Comparative Evaluation of Prevalence, Risk Factors, and Pathologic Features of Kidney Disease in Highly Active Antiretroviral Therapy-Naive and Highly Active Antiretroviral Therapy-Experienced Patients at a Tertiary Health Facility in Maiduguri, Northeastern Nigeria.

Infection of the kidneys by human immunodeficiency virus (HIV) is known to cause kidney disease. HIV-associated nephropathy occurs with variable prevalence rates in various communities and is found to be higher among sub-Saharan Africans. The disease has not been studied in Northeastern Nigeria. This study was aimed at comparing the prevalence, clinical and histo-pathologic features of kidney disease among highly active antiretroviral therapy (HAART)-experienced and HAART-naive patients in northeastern Nigeria. Four hundred HIV-infected (200 HAART-experienced and 200 HAART-naïve) patients were recruited consecutively from the ART clinic. Their socio-demographic and laboratory data including CD4+ cell counts and viral loads were obtained and documented. Out of the 200 study participants in the HAART-experienced arm, 21 (10.5%) had kidney disease whereas 61 (30.5%) participants in the HAART-naïve group had kidney disease. Their mean ages were 41.43 ± 11.04 years and 37.42 ± 9.96 years in the HAART-experienced and HAART-naïve groups, respectively. The mean serum creatinine (SCr), CD4+ cell counts, and viral load were 185.67 ± 221.80 µmol/L, 493.26 ± 241.97/mm3, and 8,856.79 ± 19,747.11/mL in the HAART-experienced group, respectively. In the HAART-naïve group, the mean SCr, CD4+ cell count, and viral load were 141.88 ± 130.56 µmol/L, 270.00 ± 154.65 cells/mm3, and 139,217.70 ± 12,598.50/mL. Focal segmental glomerulosclerosis (FSGS) was the most common histologic diagnosis in 64.7% of kidney biopsies. Risk factors for chronic kidney disease among the study population included age, low weight and body mass index, high human immunodeficiency virus (HIV)-1 viral load, low CD4+ cell counts, low hemoglobin (Hb), and proteinuria. The prevalence of kidney disease is higher among HAART-naïve HIV-infected patients than in patients who are HAART-experienced patients. Factors associated with development of kidney disease included advanced age, low CD4+ cell counts, high viral load, proteinuria, and HAART-naivety. FSGS is the most common histologic diagnosis in our study population.

Kidney Dysfunction in HIV-Positive Patients on HAART in a Nigerian Tertiary Hospital: A Comparative Study.

Background: There has been improvement in the overall outcomes of people living with human immunodeficiency virus (PLWHIV) following the advent and use of highly active antiretroviral therapy (HAART). However, there is an increased risk of nephrotoxicity from using HAART in PLWHIV as their life expectancy improves. This study assessed and compared renal dysfunction among PLWHIV on tenofovir-based and non-tenofovir-based HAART. Methodology: This comparative cross-sectional study determined and compared glomerular and tubular dysfunction among PLWHIV on tenofovir-based and non-tenofovir-based HAART. Urine beta2-microglobulin, fractional excretion of bicarbonate, uric acid, and Phosphate were used to assess proximal tubular function. The modification of diet in renal disease (MDRD) formula was used to estimate the glomerular filtration rate (eGFR). Result: There were 120 participants with a mean age of 42.2 ±9.2 years. Sixty participants were on tenofovir-based HAART, and 60 were on non-tenofovir-based HAART. The overall prevalence of proximal renal tubular dysfunction among PLWHIV on HAART was 9.1%. The proximal renal tubular dysfunction prevalence was higher in the tenofovir-based group (15.0%vs3.3% P= 0.01). The mean urine ß2 MG level was higher in the tenofovir-based HAART group (0.21±0.15ug/ml vs 0.14±0.12ug/ml; P= 0.01). The mean eGFR was lower in the tenofovir-based HAART group (86.99±18.51mls/min/1.73m2 vs 99.59±34.48mls/min/1.73m2; P=0.01). Conclusion: Tenofovir-based HAART was associated with a significant decrease in GFR and proximal renal tubular dysfunction compared to non-tenofovir-based HAART. Those on tenofovir should be regularly monitored with markers of tubular dysfunction.

Organ transplantation: legal, ethical and islamic perspective in Nigeria.

Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searching the PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/legislation backing organ/tissues transplantation in Nigeria. The government should take measures to combat transplantation tourism and the problem of national and international trafficking in human tissues and organs, ethics commission and National Transplant registry should be established in order to monitor and regulate the programme in the country.

Post transplantation diabetes mellitus in kidney allograft recipients: current concepts.

The number of kidney allograft recipients has been increasing worldwide and along with that is a proportional rise in the number of individuals who develop post-transplantation diabetes mellitus (PTDM). It is therefore necessary that physicians who render care to transplant recipients, be conversant with the current issues that relate to this relatively common complication. We searched the Medline using the keywords diabetes, transplantation, kidney and PTDM, and retrieved all relevant articles that were published in the last 15 years up to 2008. Post-transplantation diabetes mellitus is a common complication following renal trans-plantation affecting approximately 10 to 20% of such patients. In the majority of the studies we reviewed, PTDM was similar to diabetes in non-transplant patients and the risk factors included older age at transplantation, family history of diabetes, obesity, elevated body mass index, non-white ethnicity and the use of steroids and several immunosuppressive agents. Curtailment of the heavy disease burden associated with PTDM should lay emphasis on pro-active preventive measures that are aimed at modifying the known risk factors and the individualized use of immunosuppressive agents determined by the pre-transplant risk profile of the patient.

Prevention of chronic kidney disease: a global challenge.

In view of the increasing number of patients requiring renal replacement therapy (RRT) every year worldwide, attention has focused over the last two decades on meeting the health care need of patients with end-stage renal failure (ESRF). More recently, increasing awareness of the growing burden of chronic kidney disease (CKD), with a large percentage of the population affected by early stages of CKD, has shifted attention and health care priority to the prevention and early detection of CKD. This article addresses issues related to general population as well as targeted screening, favoring the latter. It also examines some of the screening initiatives undertaken in both the developing and developed worlds. It also highlights the links between albuminuria, CKD, and cardiovascular disease (CVD) as an increasing number of studies identify albuminuria/proteinuria, as well as CKD as major markers of CVD. Finally, a brief review is included of primary and secondary intervention strategies for CKD and issues related to their implementation: manpower and funding.