Capacity for the management of kidney failure in the International Society of Nephrology Africa region: report from the 2023 ISN Global Kidney Atlas (ISN-GKHA).

The burden of chronic kidney disease and associated risk of kidney failure are increasing in Africa. The management of people with chronic kidney disease is fraught with numerous challenges because of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas, we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending, which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The health care workforce across Africa was suboptimal and further challenged by the exodus of trained health care workers out of the continent. Medical products, technologies, and services for the management of people with nondialysis chronic kidney disease and for kidney replacement therapy were scarce due to limitations in health infrastructure, which was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared with the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on chronic kidney disease prevention and early detection, improving the effectiveness of the available health care workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (kidney replacement therapy or conservative kidney management) for all people living with kidney failure.

Apolipoprotein L1 gene variants and kidney disease in patients with HIV: a systematic review and meta-analysis.

BACKGROUND: The risk of various types of kidney disease is significantly increased in the presence of APOL1 high-risk genotype (carriage of two risk alleles), particularly HIV-associated nephropathy (HIVAN). However, there are discrepancies in the existing evidence about the level of association between APOL1 high-risk genotype and the risk of kidney diseases in people living with HIV (PLWHIV). METHODS: This systematic review and meta-analysis was conducted to assess the relationship between the APOL1 genotypes and kidney disease in the HIV population. An a priori protocol registered on PROSPERO (ID: CRD42021253877), was followed by a systematic search of five electronic databases. Database-specific search terms were used to identify observational studies that evaluated the outcomes chosen in the review, based on a set of prespecified eligibility criteria. Using a random effect model, the odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were pooled for the meta-analysis. RESULTS: After screening 4418 citations, 14 articles comprising 11,069 participants were included in this review. The risk of chronic kidney disease (CKD) in the HIV positive population was significantly increased in the presence of two APOL1 risk alleles (OR 4.65 [95% CI 3.51-6.15]). Also, a significant association was observed between the carriage of two risk APOL1 variants and proteinuria (OR 2.58 [95% CI 2.05-3.25]), HIVAN (OR 16.67 [95% CI 10.22-27.19]), and progression to end-stage kidney disease (ESKD) hazard ratio: 1.79 (95% CI 1.20-2.66). CONCLUSION: This review highlights a strong association between the presence of two risk APOL1 variants and an increased risk of kidney disease in PLWHIV, and provides a more precise estimate of the effect size, with smaller 95% CIs for CKD, HIVAN, and progression to ESKD.

Early Identification of CKD-A Scoping Review of the Global Populations.

Introduction: Decisions on whether to screen for chronic kidney disease (CKD) or not remain contentious in nephrology. This study provides a global overview of early CKD identification efforts. Methods: Guidelines for scoping reviews were followed and studies were identified by searching MEDLINE, EMBASE, Cochrane Library, CINAHL, ISI Web of Science, and PsycINFO. Data extracted from included studies focused on the following 4 themes: study population, measurement methods, interventions used, and available policies. Results: We identified 290 CKD screening and detection programs from 83 countries. Overall sample size was 3.72 million (North East Asia: 1.19 million), detection of CKD was the aim in 97.6%, 63.1% used population-based screening methods, and only 12.4% were in rural populations. Reported CKD prevalence (stages 3-5) was higher in targeted- (14.8%) than population-based studies (8.0%). Number of persons needed to screen (NNS) to identify 1 case was also lower in targeted studies (7 vs. 13). Single measurements (80%) and the combination of estimation of glomerular filtration rate with a urine test (albuminuria/proteinuria) (71.4%) were frequently used to detect CKD. Only 2.8% of studies included an intervention such as pharmacotherapy in identified cases. Policies on early identification were available in 30.1% of countries included. Conclusion: Methods for early CKD identification vary worldwide, often leading to wide variations in the reported prevalence. Efforts to standardize measurement methods for early detection focusing on high-risk populations and ensuring appropriate interventions are available to those identified with CKD will improve the value of programs and improve patient outcomes.

Prevalence of Chronic Kidney Disease as a Marker of Hypertension Target Organ Damage in Africa: A Systematic Review and Meta-Analysis.

INTRODUCTION: Hypertension is a major global cause of cardiovascular disease and death with rising worldwide prevalence, particularly in low-income countries. With low awareness, poor treatment, and low control of hypertension in Africans, there is an increased number of patients with target organ damage (TOD), especially chronic kidney disease (CKD), as a consequence of hypertension. The aim of our study is to assess the prevalence of CKD from studies in Africa reporting TOD related to hypertension. METHODS: We performed a search of PubMed/MEDLINE, Web of Science, EBSCOhost, and African Journals Online (AJOL) for studies reporting on CKD as TOD in patients with hypertension. The pooled estimate of CKD was then presented by subregions, age group, eGFR equations, and urban or rural location. RESULTS: We identified 1,334 articles from which 12 studies were included for quantitative analysis. The studies included 5297 participants from 6 countries (Ghana, Nigeria, Uganda, Tanzania, Democratic Republic of Congo, and South Africa). The pooled prevalence of CKD was 17.8% (95% CI 13.0-23.3%), and CKD was significantly more prevalent in West Africa (21.3% (95% CI: 16.1-27.0); p < 0.0001) and in studies conducted in urban settings (p < 0.001). CKD prevalence was not significantly different by type of GFR equation or age. CONCLUSION: This study reports a high prevalence of CKD related to hypertension with a higher prevalence in urban than rural areas. This emphasizes the role of hypertension in causing kidney damage, and the need for strategies to improve awareness, treatment, and control of hypertension in Africans. This study is registered with PROSPERO registration number CRD42018089263.

Diagnostic performance of glomerular PLA2R and THSD7A antibodies in biopsy confirmed primary membranous nephropathy in South Africans.

BACKGROUND: Serum and tissue-based tests using phospholipase A2 receptor 1 (PLA2R) and thrombospondin type-1 domain containing 7A (THSD7A) are established immune biomarkers for the diagnosis of primary membranous nephropathy (PMN). This study assessed the diagnostic performance of these biomarkers in the diagnosis of PMN in South Africans. METHODS: This was a cross-sectional analysis from a single centre in Cape Town, South Africa. Relevant biodata was collected from all patients. Histology, including slides for PLA2R and THSD7A were processed and assessed by typical microscopic and immunohistochemical features. Biopsy tissues of patients with membranous lupus nephritis (LN-V) and diabetic nephropathy (DN) were used as controls. The diagnostic accuracy for diagnosis of PMN using positive PLA2R and THSD7A were evaluated. RESULTS: Of the 88 patients included, 41 had PMN with a mean age of 44.5 ± 17.5 years and 61.0% were female. Histologically, PLA2R and THSD7A were only positive in the PMN group (51.2% and 4.9%, respectively) but negative in both control groups. The sensitivity of PLA2R and THSD7A for identifying PMN was 51.2% and 4.9%, respectively. The sensitivity of both tests together was 53.7% while the specificity and positive predictive values (PPV) for any of the tests (alone or in combination) was 100%. There was no difference in the sensitivity and specificity when using PLA2R alone compared to combining the two tests (p=0.32). CONCLUSION: Glomerular staining of PLA2R and THSD7A could have potential diagnostic values in South Africans. This has implications on how immunotherapies can be initiated and used in these settings.

Association of Genetic Polymorphisms of TGF-ß1, HMOX1, and APOL1 With CKD in Nigerian Patients With and Without HIV.

RATIONALE & OBJECTIVE: Recent studies in the human immunodeficiency virus (HIV)-infected population have suggested that there are genetic predispositions to the development of chronic kidney disease (CKD) in this context. We investigated the association of genetic polymorphisms of the genes encoding apolipoprotein L1 (APOL1), transforming growth factor ß1 (TGF-ß1; a profibrotic cytokine), and heme oxygenase 1 (HMOX1) with prevalent CKD among adults with and without HIV infection. STUDY DESIGN: Case-control study. SETTING & PARTICIPANTS: West African adults including 217 HIV-infected patients with CKD (HIV+/CKD+ group), 595 HIV-infected patients without CKD (HIV+/CKD- group), 269 with CKD and no HIV infection (HIV-/CKD+ group), and 114 with neither CKD nor HIV (HIV-/CKD- group). EXPOSURE: The genetic polymorphisms with reference single-nucleotide polymorphism (rs) identification numbers rs1800469 (TGF-ß1), rs1800470 (TGF-ß1), rs121918282 (TGF-ß1); rs60910145 (APOL1 G1 risk allele), rs73885319 (APOL1 G1 risk allele), rs71785313 (APOL1 G2 risk allele), and rs743811 (HMOX1); HIV. OUTCOME: CKD. ANALYTICAL APPROACH: Single-nucleotide polymorphism (SNP) genotyping of rs1800469 (TGF-ß1), rs1800470 (TGF-ß1), rs121918282 (TGF-ß1); rs60910145 (APOL1), rs73885319 (APOL1), rs71785313 (APOL1), and rs743811 (HMOX1) was performed. Hardy-Weinberg equilibrium was evaluated for all SNPs, and minor allele frequencies were reported. A case-control analysis was performed, and multivariable logistic regression was used to control for potential confounders. RESULTS: Minor allele frequencies for TGF-ß1 (rs1800469, rs1800470, and rs1800471), APOL1 (rs60910145, rs73885319, and rs71785313), and HMOX1 (rs743811) were 0.25, 0.46, 0.46, 0.44, 0.45, 0.17, and 0.14, respectively. Among HIV-positive individuals, only TGF-ß1 rs1800470 (GG vs AA), APOL1 (in the recessive model), and hypertension were associated with prevalent CKD (adjusted ORs of 0.44 [95% CI, 0.20-0.97], 2.54 [95% CI, 1.44-4.51], and 2.17 [95% CI, 1.35-3.48], respectively). No SNP polymorphisms were associated with prevalent CKD among HIV-negative individuals. LIMITATIONS: The lack of histopathology data for proper categorization of the type of HIV-related nephropathy. CONCLUSIONS: APOL1 polymorphisms were highly prevalent in this population and among adult patients infected with HIV and were associated with increased CKD risk. The TGF-ß1 (rs1800470) polymorphism was associated with reduced risk, and HMOX1 polymorphisms were unassociated with CKD.

Preventing CKD in Low- and Middle-Income Countries: A Call for Urgent Action.

The epidemiologic transition occurring in low- and middle-income countries (LMICs) has led to a surge in chronic kidney disease (CKD) prevalence because of a combination of highly prevalent chronic noncommunicable diseases (NCDs) and communicable diseases (CDs). The progressive rise in CKD prevalence in LMICs threatens the existing weak health systems in these countries as care for advanced CKD remains largely unavailable and unaffordable. An interplay of low literacy levels, poor health-seeking behavior, inadequate health care funding, weak health systems, and lack of skilled nephrology workforce has made it difficult for adequate CKD preventive measures to be implemented. Primary, secondary, and tertiary prevention measures need to be instituted in LMICs by a collaboration of governmental and nongovernmental organizations to stem this tide and help prevent deaths from other NCDs that share similar risk factors with CKD. For these to be effective, locally relevant knowledge is needed to contextualize existing prevention and control solutions, or to develop novel and more appropriate solutions for LMICs.

Demographics, Cost, and Sustainability of Haemodialysis among End-Stage Kidney Disease Patients in Southern Nigeria: A Single-Center Study.

CONTEXT: Access to chronic hemodialysis for patients with end-stage kidney disease has improved over the years. However, it is unclear if this has resulted in lower cost and improved dialysis vintage. AIM: We aimed to assess the demographics, cost implication, and sustainability of maintenance hemodialysis in our cohort of end-stage kidney disease (ESKD) patients. METHODS: Retrospective descriptive study of ESKD patients on maintenance HD from 2014 to 2018 using hemodialysis records. Time-to-HD discontinuation and reasons for discontinuation were recorded. Using Kaplan-Meier graphs, the time-to-dialysis discontinuation experience of the cohort was shown. Log-rank test was used to compare the experience between both genders. Univariable and multivariable Cox proportional hazard models were built to identify independent associations with time-to-dialysis discontinuation. RESULTS: Over the 5-year period, 702 individuals initiated HD, males were older than females, the complete cohort contributed 65,714 person-days to the study and the median time-to-HD discontinuation was 10 days (interquartile range, 2-42). Females had a shorter time to HD discontinuation (8 days [1-32 days]) compared to males (11 days [2-48 days]). Only 28.5%, 15.3% and 8.3% of the patients had HD beyond 30, 90, and 180 days, respectively. About 128 (18.2%) had thrice-weekly HD. Most sustained the treatment for the 1st week. Majority (98.4%) of the patients were presumed dead, while 4 (0.65%) were still alive and 6 (0.98%) had renal transplantation. All patients who discontinued dialysis did so for financial reasons. Multivariable Cox proportional hazards model showed that individuals who could afford dialysis more than once a week had reduced hazard of dialysis discontinuation. CONCLUSION: Most patients cannot sustain HD beyond a few weeks for financial reasons. Several cost containment strategies need to be deployed to bring down the cost of care.

Urinary Transforming Growth Factor-Beta 1 (uTGF-ß1) and Prevalent CKD Risk in HIV-Positive Patients in West Africa.

INTRODUCTION: This study investigated the association of urinary transforming growth factor-ß1 (uTGF-ß1) with prevalent chronic kidney disease (CKD) in the HIV-infected population. METHODS: HIV-positive patients without CKD (HIV+CKD-, n = 194) and 114 with CKD (HIV+CKD+) who did not have hypertension, diabetes mellitus, or hepatitis B or C, had their urinary protein-creatinine ratio (uPCR), serum transforming growth factor (TGF)-ß1, and uTGF-ß1 measured. uTGF-ß1-creatinine ratios (uTGF-ß1Cr) were calculated. Spearman correlation was used to determine the association between uTGF-ß1Cr and various attributes, and the Cuzick trend test was used to assess the presence of a linear trend in median uTGF-ß1Cr levels across the stages of CKD. Multivariable robust linear regression models were used to assess independent association with variability in uTGF-ß1Cr and estimated glomerular filtration rate (eGFR) levels. RESULTS: The age of the participants was 38.3 ± 10.3 years with 73.4% women. The median uTGF-ß1Cr was higher among HIV+CKD+ (4.85 ng/mmol [25th-75th percentile 1.96-12.35] vs. 2.95 [1.02-5.84]; P = 0.001]). There was significant correlation between uTGF-ß1Cr and age (P = 0.02), eGFR (P = 0.001), and uPCR (P < 0.001) in the HIV+CKD+ group. Among the HIV+CKD+ patients, there was gradual reduction in the median level of uTGF-ß1Cr with CKD severity (P = 0.04). HIV+CKD+ patients had significantly higher levels of uTGF-ß1Cr after controlling for potential confounders. Using eGFR as dependent variable, proteinuria explained the changes associated with uTGF-ß1Cr levels. CONCLUSION: HIV+CKD+ patients express higher levels of uTGF-ß1 especially in the early stages of CKD apparently related to proteinuria levels.

Prevalence and predictors of low back pain in a Southern Nigerian hospital.

Background: Low back pain (LBP) is the most common musculoskeletal disease in adults. The data on LBP from Sub-Saharan Africa are inadequate. The aim of this study was to assess the prevalence and analyze the predictors of LBP among hospital staff in a Nigerian tertiary hospital. Materials and Methods: The study participants were recruited using an opt-in approach, with the aim of including representative numbers from each professional cadre. Each participant gave formal consent. Ethical clearance was obtained. Results: Five hundred and sixty-three participants with the mean age of 36.0 ± 8.3 years and 62% female were interviewed. The point prevalence of LBP was 234 (42% [95% confidence interval [CI]: 37%-45%]). Profession was a significant predictor of LBP (P = 0.001) - nurses (53% [95% CI 43%-63%]), administrative officers (49% [95% CI 40%-59%]), engineers (50% [95% CI 24%-76%]), and health information staff (50% [95% CI 26%-75%]) had the highest prevalence. In univariate regression, female gender, increasing age, body mass index ≥25 kg/m2, and frequently adopting a bending posture, were significantly associated with LBP, while in multivariate regression, only the female gender was a significant predictor. Conclusion: The pattern of both the professions at risk, due to the well-known mechanisms of poor ergonomics, and the marked risk for the female gender, in the hospital setting, suggest underresourced work and societal environments as the underlying factors-more research is needed.

RésuméContexte: La douleur dans le bas du dos est la maladie musculeux-squelettique la plus commune parmi les adultes. Les données sur la douleur dans le bas du dos de l'Afrique sub-saharienne ne sont pas adéquates. Le but de cette communication était est d'évaluer la prévalence et d'analyser les indicateurs de la douleur dans le bas du dos parmi les travailleurs dans l'hôpital tertiaire au Nigeria. Methodes: Les participants de l'étude ont été sélectionnés à travers l'approche opt-in, pour bien représenter les gens de chaque niveau professionnel. Chaque participant a donné son consentement. L'autorisation éthique a été obtenue. Resultats: Cinq cents soixante-trois participants de l'âge moyen de 36.0 ± 8.3 et 62% de femelles ont été interviewés. Le point de prévalence de la douleur dans le bas du dos était 234 [42% (95% CI 37 ­ 45%)]. La profession est un indicateur important de la douleur dans le bas du dos (P - 0.001) ­ les infirmiers [53% (95% CI 43 ­ 63%)], les directeurs administratifs [49% (95% CI 40 ­ 59%)], les ingénieurs [50% (95% CI 24 ­ 76%)] et les travailleurs de l'information de santé [50% (95% CI 26 ­ 75%)] ont eu la plus prévalence. Dans la régression univariée, sexe féminin, l'âge croissant, IMC ≥ 25kg/m2 et adoptant fréquemment une posture de flexion, ont été associés à la douleur dans le bas du dos, tandis que dans la régression multivariée, seulement le sexe féminin était un indicateur important. Conclusion: Le schéma des deux professions sont à risque dû aux mécanismes bien reconnus de pauvres ergonomiques, et le risque marqué pour le sexe féminin, en milieu hospitalier, suggère un travail sous financé et les environnements de société en tant que facteurs sous-jacents - plus de recherche est nécessaire.

Prevalence and correlates of traditional risk factors for cardiovascular disease in a Nigerian ART-naive HIV population: a cross-sectional study.

OBJECTIVES: HIV infection environment presents a classic example of the interplay between infectious diseases and non-communicable diseases (NCDs). Traditional cardiovascular disease (CVD) risk factors abound in the HIV population even before initiation of antiretrovirals (ARVs) and predispose them to the development of stroke and myocardial infarction. This work focuses on determining the prevalence of traditional CVD risk factors among ARV-naive HIV individuals in southern Nigeria. METHODS: This was a cross-sectional study of ARV-naive patients initiating care at the University of Uyo Teaching Hospital HIV clinic cohort to determine the prevalence and correlates of hypertension, diabetes mellitus (DM), obesity and dyslipidaemia. RESULTS: The sample consisted of 4925 assessed for hypertension, 5223 for obesity, 1818 for DM and 926 for dyslipidaemia. Hypertension prevalence was 26.7% (95% CI 25.5% to 28.0%) with a male preponderance (p=0.02). DM was found in 5.6% (95% CI 4.5% to 6.7%), obesity in 8.3% (95% CI 7.6% to 9.1%) and dyslipidaemia in 29.1% (95% CI 26.1% to 32.1%) with a high prevalence of low high-density lipoprotein-c (42.6%). Hypertension was independently associated with age (OR 1.04 (95% CI 1.03 to 1.05), p<0.001) and body mass index (BMI) (OR 1.06 (95% CI 1.03 to 1.08), p<0.001), obesity with age (OR 1.02 (95% CI 1.01 to 1.03), p<0.001), male gender (OR 0.38 (95% CI 0.29 to 0.49), p<0.001) and CD4 count (OR 2.63 (95% CI 1.96 to 3.53), p<0.001) while dyslipidaemia was associated with BMI (OR 1.05 (95% CI 1.01 to 1.10), p=0.03). CONCLUSION: The prevalence of traditional CVD risk factors is high in this ART-naive HIV population. An integrated approach of HIV and NCD screening/treatment may be relevant for centres in sub-Saharan Africa.

Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis.

INTRODUCTION: The widespread use of antiretroviral therapies (ART) has increased life expectancy in HIV patients, predisposing them to chronic non-communicable diseases including Chronic Kidney Disease (CKD). We performed a systematic review and meta-analysis (PROSPERO registration number CRD42016036246) to determine the global and regional prevalence of CKD in HIV patients. METHODS: We searched PubMed, Web of Science, EBSCO and AJOL for articles published between January 1982 and May 2016. CKD was defined as estimated glomerular filtration rate (eGFR) <60ml/min using the MDRD, Cockcroft-Gault or CKD-EPI equations. Random effects model was used to combine prevalence estimates from across studies after variance stabilization via Freeman-Tukey transformation. RESULT: Sixty-one eligible articles (n = 209,078 HIV patients) in 60 countries were selected. The overall CKD prevalence was 6.4% (95%CI 5.2-7.7%) with MDRD, 4.8% (95%CI 2.9-7.1%) with CKD-EPI and 12.3% (95%CI 8.4-16.7%) with Cockcroft-Gault; p = 0.003 for difference across estimators. Sub-group analysis identified differences in prevalence by WHO region with Africa having the highest MDRD-based prevalence at 7.9% (95%CI 5.2-11.1%). Within Africa, the pooled MDRD-based prevalence was highest in West Africa [14.6% (95%CI 9.9-20.0%)] and lowest in Southern Africa (3.2%, 95%CI 3.0-3.4%). The heterogeneity observed could be explained by WHO region, comorbid hypertension and diabetes mellitus, but not by gender, hepatitis B or C coinfection, CD4 count or antiretroviral status. CONCLUSION: CKD is common in HIV-infected people, particularly in Africa. HIV treatment programs need to intensify screening for CKD with added need to introduce global guidelines for CKD identification and treatment in HIV positive patients.

Prevalence and correlates of chronic kidney disease (CKD) among ART-naive HIV patients in the Niger-Delta region of Nigeria.

Widespread use of antiretroviral therapy (ART) in human immunodeficiency virus (HIV) patients has led to improved longevity with the attendant increase in noncommunicable disease prevalence including chronic kidney disease (CKD). This study documents the prevalence of CKD in a large HIV population in Southern Nigeria.This is a single center, 15-year analysis in ART-naïve patients. CKD was defined as the occurrence of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m on 2 consecutive occasions 3 to 12 months apart using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. The Cochran-Armitage and Cuzick tests were employed to assess for trend across the years for CKD prevalence and CD4 count, respectively. Multivariable logistic regression models were used to identify independent associations with CKD.In all, 1317 patients (62.2% females) with mean age of 34.5 years and median CD4 count of 194 cells/µL were included. CKD prevalence was 13.4% (95%CI 11.6%-15.4%) using the CKD-EPI equation (without the race factor). Multivariable analysis identified increasing age and CD4 count <200 cells/µL as being independently associated with CKD occurrence.This study reports a high prevalence of CKD in ART-naïve HIV-infected patients. Measures to improve diagnosis of kidney disease and ensure early initiation of treatment should be integrated in HIV treatment programmes in this setting.

Clinical profile and outcome of patients with biopsy-proven acute interstitial nephritis in Cape Town: a 10-year review
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BACKGROUND: Acute interstitial nephritis (AIN) is a common cause of acute kidney injury that has not been adequately characterized in Sub-Saharan Africa (SSA) despite an increasing use of potentially inciting agents for the treatment of human immunodeficiency virus (HIV) and tuberculosis in the region. METHODS: A retrospective audit of records of patients with biopsy-proven AIN diagnosed at Groote Schuur Hospital, Cape Town from the 1st of January, 2006, to the 31st of December, 2015. RESULTS: 54 patients with biopsy-proven AIN were reviewed. The majority were of black African origin (59.2%), with HIV (42.8%) and HIV-tuberculosis coinfection (30.5%) as the most common comorbidities. Drug-related AIN was seen in 38 (67.9%) patients, with rifampicin as the most often implicated medication. Probable drug-related AIN was seen in 3 (5.4%) patients, infection-related AIN in 8 (14.3%), and unspecified causes in 4 (7.4%). AIN was suspected in 44.6% of patients before biopsy. 18 patients (34%) received hemodialysis, while 19 (35.2%) were treated with corticosteroids. Complete renal recovery at 30 and 90 days was seen in 23 (42.6%) patients and 24 (45.3%) patients, respectively, with the majority seen among those with drug-induced AIN. Six (11.1%) patients died; 4 (10.5%) of the patients were in the drug-related group. There was no correlation between degree of interstitial inflammation and severity of renal failure (p = 0.10). On multivariate logistic regression, drug-related causes of AIN were predictive of complete recovery at day 30 (OR 16.63; 95% CI: 1.71 - 161.6, p = 0.02), and presence of interstitial fibrosis reduced likelihood of recovery (OR 0.03; 95% CI 0.002 - 0.46, p = 0.012). Steroid use did not influence partial recovery (OR 0.59, 95% CI 0.17 - 1.77; p = 0.32) or complete recovery (OR 3.38, 95% CI 0.38 - 30.39, p = 0.28). CONCLUSIONS: AIN is common in patients with HIV or those on treatment for tuberculosis. Drug-related AIN is often associated with improved outcomes. This is particularly reassuring in the SSA region where the use of potentially-inciting medications is rife from a high burden of HIV and tuberculosis.
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The Knowledge, Attitude, and Perception towards Epilepsy amongst Medical Students in Uyo, Southern Nigeria.

Background and Aim. Epilepsy remains a stigmatized disease especially in Sub-Saharan Africa. Lack of information and illiteracy has been blamed as the cause of the stigmatization. This stigmatization stems from the fact that the traditional African belief views epilepsy as a spiritual disease. We studied the knowledge, attitude, and perception towards epilepsy amongst medical students comparing the knowledge of the clinical students with that of the basic medical (preclinical) students. Methodology. The participants were medical students in University of Uyo. We administered questionnaires which explored the knowledge of etiology (perceived and medically proven). We studied the beliefs in infectivity of epilepsy, treatment together with their attitudes, and perception to persons with epilepsy. Results. Most of the participants do not have a good knowledge of epilepsy. The knowledge, however, was much better amongst the clinical students. There is some difference in the attitudes of the clinical students compared with the basic students. Conclusion. There is a knowledge gap in epilepsy even amongst medical students. Participants still harbor the traditional African beliefs that epilepsy is a spiritual disease. Mercifully, the knowledge is better amongst the clinical students. This is not surprising since the clinical students have had clinical exposure to epilepsy.

Acute Renal Failure Induced by Chinese Herbal Medication in Nigeria.

Traditional herbal medicine is a global phenomenon especially in the resource poor economy where only the very rich can access orthodox care. These herbal products are associated with complications such as acute renal failure and liver damage with a high incidence of mortalities and morbidities. Acute renal failure from the use of herbal remedies is said to account for about 30-35% of all cases of acute renal failure in Africa. Most of the herbal medications are not usually identified, but some common preparation often used in Nigeria includes "holy water" green water leaves, bark of Mangifera indica (mango), shoot of Anacardium occidentale (cashew), Carica papaya (paw-paw) leaves, lime water, Solanum erianthum (Potato tree), and Azadirachta indica (Neem) trees. We report a rare case of a young man who developed acute renal failure two days after ingestion of Chinese herb for "body cleansing" and general wellbeing. He had 4 sessions of haemodialysis and recovered kidney function fully after 18 days of admission.

Prevalence of Hypertension in Akwa Ibom State, South-South Nigeria: Rural versus Urban Communities Study.

Recent studies have shown an increasing trend in the prevalence of hypertension in rural communities compared to that of the urban communities. This study was therefore carried out to determine the prevalence of hypertension and its predictors (if any) in both urban and rural communities of Akwa Ibom State of Nigeria. Subjects and Method. This was a cross-sectional study of urban and rural communities of Akwa Ibom State for the prevalence of hypertension and its predictors. Two urban cities and two rural communities were randomly selected from the three senatorial districts of the state. Hypertension was defined based on the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of Hypertension. Results. Nine hundred and seventy-eight (978) participants were recruited from rural areas and five hundred and ninety (590) from urban centers. The rural populace had higher systolic, diastolic, and mean arterial blood pressure than the urban populace (P < 0.001, < 0.002, < 0.001, resp.). The prevalence of hypertension was significantly higher in the rural populace than in the urban populace [44.3% (95% CI 41.1-47.4%) versus 28.6% (95% CI 24.9-32.3%)]. Age, BMI, and proteinuria were independent predictors of hypertension occurrence. Conclusion. There is an epidemiologic change in the prevalence of hypertension in the rural communities of Nigeria.

Lung function indices of children exposed to wood smoke in a fishing port in South-South Nigeria.

Children in the warm rain forest are at risk of having their lung function compromised by a variety of factors, including smoke from wood fires. A total of 358 children from a fishing port and 400 children living in a farm settlement were tested to determine their peak expiratory flow rate (PEFR), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory volume in 1 s per cent and forced expiratory flow between 25 and 75%. The values for the PEFR, FVC, FEV1, forced expiratory volume in 1 s per cent and forced expiratory flow between 25 and 75% of the subjects were significantly lower than those of the controls (P value for males = <0.001, 0.01, 0.002, 0.01 and <0.001, respectively, whereas for their female counterparts = <0.001, 0.003, 0.001, 0.04 and <0.001, respectively). These deficits were observed to be more with increasing duration of exposure to wood smoke for PEFR, FVC and FEV1. Chronic exposure to fish drying using firewood can impair lung function in children. There is a need for alternative methods of fish preservation for those engaged in fish drying.