Obstructive Nephropathy in a Kidney Care Hospital in Southwest Nigeria: The need for early screening and prevention

Background: Most of the preventive efforts in Nephrology are focused on hypertension and diabetes mellitus. Obstructive Nephropathy (ON) which is a relatively common cause of CKD in Nigeria has not received adequate attention. This study reviewed the clinical profile of patients with ON at a Kidney hospital with the aim of identifying areas where preventive strategy should be targeted. Materials and Methods: This was a 3 year retrospective study that reviewed records of patients managed for ON in a Kidney hospital in Southwest Nigeria. Results: Thirty patients managed during the review period had ON with a prevalence of 7.0%. The mean age of the patients was 63.4 ± 12.08 years. Twenty-three (76.7%) were males and 7(23.3%) were females. The mean packed cell volume, creatinine and estimated glomerular filtration rate at presentation were 25.17 ± 7.84%, 920.41 ± 642.79 micromol/l and 14.27 ± 15.45mls/min/1.72 m2 respectively. Common aetiologies of ON were prostate cancer 13(43.3%), urolithiasis 6(20.0%), and cervical cancer 5(16.7%). Identified renal co-morbidities were hypertension 21(70.0%), diabetes mellitus 4(13.3%) and urinary tract infection in 11(36.7%). Anemia was present in 27(90.0%), hyperkalemia in 16(53.3%) and metabolic acidosis in 23(76.7%). Twenty-one (70.0%) had stage 5 CKD. A higher proportion of patients with malignancies had stage 4 and 5 CKD. Twenty-one (70.0%) had haemodialysis. Conclusion: Majority of patients with ON presented late and required hemodialysis. The common causes of ON were prostate cancer, stones, and cervical cancers which are largely preventable or treatable. Screening for prostate and cervical cancer and human papilloma virus vaccination of at risk population is highly recommended.