**3.1 Characteristics of subjects studied**

A total of 115 patients were screened for the study. 52 of them were studied, having met the inclusion criteria. This was made up of 30 (58%) males and 22 (42%) females. 40 age and sex matched controls, made up of 22 (55%) males and 18 (45%) females were also studied. The age range of the study population was 18 – 65 years. 3 (5%) of the CRF patients were in the age range less than 30 years, 16 (30%) were in the 31 – 40 years age range, 13 (25%) and 14 (26%) were in the age range 41 – 50 years and 51 – 60 years respectively, while 6 (11%) were in the age range greater than 60 years. The peak incidence of CRF was in the 31 – 40 years age range. The mean age of the CRF patients and controls were 42.5 + 11.6 years and 40.4 + 11.3 years respectively (refer to table 1).


Table 1. Age and sex distribution of both CRF and control groups.

4. Clearing of excess alcohol: to rinse off excess alcohol that could be in the tissue, it was

5. Impregnation with paraffin wax: the tissue was then impregnated with paraffin wax,

6. Cutting into sections: the tissue embedded into paraffin block was cut into section of

7. The cut section was then placed on a slide and allowed to dry for a minimum of 30 min.

Data analysis was done using SPSS package, and the storage was in Microsoft excel. Data are expressed in tabular, bar chart and prose forms. Mean standard deviation and percentages of all data were derived. Odd ratio was used to measure strength of association

The t-test and chi-squared test were used to determine the differences in means of the CRF

A total of 115 patients were screened for the study. 52 of them were studied, having met the inclusion criteria. This was made up of 30 (58%) males and 22 (42%) females. 40 age and sex matched controls, made up of 22 (55%) males and 18 (45%) females were also studied. The age range of the study population was 18 – 65 years. 3 (5%) of the CRF patients were in the age range less than 30 years, 16 (30%) were in the 31 – 40 years age range, 13 (25%) and 14 (26%) were in the age range 41 – 50 years and 51 – 60 years respectively, while 6 (11%) were in the age range greater than 60 years. The peak incidence of CRF was in the 31 – 40 years age range. The mean age of the CRF patients and controls were 42.5 + 11.6 years and 40.4 +

AGE (YEARS) CRF GROUP (n = 52) CONTROL GROUP (n = 40)

Frequency (%) Frequency (%)

7 (17%) 12 (30%) 10 (25%) 7 (17%) 4 (10%)

9. Reading of slide: the slide was read and reported by an experienced histopathologist.

rinsed with xylene or toluene.

about 5 micron thick.

**2.14 Statistical analysis** 

group and control.

**3. Results** 

<30 31 –40 41 – 50 51 – 60 >60

between ROD and their relative risk.

**3.1 Characteristics of subjects studied** 

11.3 years respectively (refer to table 1).

3 (5%) 16 (30%) 13 (25%) 14 (26%) 6 (11%)

Table 1. Age and sex distribution of both CRF and control groups.

P value of less than 0.05 was regarded as significant.

and subsequently embedded into paraffin block.

8. Staining process: heamatin and eosin stains were used.


Table 2. Characteristics of CRF and control group.

In the age ranges <30 years and 31 – 40 years, the mean creatinine clearance were 7 + 1.83 mls/min and 12.6 + 2.16 mls/min respectively. In the age ranges 41 – 50 years and 51 – 60 years, the mean creatinine clearances were 8.6 + 3.2mls/min and 8.2 + 2.6mls/min respectively. In the age range >60 years, the mean creatinine clearance was 11.8 + 5.2mls/min. Creatinine clearance was lowest in the <30 years age range. This is represented in figure1.

### **3.2 Symptoms of renal osteodydtrophy (ROD)**

The symptoms suggestive of ROD in the study population include bone pain and pruritus. 7(14%) of the CRF group had symptoms. This was made up of 5(71%) that had bone pain and 2(29%) that had pruritus. 5(12%) of the control group had bone pain. None had pruritus. The symptom of bone pain was commoner in males compared to females. Of those that had bone pain, 4 (80%) were males while 1 (20%) was a females. Pruritus was equally as common in both sexes (1 male and 1 female).

The entire patients that had pruritus in the CRF group had elevated serum alkaline phosphatase, hyperphosphataemia and elevated calcium-phosphate product. There was a statistically significant correlation between bone pain and creatinine clearance (r =-0.3), such that bone pain occurred more commonly in patients with end stage renal disease (ESRD).

The Prevalence of Renal Osteodystrophy in

kidneys (<11cm).

Small size (<9cm)

**3.5 Serum calcium of subjects** 

tends to be lower in ESRD patients (see table 6).

9 – 10.9cm Normal size (11 – 12cm) Large size >12cm

(p<0.05).

**3.4 Renal ultrasonographic scan of subjects** 

Renal sizes (cm) Frequency

Chronic Renal Failure Patients in Urban Niger Delta of Nigeria 57

The mean kidney sizes in the CRF group was 8.2 + 0.5cm and 8.3 + 0.5cm for the right and left kidneys respectively, while that of the control was 12.10 + 0.33cm and 12.02 + 0.33cm for the right and left kidneys respectively. 52 (100%) patients in the CRF group had shrunken

There was a weak positive correlation between renal sizes and creatinine clearance, with r =

51 1


Normal kidney size: 11 – 12cm (Brenner and Rector. The kidney vol.1, 6th edition 2000).

The mean serum calcium in the CRF and control groups was 6.9 + 2.3mg/dl and 9.12 + 0.53mg/dl respectively. This difference between the means was statistically significant

Table 6 shows the pattern of serum calcium concentration in the study population. In the CRF group, 37 (71%) patients had hypocalcaemia (<8.5mg/dl), 3 (6%) had hypercalcaemia (>10.5mg/dl, while 12 (23%) had normal calcium levels (8.5 – 10.5mg/dl). In the control group, 39 (97%) patients had normal calcium levels, while only 1 (3%) had hypocalcaemia. None in the control group had hypercalcaemia. There was a weak positive correlation between serum calcium and total alkaline phosphate in the CRF group (r = 0.04), such that as the serum alkaline phosphate was increasing, the serum calcium was decreasing. Amongst the CRF patients with total serum alkaline phosphate of <25iu/l, the mean serum calcium was 6.4 + 1.6mg/dl, while in the group with total serum alkaline phosphate of 25 – 95iu/l, the mean serum calcium was 7.9 + 3.0mg/dl, and in the group with total serum alkaline phosphate of >95iu/l, the mean serum calcium was 6.8 + 1.8mg/dl. There was an insignificant correlation between serum calcium and creatinine clearance (r = 0.007). Amongst the CRF patients with creatinine clearance of <15mls/min, the mean serum calcium was 5.2 + 2.4mg/dl, while in the group that had creatinine clearance of 15 – 29mls/min, the mean serum calcium was 6.3 + 2.1mg/dl, and in the group with creatinine clearance of >30mls/min, the mean serum calcium was 8.4 + 1.6mg/dl. Mean serum calcium

CONTROL GROUP


40 -

(n = 40)

Right Left Right Left


40 -

0.12 and r = 0.17 for the right and left kidneys respectively (see Table 5).

51 1


Table 5. Renal sizes of subjects on abdominal ultrasonographic scan.

CRF GROUP (n = 52)


Only 1(1%) patient in the CRF group had radiological evidence of Rugger Jersey Spine. Radiological evidence of osteoarthritis was found in 3(60%) and 2(40%) of the patients that had bone pain in the CRF and control group respectively (see Table 3).

RJS = Rugger Jersey spine, PO4 = Phosphate, Ca = Calcium, Alk Phosp = Alkaline phosphate, Crcl = Creatinine clearance, OA = Osteoarthritis.

Table 3. Characteristics of CRF patients symptomatic of ROD.
