Abstract Background: Mortality rates in acute kidney injury (AKI) are still very high despite enormous research and technological advances in its management. It varies between 40-50% in hospitalized patients and 70-90% in cases admitted into intensive care units.Management of severe AKI is capital intensive and majority of Nigerians with the disease die prematurely because they can hardly afford cost of renal replacement therapy (RRT). Reasons for the persistent poor survival may vary from one region to another, even in the same environment.Objective: To review clinical features and factors contributing topoor outcome of patients with AKI in Ilorin, Kwara State.Subjects and Method: Retrospective appraisal of acute kidney injury at University of Ilorin Teaching Hospital, Ilorin, Nigeria (Jan.1989- Dec. 2009.) All patients that met stage 3 RIFLE criteria forAKI and presented primarily or referred to our renal care centre were studied. RIFLE is the acronym for staging AKI which means Risk of renal dysfunction, Injury to the kidneys, Failure of renal function persisting for 24hours, Loss of renal function persisting formore than 1 month and End stage kidney disease (loss of function for more than 3 months). A total of 113(52males and 61 females) outof 1,275 renal patients that had AKI (8.86%) were reviewed.Results: Unusual weakness, oliguria, altered sensorium, vomiting and hiccups were major presenting features. About 80.5% of the patients were less than 40 years of age with male and female meanages of 27.29 + 7.77 and 29.15+ 6.98 years respectively. The aetiological factors were septicaemia, severe gastroenteritis, acute glomerulonephritis, drug induced, ante/post partum haemorrhage and obstructive uropathy. Overall mortality rate was 47.6%. Sixtythree patients were managed conservatively with 62% mortality while 33 and 9 patients had haemodialysis and peritoneal dialysiswith mortality rates of 15% and 67% respectively.Conclusion. Aetiological factors were largely preventable and treatable conditions. The main contributory factors to highmortality rate were ignorance, late presentation, delayed intervention therapy, bleeding diathesis, severe infections, financial constraints and high cost of dialysis. Haemodialysis appear to be abetter modality of treatment than peritoneal dialysis for severe AKI in our environment.

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Abstract Background: With the development of antibiotic therapy and modern blood-banking techniques, caesarean section has evolved into one of the safest and most commonly performed major operative procedures.Objective: To determine the caesarean section rate, its morbidity and mortality in Aminu Kano Teaching Hospital, Kano.Study Design: A two-year descriptive study from 1st January2006 to 31st December 2007, in Aminu Kano Teaching Hospital,Kano. All patients that were delivered by caesarean section were included.Results: There were 6,355 deliveries from 1st January 2006 to 31stDecember 2007, out of which 1,005 were by caesarean section,giving a caesarean section rate of 15.8%. Nine hundred and thirty eight (938) case notes were retrieved, out of which emergency caesarean sections were performed in 812 (86.6%) and elective caesarean sections in 126 (13.4%). Of the 938 patients, 434(46.3%) were booked at Aminu Kano Teaching Hospital, Kano,314 (33.5%) were booked elsewhere and 190 (20.2%) were unbooked.The commonest indication was cephalo-pelvic disproportion/obstructed labour in 27.7% of the patients, thenprevious caesarean sections in 18.6%, hypertensive disorders in14.8% and ante partum haemorrhage in 11.1% of the patients.Three hundred and six (33.6%) of the patients had at least one complication. The common complications were postpartum anaemia (21.3%), prolonged hospital stay (9.4%) and postpartum haemorrhage (4.5%). The caesarean section related mortality rate was 1.1% or 1066/100,000; 80% of which occurred in unbooked patients, 60% occurred in patients with eclampsia, 20% inpatients with obstructed labour and the other 20% in patients with ante partum haemorrhage.Conclusion: Morbidity and mortality from caesarean section isstill high, due to the high number of unbooked patients and late referrals. Efforts should be made to educate our women about the importance of antenatal booking and early presentation in labour.Early referrals should be encouraged through continuing education programme for Doctors in private and government hospitals.

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