Hemodialysis (HD) treatment had, over many years, improved the survival rate of patients with end-stage renal disease. However, standard or conventional HD prescription is far from being optimal in replacing the function of normal kidneys. Its unphysiologic clearance pattern and inability to remove all types and sizes of uremic toxins results in inter- and intra-dialysis complications and an unacceptably high rate of cardiovascular morbidity and mortality. Efficiency of HD can be improved by increasing blood and dialysate flow rates, dialyzer size and surface area and duration and frequency of dialysis sessions. Home HD, where short daily or long slow nocturnal HD sessions can conveniently be performed, provides an excellent option for quality of life improvement and reduction in morbidity and mortality. Recent innovations in the specifications of HD machines and improvement in dialysis membranes characteristics and water treatment technology paved the way for achieving quality HD. These advancements have resulted in efficient implementation of adsorption, diffusion and/or convection principles using adsorption HD, hemofiltration, hemodiafiltration (HDF) and online HDF modalities in order to achieve optimum HD. Implementation of these innovations resulted in better quality care achievements in clinical practice and reduction in morbidity and mortality rates among HD patients.

The aim of this study was to evaluate the outcome of various treatment modalities of symptomatic lymphoceles and suggest an optimal management protocol. Case records of 744 renal transplant recipients who underwent surgery between January 2000 and December 2007 were retrospectively reviewed. There were a total of 36 (4.38%) lymphoceles detected in the postoperative period, of which 14 (1.88%) were symptomatic. A total of 32 procedures for the treatment of lymphocele were performed in 14 of these patients. Aspiration or percutaneous catheter drainage was performed as a primary procedure in all cases. Open marsupialization and laparoscopic marsupialization procedures were performed as secondary treatments. Percutaneous nephrostomy was required in one case before definitive treatment. Primary aspiration was successful in (n = 2) 28.5% and percutaneous drainage in (n = 3) 42.8%. Sclerotherapy was definitive in (n = 2 of 3) 66.6%. Seven of 14 patients required secondary procedure. Laparoscopic marsupialization was successful in (n = 4 of 5) 80% and open technique (n = 3) was curative in all cases. In our opinion, the first step in the management of symptomatic lymphocele in post-renal transplant recipients should be percutaneous drainage with or without drug instillation. This can stabilize renal function and optimize patients who may require surgery. Surgical marsupialization offers superior definitive treatment of lymphoceles with the least recurrence rates.

Inadequate cyclosporine blood levels may cause acute rejection in transplanted renal graft, and its increase is accompanied with graft toxicity. Cyclosporine has variable bioavailability and pharmacokinetics among patients at different times after transplantation. In this study, we compared the effects of cyclosporine blood levels (trough versus 2-hour peak, C2) on renal graft function during the first six months after transplantation in order to find better methods for drug levels assessment in our patients. We studied 50 patients who received grafts at Mashhad transplant centers from October 2006 to May 2007. Drug levels were monitored seven times during the study; in each assessment, more than 80% of the patients did not reach the therapeutic C2 levels. There was no significant correlation between age, sex, times of transplantation and acute rejection with drug C2 levels. There was no difference between graft function in patients with therapeutic C2 level and those with inadequate C2 levels. However, we found a significant correlation between trough levels and acute rejection (P <0.05). Only during the 6 ^th month after transplantation was the drug dosage significantly higher in patients with therapeutic C2 level than that in other patients (P >0.05). Apparently, peak levels were not a suitable method in drug monitoring in our patients, or peak levels might have occurred at a different time (like 1.5 or 3 or 4 h after ingestion of the drug) in our population. Based on this study, trough level may be a better method of evaluation of cyclosporine effects on renal allografts than 2-h peak levels in our patients.

Effects of laparoscopic donor nephrectomy (LDN) on graft function, especially early post-transplant, have been controversial. To assess and compare early and late graft function in kidneys procured by open and laparoscopic methods, a retrospective observational study was carried out on 37 recipients-donors who underwent LDN after introduction of this technique in February 2007 at our center, a tertiary care nephrology referral center. Demographic, immunological and intraoperative variables as well as immunosuppressive protocols and number of human leukocyte antigen (HLA) mismatches were noted. Early graft function was assessed by serum creatinine on Days two, five, seven, 14 and 28 and at the time of discharge. Serum creatinine values at three months and at one year post-transplant were considered as the surrogates of late graft function. Data obtained were compared with the data from 33 randomly selected kidney transplants performed after January 2000 by the same surgical team, in whom open donor nephrectomy was used. Pearson's chi square test, Student's t test and Mann-Whitney U test were used for statistical analysis. Early graft function (serum creatinine on Day five 2.15 mg/dL vs 1.49 mg/dL, P = 0.027) was poorer in the LDN group. Late graft function as assessed by serum creatinine at three months (1.45 mg/dL vs 1.31 mg/dL, P = 0.335) and one year (1.56 mg/dL vs 1.34 mg/dL, P = 0.275) was equivalent in the two groups. Episodes of early acute graft dysfunction due to acute tubular necrosis were significantly higher in the LDN group (37.8% vs 12.1%, Z score 2.457, P = 0.014). Warm ischemia time was significantly prolonged in the LDN group (255 s vs 132.5 s, P = 0.002). LDN is associated with slower recovery of graft function and higher incidence of early acute graft dysfunction due to acute tubular necrosis. Late graft function at one year is however comparable.

Chronic hemodialysis patients are susceptible to median nerve compression. The clinical symptoms, surgical results and prognosis of chronic hemodialysis-related carpal tunnel syndrome have different results from those of idiopathic carpal tunnel syndrome. The aim of this study was to evaluate the clinical results of extended open carpal tunnel release in chronic hemodialysis-related carpal tunnel syndrome. A review of 31 open-extended carpal tunnel decompressions in 27 chronic dialysis patients was performed. The surgical technique is detailed and the clinical results analyzed. There was an improvement in symptoms and strength in all patients. There were no instances of recurrence of nerve compression during the one year follow-up period. Extended open carpal tunnel decompression improves symptoms and enhances hand function in patients receiving chronic hemodialysis.

Elevated levels of intact parathyroid hormone (iPTH) may play an important role in the pathogenesis of the dyslipidemia in hemodialysis (HD) patients, but the underlying mechanisms are not clearly defined. In this cross-sectional study, we examined the effects of iPTH on dyslipidemia among HD patients by analyzing the data of 51 patients (18 males and 33 females) with combined mean age 51.7 ± 18.3 years (range 22-85 years) who were on HD between April 2009 and April 2010, in the dialysis center of Imam Khomeini Hospital Complex in Iran. On enrollment, we measured lipid profile, apoprotein (apo) A, apo B, alkaline phosphatase, calcium and phosphorus and also recorded the duration that they were on HD, and evaluated the correlation of these with iPTH level using Spearman's rank analysis. The mean duration on HD was 7.07 ± 6.53 years. Except for high-density lipoprotein, there were no changes in the lipid parameters in our HD patients. We also compared lipid profile among subjects, classifying them according to their iPTH levels. There was no correlation between serum lipids and iPTH levels in these groups. A significant positive correlation was found between iPTH and alkaline phosphatase( ALP) (r = 0.333, P = 0.017) between iPTH and HD duration (r = 0.408, P = 0.003), whereas there was a significant negative correlation between iPTH and Ca (r = -0.294, P = 0.037) between iPTH and apo B (r = -0.431, P = 0.002) and between iPTH and Body Mass Index (r = -0.362, P = 0.009). In conclusion, no significant relationship between iPTH and lipids was found in the studied HD patients. These findings suggest that iPTH most probably does not play a significant role in the dyslipidemia of renal failure.

Vascular changes in lupus nephritis (LN) may be the cause of renal function derangement without obvious changes in activity or chronicity indices. Although a few morphological studies of renal vasculature exist, arteriolar morphometric parameters in LN have not been evaluated. For this study, 40 patients with LN and 40 age-matched patients with minimal change disease (controls) were included. Their clinical features were noted, renal biopsy changes classified according to the modified World Health Organization classification of LN and activity and chronicity indices were calculated. Arteriolar morphometric parameters were obtained using manual tracing and an image analysis software. Appropriate statistical tests were applied to assess significance of difference between various groups. Arteriolar wall thickness as well as circumference was significantly higher in all classes of LN as compared with controls (P <0.05). However, no difference was observed in the wall-to-lumen ratio between the two groups (P >0.05). An inter-class analysis of LN did not show any significant difference for any of the arteriolar morphometric parameters (P >0.05). No correlation was found between activity or chronicity indices and the various arteriolar morphometric parameters. This study demonstrates morphometric evidence of arteriolar wall changes in LN. Although no correlation was found with the histological features, further studies are required in this area.

The nutritional status in chronic kidney disease (CKD) patients is a predictor of prognosis during the first period of dialysis. Serum albumin is the most commonly used nutritional marker. Another index is plasma amino acid profile. Of these, the plasma levels of branched chain amino acids (BCAA), especially valine and leucine, correlate well with nutritional status. Plasma BCAAs were evaluated along with albumin and C-reactive protein in 15 patients of early stages of CKD and 15 age- and sex-matched healthy controls. A significant decrease in plasma valine, leucine and albumin levels was observed in CKD patients when compared with the controls (P <0.05). No significant difference in C-reactive protein (CRP) levels was observed between the two groups. Malnutrition seen in our CKD patients in the form of hypoalbuminemia and decreased concentrations of BCAA points to the need to evaluate the nutritional status in the early stages itself. Simple measures in the form of amino acid supplementation should be instituted early to decrease the morbidity and mortality before start of dialysis in these patients.

Cognitive dysfunction includes reduced mental alertness, intellectual impairment, decreased attention and concentration, memory deficits and diminished perceptual-motor coordination. Chronic kidney disease (CKD) patients may suffer from cognitive impairment, which may decrease an individual's quality of life, increase resource utilization and result in suboptimal medical care. This study was carried out on 120 patients with different stages of CKD from our nephrology outpatient clinic divided into three groups: Group I: 50 CKD patients, stage 3 and stage 4; Group II: 50 end-stage renal disease patients on regular hemodialysis with K t/v >1.1; and Group III: 20 acute kidney injury patients, followed-up till their renal functions stabilized besides Group IV: 20 healthy subjects served as controls. All patients underwent laboratory investigations and psychometric tests, which include trial making test part B, digit span test, digit symbol test and mini-mental state examination. There was a significant difference of mean values of cognitive function tests in Groups I, II and III on comparing them with Group IV. Stage 3 CKD scored better than stage 4 CKD, which was worse than hemodialysis patients, and lastly acute kidney injury patients had mild cognitive impairment, which was restored after recovery. We found an association between hemoglobin and cognitive function tests score in the studied groups. The degree of cognitive impairment was associated with the severity of CKD, and dialysis improved cognitive performance.

The renin-angiotensin system has a major role in the development of diabetic nephropathy (DN). It is reported that vitamin D analogues are able to suppress renin excretion. Thus, this study was conducted to determine whether there is any correlation between albuminuria as a marker of DN with vitamin D levels in diabetic patients. Also, an assessment was made on the effects of vitamin D therapy on albuminuria in this group of patients. We conducted this cross-sectional study on 119 outpatients with type-2 diabetes. The serum levels of 25-hydroxy vitamin D [25 (OH) D] and the albumin to creatinine ratio were assessed in all the study patients. Patients with vitamin D deficiency/insufficiency received calcitriol therapy for eight weeks, following which the laboratory tests were repeated. The mean age of the study patients was 55.3 ± 11.2 years, 43 (36.13%) had vitamin D insufficiency [25 (OH) D <25 ng/mL] and 31 (26.1%) had vitamin D deficiency [25 (OH) D <15 ng/mL]. We found a significant correlation between 25 (OH) D levels and presence of microalbuminuria (P = 0.04) in patients with vitamin D deficiency. Therapy with calcitriol had a beneficial effect on the albumin excretion rate, although this change was not significant (P = 0.22). However, the effects of calcitriol on reduction of diastolic blood pressure (P = 0.004), glycosylated hemoglobin (P = 0.014) and levels of total cholesterol (P = 0.019), low-density lipoprotein (0.04) and high-density lipoprotein (P = 0.001) was significant. Our study suggests that vitamin D deficiency has a negative effect on albuminuria in diabetic patients, and its replacement may be associated with a beneficial effect on the risk factors of DN, such as hyperlipidemia and hypertension.

The objective of the study is to review the indications for nephrectomy in children. This study was conducted in the Division of Pediatric Surgery at the King Hussein Medical Center, Amman, Jordan, between the years 1997 and 2009. The medical records of 119 of 141 patients who underwent nephrectomy were reviewed. The patients included 67 males and 52 females, and their ages ranged from two months to 13 years. The study patients underwent simple or radical nephrectomy or nephron-sparing surgery during the 13-year period. They were studied with regard to gender, age, indication for nephrectomy, morbidity and mortality. The indications for nephrectomy were divided into benign and malignant conditions. Of the 119 nephrectomies performed, 49 patients (41.2%) had malignant conditions and 70 (58.8%) had a benign etiology. In the benign group, 23.5% of the patients underwent nephrectomy for complicated vesicoureteric reflux, urinary tract stones or infection (1.6%). Other conditions in this group included ureterocele, posterior urethral valve, etc. Benign conditions and ureterocele necessitating nephrectomy were predominant in female patients, while pelvi-ureteric junction obstruction was predominant in males. The malignant lesions necessitating nephrectomy included Wilms tumor and neuroblastoma. The over-all mortality rate was nil in the absence of malignancy. Obstructive nephropathy was the main cause of nephrectomy in this series, followed by malignancy of the kidney. It remains to be seen whether better management will reduce the incidence of nephrectomies in preventable cases. It is also important that children with a solitary functioning kidney have long-term follow-up.

Low urinary citrate excretion is a risk factor in stone formers (SF). This study aimed to measure the urinary citrate excretion in SF and healthy volunteers at our center from 12 June 2008 to 20 August 2009. There were 28 SF patients (18 males and ten females) and 27 (18 males and nine females) age-matched healthy adult volunteers who participated in this study. Both groups had a similar living environment, extrinsic factors, diet and genetic descent. After collecting 24-h urine, citrate was measured using an enzymatic kit. Routine urinalysis and 24-h creatinine and uric acid were also performed. There was a significant difference in urinary citrate excretion level among SF (mean 310, SD 260 mg/L) and normal volunteer subjects (mean 800, SD 300 mg/L). By applying the previously defined normal values (320 mg/24 h) of urinary citrate in the local population, 43% of the SF in our study group was hypocitric, and none among the controls. We conclude that prevalence of hypocitraturia in stone formers was higher than that in healthy volunteers in our population.

This retrospective descriptive study was conducted among patients who presented with variable symptoms of urolithiasis at the Department of Surgery and Urology of Gulf Medical College Hospital and Research Centre (GMCHRC), Ajman, United Arab Emirates (UAE), in order to assess whether the occurrence of urolithiasis differed in relation to season, temperature and humidity. A checklist was used for abstracting the case record and analysis was performed using PASW 17 version. Maximum number of cases was below the age of 40 years, with a male to female ratio of 5.2:1. The present study revealed a higher number of cases during summer compared with the other seasons, but it was not statistically significant. No significant correlation was seen between atmospheric temperature, relative humidity and number of cases with urolithiasis. Our study also revealed that the admission rate for renal colic was higher in the summer season as against the rest of the year, although the difference was not significant. In conclusion, urolithiasis is an important public health issue that predominantly affects people of the productive age groups. Men are affected more commonly than women. No significant seasonal variation in the number of patients with urolithiasis was observed in the study.

The development of malignancies after solid organ transplants is a well-known complication. Cancer is associated with significant consequences for the organ transplant patient. It is expected that cancer will surpass cardiovascular complications as the leading cause of death in transplant patients within the next few years. We report on a 36-year-old male patient who developed mixed germ-cell testicular tumor seven years after liver transplantation for alcoholic cirrhosis. He was treated with orchiectomy, retroperitoneal lymph node dissection and post-operative chemotherapy.

A 70-year-old male presented with progressive weight loss for eight months. Radiological imaging showed a large tumor in the right kidney. The patient underwent right open radical nephrectomy and histopathology revealed pleomorphic undifferentiated sarcoma (PUS) earlier known as malignant fibrous histiocytoma (MFH). One year after surgery, the patient developed pulmonary metastasis. Unfortunately, the patient died after six months.

Bilateral supernumerary kidney is a very rare urogenital anomaly, with four cases reported in the literature thus far. To the best of our knowledge, bilateral supernumerary kidney in conjunction with horseshoe fusion anomaly is not reported till date. Herein, we report a 63-year-old male patient with persistent lower abdominal pain. Complete radiological evaluation including ultrasound, computed tomography scan, excretory urography and retrograde pyelography were done and the diagnosis was established. The dilemma faced in the diagnosis and management of patients with supernumerary kidneys is discussed.

Fibrillary glomerulonephritis (Fib GN) is among the newly recognized primary glomerular diseases. This rare cause of end-stage kidney disease has characteristic electron microscopic findings based upon the deposition of randomly distributed (18-22 nm) microfibrills in the mesangium and less frequently in the capillary basement membrane. The main differential diagnosis at the pathological level is amyloidosis; however, the apple green birefringence Congo red positivity of amyloid deposition is not seen in Fib GN. Clinically, the patient usually presents with proteinuria of nephrotic range, and the sine qua non for the diagnosis of Fib GN is the availability of high-magnification electron micrographs. Here is a case report of Fib GN with special emphasis on electron microscopy study and its role in the diagnosis.

The bisalbuminemia acquired outside of the long-term antibiotic treatment is an exceptional event. It is a rare condition characterised by the presence of two distinct fractions of serum albumin on electrophoresis. This anomaly reflects the presence, at the same time, of a normal albumin and a modified albumin. These changes of albumin may be related to various causes. Their association with nephrotic syndrome is exceptional. We report a case of bisalbuminemia during a period of remission of nephrotic syndrome.

Urinary lithiasis is one of the most common and the oldest known afflictions of the urinary tract. The management of renal stones has undergone radical changes in recent years, the latest being the minimally invasive procedures like extra-corporeal shock wave lithotripsy and percutaneous nephrolithotomy, making the open surgical procedures relatively obsolete. However, there are situations where the above-mentioned minimally invasive procedures prove to be lacking in achieving the cure; laparoscopic pyelolithotomy caters to such group of patients, e.g. the presence of calculi in malrotated or malpositioned kidneys. Herein, we report a case of pelvic kidney with a large calculus managed by laparoscopic trans-peritoneal pyelolithotomy.

An 18-year-old man presented with severe nephrotic syndrome due to focal segmental glomerulosclerosis. His disease failed to remit with corticosteroids, calcineurin inhibitors, mycophenolate and rituximab. As his disease progressed with time, his anasarca became more resistant to high-dose combination diuretics and he developed multiple life-threatening bacterial infections. He was subjected to bilateral renal artery embolization with 99.8% alcohol to ablate his kidneys. Subsequently, the patient was maintained on hemodialysis and had normal serum albumin and did not have further infections. The procedure itself was simple and well tolerated, with only a minor post-embolization syndrome.

Acute renal failure following vasculotoxic viperine snake bites is very common in South Asia. Acute tubular necrosis and acute cortical necrosis are the common findings, with acute interstitial nephritis (AIN) being a rare presentation. We conducted renal biopsies in all patients who were admitted in our institute with viperine snake bite-related acute kidney injury (AKI) and who did not improve after three weeks of supportive care. Patients who had findings of AIN on renal histology were included for this study. Of a total of 42 patients, there were five patients (11.9%) with AIN. Our series of five patients is the largest series of this rare presentation in the literature. All of these five patients had features of severe envenomation, severe AKI network stage of AKI and very high antivenom requirements. They had a very prolonged stay in the hospital, and four of the five patients developed chronic kidney disease on follow-up. The overall outcome in this group was worse as compared with those who did not have AIN. AIN following viperine snake bites is not a very rare presentation. The reason for the development of this pathology is unclear, but direct venom-related effects are possible. This presentation portends a poor overall long-term prognosis as demonstrated in our case series.

To identify and assess the level of knowledge and attitudes of health care professionals (HCP) in Qatar toward organ donation and transplantation, this cross-sectional study was carried out from October 2007 to February 2008 in the Accident and Emergency Departments and Intensive Care Units of the hospitals of the Hamad Medical Corporation (HMC). A representative sample of 585 HCP working in the hospitals of the HMC was approached and 418 staff gave consent to participate in the study (71.5%). 36.8% were physicians, 48.6% nurses and 14.6% Emergency Medical Service (EMS) technicians. Of the surveyed HCP, 40.7% were males and 59.3% were females. Majority of the staff were in the age group of 30-39 years (58.6%). More than half of the physicians (59.7%) and technicians (57.4%) assumed that organs can be bought and sold in the State of Qatar. Most of the physicians (76.6%) and nurses (75.9%) knew that brain-dead persons are eligible for organ donation, whereas only 57.4% of the EMS technicians thought so. Majority of the HCP supported organ donation; physicians (89.0%), nurses (82.3%) and technicians (70.5%). The attitude of the physicians (24.0%) and nurses (20.2%) to donate a kidney to a family member was very poor compared with the attitude of the technicians (44.3%). Although the HCP support organ donation (83%), more than half of the physicians (51.3%), nurses (61.6%) and technicians (54.1%) wanted to be buried with all their organs intact. The findings, although they give cause for hope, suggest that there is much work yet to be done before organ donation and transplantation can become fully accepted by the medical community in Qatar.

Urinary tract infection (UTI) is the most frequent infectious complication among renal transplant recipients and a frequent cause of bacteremia, sepsis and acute graft failure. To evaluate the incidence, risk factors, type of pathogens and long-term effect of UTIs on graft and patient survivals in our center, we performed a retrospective cohort study reviewing the medical records of patients who received a renal transplant at our center from June 1986 to December 2009, excluding patients who lost their grafts in the first month due to arterial or veins thrombosis and acute antibody-mediated rejection. We studied 393 kidney-transplanted recipients; at least one UTI occurred in 221 (53.69%) patients during the follow-up period. The most frequent pathogens isolated in urine culture were Escherichia coli (n = 39, 18.4%) and Klebsiella pneumonia (n = 31, 14.6%). When patients with UTIs were compared with those without UTIs, female gender and use of mycophenolate mofetil or azathioprine seemed to be risk factors for UTIs on univariate analysis. However, female gender was the only independent risk factor on multivariate analysis RR = 1.964 (1.202-3.207), P = 0.007. This study confirmed that UTIs remain a major problem in renal transplant recipients, and female gender was the only independent risk factor.

The morbidity and mortality from acute kidney injury (AKI) have remained relatively high over the last six decades. The triad of infections, nephrotoxins and obstetric complications are still major causes of acute kidney injury in the tropics. This retrospective study is a five-year audit of acute renal failure (ARF) (or stage 3 AKI) in patients requiring hemodialysis at the renal unit of the Department of Medicine of the Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, Nigeria. A total of 80 patients with AKI were treated over a five-year period at our center, of which 45 (56.2%) were in ARF, i.e. stage 3 AKI requiring hemodialysis. There were 24 males and 21 females. The most common cause of ARF among the patients was sepsis syndrome 16 (35.5%), while pregnancy-related cases accounted for 15 (33.3%) and nephrotoxins for 6 (13.3%). Five (33%) of the 15 pregnancy-related patients survived, and all were cases of septic abortion. Of the other 10 patients that did not survive, three (30%) had post-partum hemorrhage and seven (70%) post-partum eclampsia. In all, the mortality rate among our AKI presenting for hemodialysis at our center over a given year period was 28.8%. Majority of these were eclampsia related. The causes of ARF still remain the same in the tropics, eclampsia portends poor prognosis. Concerted efforts should be made at limiting this trend by active preventive services and early recognition of high-risk obstetrics cases.

Studies have identified microalbuminuria (MA) and asymptomatic bacteruria (ASB) as co-morbid factors in sickle cell anemia (SCA). However, the relationship between these comorbid factors remains unclear and data are lacking for Nigerian patients. This study determined the prevalence of MA and ASB in a cohort of patients with SCA in a steady state, in Lagos, Nigeria. Early morning mid-stream urine samples were collected in sterile bottles from 103 patients comprising 48 males and 55 females with a mean age of 10.4 years. Aerobic culture and colony count of organisms was done using conventional methods. Serum creatinine and hematological indices, including irreversibly sickled cells (ISC), were also assayed. Of the 103 urine samples screened, 23 (22.3%) had albuminuria (ALB), and consisted of nine males and 14 females (P > 0.05); 16.5% of the cases had MA (P <0.05). Age at onset of MA was seven years, and children accounted for 23.5% of all cases with ALB (P >0.05). The prevalence of confirmed ASB was 14.6%, with females accounting for 14 of 19 probable ASB cases (P <0.05). Univariate regression analysis demonstrated a significant (P <0.05) association between age at onset of MA, hemoglobin level, reticulocyte count, ISC and occurrence of ASB, but with only ISC evolving as an independent predictor. Twenty-eight bacterial isolates predominated by Escherichia coli (39.3%; P <0.05), of whom 89.3% were multi-drug resistant, were recovered from the ASB urine samples. In conclusion, both MA and ASB are common in Nigerian SCA patients, with the former occurring from the first decade of life.