Case 2 Twelve-year-old R. O. from Nkoranza was referred to KATH as a possible seizure disorder. He had presented to a local hospital with fever, severe headache and several episodes of generalised

convulsions. The child was fully conscious but had a BP of 140/94mmHg (both systolic and diastolic values > 99th centile +5 for his age). Bedside urine dipstick showed protein and blood of 2+ each. Baseline laboratory test results were as follows: Serum chemistry: Na+ 136, K+ 5.6, urea 16.3, creatinine 389µmol/l, Hb 10.5g/dl, MCV 72 fl, WBC 9.9 × 109/l, platelet 444× 109/l Urine microscopy showed pus cells 5–6/HPF, RBCs > 10/HPF, and S. haematobiuon ova were present. Urine culture result was negative. USS showed a lobulated, hypoechoeic urinary bladder trigone mass with resultant Selleckchem CB-839 bilateral hydroureteronephrosis. Diagnoses of hypertensive encephalopathy and acute kidney injury secondary

to schistosoma related obstructive uropathy were made. He was treated with praziquantel and amlodipine. A scheduled OSI906 nephrostomy tube insertion and cystoscopic excision of the trigone mass could not be done as patient defaulted follow up for several months. When he re-surfaced 6 months later, there had been spontaneous improvement in his renal function with the serum creatinine falling to 150 µmol/l. The trigone mass has reduced in size and the left hydroureteronephrosis had resolved completely. BP had been well controlled on amlodipine. He was then scheduled for 6-monthly review to assess progress. In the subsequent six months, all the hydroureteronephrosis had resolved spontaneously. The left kidney had shrunken somewhat, measuring 6.3 × 2.7cm but with good cortico-medullary differentiation. Right kidney measured 8.3 × 3.3cm. A residual mass in the trigone area had remained. The kidney function had stabilised with serum creatinine at 130 µmol/l and urea of 4.1mmol/l. He was put on lisinopril to control his proteinuria

Farnesyltransferase and slated for another 6 months review as a case of Stage 3 Chronic Kidney Disease (eGFR 52.7ml/min/1.73m2). Case 3 Twelve-year-old O. A. from Yeji, a schistosomiasis endemic area, presented with recurrent abdominal pain. He has had on and off terminal haematuria since age 4 years. Essential findings on physical examination were moderate pallor, BP 127/90mmHg (systolic >95th centile, diastolic > 99th centile), and fullness at the left flank with some tenderness. Bedside urine dipstick showed protein of 1+ and blood of 3+. Initial laboratory findings were as follows: Urine microscopy; pus cells too numerous to count, RBCs > 100/HPF, S. haematobium ova 2+; urine culture isolated E. coli sensitive to ciprofloxacin and ceftazidime; Hb 8.7g/dl, MCV 73 fl ; blood urea 1.9mmol/l, creatinine 20µmol/l, Na 139 mmol/l, K 4.0 mmol/l.