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 check details 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 see more 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

Edoxaban 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.