Peritoneal dialysis vs. haemodialysis in the management of paediatric acute kidney injury in Kano, Nigeria: a cost analysis.

OBJECTIVE: To determine the cost of the dialytic management of paediatric acute kidney injury in a low-income country. METHODS: All children under the age of 15 years, who had either peritoneal dialysis or haemodialysis for acute kidney injury in Aminu Kano Teaching Hospital over a 1-year period, were studied. The average cost of each dialysis modality was estimated. RESULTS: Of 20 children, who had dialysis for acute kidney injury, 12 (60%) had haemodialysis and 8 (40%) had peritoneal dialysis. The mean cost for haemodialysis exceeded that of peritoneal dialysis ($363.33 vs. $311.66, t = 1.04, P = 0.313) with the mean cost of consumables significantly accounting for most of the cost variation ($248.49 vs. $164.73, t = 2.91, P = 0.009). Mean costs of nephrologist visit and nursing were not found to be significant. CONCLUSION: Peritoneal dialysis is the less costly alternative for managing acute kidney injury in children in our environment.

Burden and severity of deranged electrolytes and kidney function in children seen in a tertiary hospital in Kano, northern Nigeria.

INTRODUCTION: Derangement in serum electrolytes and kidney function is often overlooked, especially in resource-constrained settings, and associated with increased risk of morbidity and mortality. This study aimed to describe the burden of derangements in serum electrolytes and kidney function in children presenting to a tertiary hospital in Nigeria. METHODS: The laboratory records of all children who had serum electrolytes urea and creatinine ordered on their first presentation to hospital between January 1 and June 30, 2017 were retrospectively reviewed. Basic demographic data including admission status (inpatient or outpatient) were recordedandserum levels of sodium, potassium, chloride and bicarbonate were assessed for derangements usingnormal values from established reference ranges. Results of repeat samples were excluded. Kidney function was classified based on the serum creatinine relative to normal values for age and sex. RESULTS: During the study period, 1909 children (60.3% male); median (IQR) age 42 (11.9) months had serum chemistry and 1248 (65.4%) were admitted. Results of their first samples were analyzed. Electrolyte derangements were present in 78.6% of the samples most commonly hyponatraemia (41.1%), low bicarbonate(37.2%), hypochloraemia (33.5%) and hypokalemia(18.9%). Azotaemia was found in 20.1% of the results. Elevated serum creatinine levels were found in 399 children (24.7%), 24.1% of those being in the severe category. Children aged 5 years and younger accounted for 76.4% of those with derangement in kidney function. One hundred and eight outpatients (17.8%) had deranged kidney function. CONCLUSION: Deranged serum electrolytes and kidney function were common in this cohort.

School-based Study of the Prevalence and Associated Factors of Prediabetes Among Adolescents in Kano, Nigeria.

Background: Prediabetes and diabetes are important metabolic public health problems, especially among adolescents. However, they are being given little or no attention, especially in Sub-Saharan Africa (SSA). Prediabetes increases the risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular diseases. Objective: To determine the prevalence of prediabetes and its associated factors among adolescents in Kano, northwest, Nigeria. Methods: This was a cross-sectional study of 650 secondary school students aged 10-19 years in Tarauni LGA of Kano state. A self-administered questionnaire was used to obtain the socio-demographic data and family history of diabetes of the participants. Each participant had his/her FBS and OGTT measured. Prediabetes was defined using the ISPAD criteria (FBS of 5.6-6.9mmol/L and 2HPP glucose level of 7.8-11.0mm). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for the FBG test against the OGTT test. Bivariate and multivariate logistic regressions were done to ascertain the associated factors of prediabetes. Results: There were 372 females and 278 males. The age range was 10-19 years with a mean 14.9±1.8 years. The prevalence of prediabetes using FBG was 5.5% while using OGTT was 8.9%, while 0.6% of students had combined IFG/IGT. FBG had a sensitivity of 7%, specificity of 95%, PPV of 11% and a NPV of 91%. Male gender (AOR=2.56, C.I= 1.25 - 5.23) and socioeconomic class (AOR= 3.36, C.I = 1.32 - 8.54) were found to be associated with IFG while positive family history of diabetes (AOR= 0.39, C.I = 0.18 - 0.84) was associated with IGT. Conclusion: Prediabetes is common among the study population and the sex-specific prevalence rate was higher among males. Higher socioeconomic class and a positive family history of diabetes were significant associations.

Prevalence and Determinants of Endothelial Dysfunction among Adults Living with HIV in Northwest Nigeria.

Background: Endothelial dysfunction constitutes an early pathophysiological event in atherogenesis and cardiovascular disease. This study aimed to assess the prevalence, determinants, and degree of endothelial dysfunction in antiretroviral therapy (ART)-treated people living with HIV (PLWH) in northwestern Nigeria using brachial flow-mediated dilatation (FMD). Methods: This was a comparative, cross-sectional study. A total of 200 ART-treated adults living with HIV with no evidence of kidney disease were compared with 200 HIV-negative participants attending a tertiary hospital in Kano, Nigeria, between September 2020 and May 2021. Endothelial function was evaluated by measuring FMD with a high-resolution vascular ultrasound transducer. FMD was calculated as the ratio of the brachial artery diameter after reactive hyperemia to baseline diameter and expressed as a percentage of change. Blood and urine samples were obtained from participants in both arms. Urine albumin-to-creatinine ratio (uACR) was calculated using the 2021 CKD-EPI estimated glomerular filtration rate (eGFR) creatinine-cystatin C equation without the race variable, and low-density lipoprotein (LDL) cholesterol was measured using enzymatic method. Results: The overall mean age (± standard deviation) of the study participants was 42 ± 11 years. Participants in the comparison arm were younger than PLWH (38 ± 11 versus 46 ± 10 years, respectively). The median (interquartile range) uACR was 41.6 (23.2-162.9) mg/g for the ART-treated PLWH versus 14.5 (7.4-27.0) mg/g for healthy controls. PLWH had a significantly lower mean percent FMD when compared to HIV-negative participants (9.8% ± 5.4 versus 12.1% ± 9.2, respectively). Reduced FMD was independently associated with HIV infection (ß = -2.83%, 95% CI, -4.44% to -1.21%, p = 0.001), estimated glomerular filtration rate (ß = -0.04%, 95% CI, -0.07% to -0.01%, p = 0.004) and LDL cholesterol (ß = -1.12%, 95% CI, -2.13% to -0.11%, p = 0.029). Conclusion: HIV-positive status, lower estimated GFR, and higher LDL cholesterol levels were independently associated with endothelial dysfunction. Future prospective studies with larger cohorts of persons living with HIV (and age- and sex-matched HIV-negative controls) are needed to gain further insight into these important findings. In the interim, aggressive management of modifiable risk factors is warranted.

Prevalence and distribution of primary glomerular diseases in Africa: a systematic review and meta-analysis of observational studies.

Glomerulonephritis (GN) is a predominant cause of kidney failure in Africa. The prevalence of primary GNs varies widely across Africa depending on the relative proportion of secondary GNs and genetic predispositions. We assessed the overall and sub-regional prevalence of primary GN and its histologic subtypes in Africa. We searched PubMed, EMBASE and African Journals Online for studies of biopsy-proven primary GNs across all age groups in Africa published between 2010 and 2022. Data for primary GNs [minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), mesangioproliferative GN (MesPGN), membranoproliferative GN (MPGN), post-infectious GN (PIGN), IgA Nephropathy (IgAN), and crescentic GN (CresGN)] were extracted. Pooled prevalence was determined using the random effects model. Seventeen eligible articles (n = 6,494 individuals) from 8 African countries met the inclusion criteria. The overall pooled prevalence of FSGS, MCD, MN, MPGN, MesPGN, PIGN, IgAN and CresGN was 26.10%, 22.40%, 8.40%, 6.40%, 6.40%, 2.60%, 2.60%, 1.40%, respectively. Only 4 studies (23.5%) used light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM) for diagnosis. There were significant differences in the distribution of histologic subtypes in the paediatric compared to the adult population and across geographic sub-regions, with West Africa having a higher prevalence of FSGS. Overall, the dominance of FSGS across most regions and age groups has implications for disease diagnosis and ongoing care. Research efforts to understand the impact of this trend on kidney disease outcomes and efforts to improve kidney biopsy practice as a means of early disease detection are needed in Africa.

Epidemiology and Outcomes of Glomerular Diseases in Low- and Middle-Income Countries.

Glomerular diseases account for a significant proportion of chronic kidney disease in low-income and middle-income countries (LMICs). The epidemiology of glomerulonephritis is characterized inadequately in LMICs, largely owing to unavailable nephropathology services or uncertainty of the safety of the kidney biopsy procedure. In contrast to high-income countries where IgA nephropathy is the dominant primary glomerular disease, focal segmental glomerulosclerosis is common in large populations across Latin America, Africa, Middle East, and South East Asia, while IgA nephropathy is common in Chinese populations. Despite having a high prevalence of known genetic and viral risk factors that trigger focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis also is common in adults and children in some African countries. Treatment of glomerular diseases in adults and children in LMICs largely is dependent on corticosteroids in combination with other immunosuppressive therapy, which often is cyclophosphamide because of its ready availability and low cost of treatment, despite significant adverse effects. Partial and/or complete remission status reported from studies of glomerular disease subtypes vary across LMIC regions, with high rates of kidney failure, mortality, and disease, and treatment complications often reported. Improving the availability of nephropathology services and ensuring availability of specific therapies are key measures to improving glomerular disease outcomes in LMICs.

Histopathological Pattern of Kidney Diseases Among HIV-Infected Treatment-Naïve Patients in Kano, Nigeria.

INTRODUCTION: Kidney biopsy in patients with HIV-associated kidney diseases allows for histopathologic diagnosis and institution of appropriate treatment as well as proper prognostication. There is a paucity of data on the histopathological pattern of HIV-associated kidney diseases in most sub-Saharan African countries. This study was aimed at evaluating the histopathologic patterns of kidney diseases seen among HIV-infected treatment-naive patients in our center as this will allow for proper diagnosis and institution of appropriate treatment. METHODS: In this cross-sectional study, consecutive patients who satisfied inclusion criteria and consented to participate were recruited. Percutaneous kidney biopsies were carried out as day procedures under real-time ultrasound guidance using an automatic spring-loaded biopsy gun as per our unit protocols. Baseline investigations including urea, creatinine, electrolytes, CD4 count, complete blood count, and glomerular filtration rate (eGFR) calculations, urinalysis and urine protein creatinine ratios were done on all the participants. RESULTS: Fifty-five patients who satisfied the inclusion criteria were studied. The mean age of the study population was 38.34± 9.26 years, with 32% females. Mean serum creatinine was 249.6±164.6 µmol/L, and mean CD4 count was 238 ±210 cells/mL. The commonest histological type was FSGS seen in 20 patients (37.7%), followed by HIVAN seen in 17 (32.1%) patients; chronic interstitial nephritis in 7 patients (13.2%) and 6 (11%) had no significant pathological finding. Compared to non-HIVAN, HIVAN patients tended to have higher systolic BP (p= 0.05); higher serum creatinine levels (p= 0.05); lower eGFR (0.03) and higher urine protein to creatinine ratio [uPCR; p= 0.02]. CONCLUSION: Kidney involvement is still a form of presentation among HIV-infected treatment-naïve patients and though a wide range of glomerular and tubulointerstitial lesions may be seen, FSGS and HIVAN are still the most common. We recommend assessment of kidney function, including urinalysis, as part of the routine evaluation of newly diagnosed HIV patients and biopsy where indicated to prognosticate and institute appropriate early treatment.

Juvenile dermatomyositis in a 14-year old Nigerian girl.

Juvenile Dermatomyositis is a rare idiopathic autoimmune and inflammatory myopathy and vasculopathy whose hallmarks are symmetrical proximal muscle weaknesses and a characteristic rash. Only few cases have been reported in West Africa subregion. We present a 14-year old Nigerian girl with clinical and histopathologic features of definitive juvenile dermatomyositis based on EULAR/ACR classification criteria but probable Juvenile dermatomyositis according to Bohan and Peter criteria. The patient had normal aspartate and alanine aminotransferase levels. Creatine kinase, Lactate dehydrogenase and aldolase which are not available in our center could not be evaluated. There was remarkable clinical improvement 3 weeks after the onset of systemic corticosteroid therapy. Our case highlights that relying on these normal enzyme values, especially where muscle biopsy and EMG are not available as is the case in most centers in developing countries, would have resulted in missed diagnosis using Bohan and Peter criteria.

Gross motor developmental delay in human immunodeficiency virus-infected children under 2 years of age.

Background: Human immunodeficiency virus (HIV) infection has significant effects on child development. We report the outcome of gross motor developmental assessment in HIV-infected children <2 years compared with that of uninfected children. Materials and Methods: Every child <2 years of age presenting for the first time to the pediatric outpatient department of the hospital over 3 months was studied. Each child had a physical examination with gross motor milestone assessment, as well as initial double rapid HIV antibody tests with confirmatory tests for those with positive or discordant results. Children with evidence of motor delay were booked for reassessment after 1 month. The milestone performance criteria of the Multicenter Growth Reference Study of the World Health Organization were used as a standard. Results: One hundred and eight children were studied. Male-to-female ratio was 1:1. Fourteen children (13.0%) were HIV infected. Nine children (8.3%) had delayed development of gross motor milestones, of which five were HIV infected and four were uninfected (P = 0.001). Each motor milestone was attained at a significantly later mean age by the HIV-infected children when compared to the uninfected. Evidence of delay in gross motor milestones was apparent by the first 6 months of life. Conclusions: A tendency to poorer motor development is apparent in young children infected by HIV and can manifest as early as the first 6 months of life. Routine HIV screening as well as early developmental assessment of all children should be encouraged.

RésuméContexte: L'infection par le virus de l'immunodéficience humaine a des effets importants sur le développement de l'enfant. Nous rapportons les résultats de l'évaluation du développement moteur global chez les enfants infectés par le VIH âgés de moins de deux ans par rapport à ceux d'enfants non infectés. Matériels et Méthodes: Tous les enfants de moins de deux ans se présentant pour la première fois au service de consultations externes pédiatriques de l'hôpital pendant une période de trois mois ont été étudiés. Chaque enfant a subi un examen physique avec une évaluation des étapes motrices globales, ainsi que des tests initiaux de double anticorps anti-VIH rapides avec des tests de confirmation pour les enfants présentant des résultats positifs ou discordants. Les enfants présentant des signes de retard moteur ont été réservés pour une réévaluation après un mois. Les critères de performance repères de l'étude de référence sur la croissance multicentrique de l'Organisation mondiale de la santé ont été utilisés comme norme. Résultats: Cent huit enfants ont été étudiés. Le ratio hommes / femmes était de 1: 1. Quatorze enfants (13,0%) étaient infectés par le VIH. Neuf enfants (8,3%) présentaient un retard dans le développement des jalons moteurs, dont cinq étaient infectés par le VIH et quatre non infectés (p = 0,001). Chaque jalon moteur a été atteint à un âge significativement plus tardif par les enfants infectés par le VIH par rapport aux enfants non infectés. La preuve d'un retard dans les jalons moteurs bruts était apparente dès les six premiers mois de la vie. Conclusions: Une tendance à un développement moteur plus faible est apparente chez les jeunes enfants infectés par le VIH et peut se manifester dès les six premiers mois de la vie. Le dépistage systématique du VIH ainsi que l'évaluation précoce du développement de tous les enfants devraient être encouragés.

Elevated Mean Pulmonary Artery Pressure and Right Ventricular Dysfunction in Children with Chronic Kidney Disease.

BACKGROUND: Elevated mean pulmonary artery pressure (mPAP) and right heart failure increase mortality in patients with chronic kidney disease (CKD). OBJECTIVES: The objective of this study is to determine the prevalence of elevated mPAP in children with CKD compared with matched controls and to ascertain the relationship between elevated mPAP with right ventricular dysfunction and history of hemodialysis. MATERIALS AND METHODS: A cross-sectional comparative study of mPAP and tricuspid annular plane systolic excursion of 21 children with CKD and age- and sex-matched controls asymptomatic for cardiac disease was conducted. RESULTS: Median mPAP was 27.69 (18.3-36.1) mmHg in CKD patients compared with 14.55 (13.5-17.1) mmHg in controls (P = 0.002). Elevated mPAP was present in 42.9% of CKD group and 0% in controls (P < 0.001). The prevalence of right ventricle (RV) dysfunction in CKD was 9.5% and 0% in controls (P = 0.49). Right ventricular dysfunction was significantly more common in patients with elevated mPAP compared with those with normal mPAP (P < 0.001). Children with CKD who had a history of having been dialyzed were less likely to have elevated mPAP (P < 0.001). CONCLUSION: Elevated mPAP is significantly more common in children with CKD compared with controls. CKD population with mPAP elevation is more likely to have impaired RV function. The occurrence of elevated mPAP was more common in those who were never dialyzed.

Salvageability of renal function following renal revascularisation in children with Takayasu's arteritis-induced renal artery stenosis.

BACKGROUND: Renal artery revascularisation procedures are usually carried out on children with renal artery stenosis from varied causes, including Takayasu's arteritis. Reports on the outcome of such procedures in children usually refer to the improvement in blood pressure, with only minimal mention of effects on renal function. OBJECTIVE: Salvageability of renal function in children who underwent renal revascularisation for Takayasu's arteritis-induced renal artery stenosis (TARAS) was the focus of this study. METHODS: We undertook a retrospective analysis of children aged ≤16 years with angiographically confirmed TARAS who underwent renal artery revascularisation procedures between 1990 and 2010. Outcomes of renal function were studied over a period of 2 years and were defined as: (i) improvement: >20% increase in estimated glomerular filtration rate (e-GFR) from presurgery value; (ii) stabilisation: e-GFR within 20% of presurgery value; and (iii) failure: >20% deterioration in e-GFR from presurgery value. The GFR was estimated using the Schwartz formula. RESULTS: Twenty children (9 males and 11 females, age range 2 - 14 years) had 27 renal artery revascularisation procedures. Thirteen of the patients (65.0%) had bilateral renal artery stenosis. The baseline mean e-GFR was 88.6 (standard deviation (SD) 25.4) mL/min/1.73 m2 and the mean duration of follow-up was 28.80 (SD 25.62) months. All the patients had stable or improved renal function until the 2-year follow-up, when the proportion decreased to 92.3% (12/13), as failure was recorded in one child. Bilateral revascularisation was found to be significantly associated with improvement in renal function in the early postoperative period (p=0.04). CONCLUSION: Renal artery revascularisation procedures are successful in salvaging renal function in children with TARAS.

Out-patient percutaneous renal biopsy among children in Northern Nigeria: a single center experience.

BACKGROUND: The safety of percutaneous renal biopsy (PRB) has been debated. The primary aim of this study was to review the procedure and secondary aim is to evaluate the safety of PRB in children in a developing nephrology unit in Northern Nigeria. METHODS: Renal biopsies carried out in the renal unit of a teaching hospital in northern Nigeria between November 2011 and April 2013 were retrospectively reviewed. All biopsies were carried out electively and under real-time ultrasound guidance using an automatic spring-loaded biopsy gun. Risk factors for complications were analyzed using logistic regression. RESULTS: A total of 24 biopsies were carried out in 20 children with nephrotic syndrome during the period under review. Mean age was 8.3 ΁ 3.0 years. Steroid resistant nephrotic syndrome was the most common indication for biopsy in 11 (55%) cases. Adequate tissue was obtained in 91.7%. Complications occurred in 2 (8.3%) cases. One required hospitalization with blood transfusion. Pre-biopsy hemoglobin concentration of <10 g/dL was found to be a significant predictor for the development of complications (P < 0.05). There was no significant difference in the rate of complications between the in-patient biopsies and day case biopsies. CONCLUSIONS: PRB can be safely carried out as an out-patient procedure in children. Low hemologlobin concentration was the major risk factor for complication.