outcomes. Mortality rate was 23.5% (58/246). After adjusting for confounders, predictors of hospitalization deaths were neck swelling with an adjusted odds ratio (AOR) of 9.80 (95% CI 1.68–56.47), abnormal respiratory findings (AOR, 149.99 [95% CI, 15.60–1442.02] ), hypoxemia (AOR, 37.79 [95% CI, 4.26–331.96] ), and elevated serum creatinine above 1.5 mg/dL (AOR 107.78, 95% CI, 7.94–1462.38). Conclusions Diphtheria is a significant burden in Nigeria, particularly among children. Neck swelling, hypoxemia, abnormal respiratory findings, and impaired renal function were predictive of hospitalization death. Although antitoxin and vaccination were related to outcomes, they did not predict hospitalization death.

Objective: Studies on acute glomerulonephritis (AGN) in Nigeria described the epidemiological profile without an in-depth analysis of variables associated with outcomes. Herein, we describe the profile and factors associated with hospitalization outcomes (discharge or death) among childhood AGNs at a health facility in northwestern Nigeria. Material and Methods: This prospective cross-sectional study was conducted between 1st January 2018 and 31st December 2019 at a tertiary health facility in northwestern Nigeria. The diagnosis of AGN was based on a clinical diagnosis. We also obtained relevant history, clinical, and laboratory features. Results: Thirty-five children were admitted with AGN during the study period. The mean age was 7.7 ± 3.3 years. Most were aged 5 to 10 years (23; 65.7%), male (60.0%), and from a lower socio-economic class (77.2%). The annual incidence of AGN was 11 cases per 1000 children. The most common clinical presentations were generalized body swelling (100.0%), reduced urine output (85.7%), and hypertension (74.3%). The medians (interquartile range) of urea and creatinine were 10.0 (4.50 to 23.90) mmol/L and 85 (67.60 to 204.00) µmol/L, respectively. Among the clinical features, only fever was associated with outcomes, while serum urea and creatinine levels were significantly higher among non-survivors, p<0.05. We recorded four deaths (case fatality rate of 11.4%), two each from congestive cardiac failure and hypertensive encephalopathy. Conclusion: This study shows a high incidence of childhood AGN and mortality in Katsina, northwestern Nigeria. Fever was associated with outcomes, while serum creatinine and urea levels were elevated among non-survivors.