FACULTY OF CLINICAL SCIENCES

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    The current status of kidney transplantation in Nigerian children: still awaiting light at the end of the tunnel
    (Pediatric Nephrology, 2020) Eke, F. U.; Ladapo, T. A.; Okpere, A. N.; Olatise, O.; Anochie, I.; Uchenwa, T.; Okafor, H.; Ibitoye, P.; Ononiwu, U.; Adebowale, A.; Akuse, R.; Oniyangi, S.
    Background Kidney transplantation (KT) is the gold standard treatment for childrenwith chronic kidney disease stage 5 (CKD5). It is easily accessible in well-resourced countries, but not in low/middle-income countries (LMICs). We present, a multicenter experience of paediatric KT of children domiciled in Nigeria. We aim to highlight the challenges and ethical dilemmas that children, their parents or guardians and health care staff face on a daily basis. Methods A multicentre survey of Nigerian children who received KTs within or outside Nigeria from 1986 to 2019 was undertaken using a questionnaire emailed to all paediatric and adult consultants who are responsible for the care of children with kidney diseases in Nigeria. Demographic data, causes of CKD5, sources of funding, donor organs and graft and patient outcome were analysed. Using Kaplan-Meier survival analysis, we compared graft and patient survival. Results Twenty-two children, aged 4–18 years, received 23 KTs, of which 12 were performed in Nigeria. The male-to-female ratio was 3.4:1. Duration of pre-transplant haemodialysis was 4–48 months (median 7 months). Sixteen KTs were self-funded. State governments funded 3 philanthropists 4 KTs. Overall differences in graft and patient survival between the two groups, log rank test P = 0.68 and 0.40, respectively were not statistically significant. Conclusions The transplant access rate for Nigerian children is dismal at < 0.2%. Poor funding is a major challenge. There is an urgent need for the federal government to fund health care and particularly KTs
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    Trends in the epidemiology of childhood nephrotic syndrome in Africa: A systematic review
    (Pediatric Nephrology, 2021) Wine, R.; Vasilevska-Ristovska, J.; Banh, T.; Knott, J.; Noone, D.; Gbadegesin, R.; Ilori, T. O.; Okafor, H. U.; Adetunjil, A. E.; Boima, V.; Amira, O.; Osafo, C.; Guemkam, G.; Ajayiq,, S.; Makusidi, M. A.; Anigilaje, E. A.; Ruggajo, P.; Asinobi, A. O.; Ademola, A. D.; Parekh, R. S.
    Background: Childhood nephrotic syndrome, if left untreated, leads to progressive kidney disease or death. We quantified the prevalence of steroid-sensitive nephrotic syndrome, steroid-resistant nephrotic syndrome, and histological types as the epidemiology of nephrotic syndrome in Africa remains unknown, yet impacts outcomes. Methods: We searched MEDLINE, Embase, African Journals Online, and WHO Global Health Library for articles in any language reporting on childhood nephrotic syndrome in Africa from January 1, 1946 to July 1, 2020. Primary outcomes included steroid response, biopsy defined minimal change disease, and focal segmental glomerulosclerosis (FSGS) by both pooled and individual proportions across regions and overall. Findings: There were 81 papers from 17 countries included. Majority of 8131 children were steroid-sensitive (64% [95% CI: 63–66%]) and the remaining were steroid-resistant (34% [95% CI: 33–35%]). Of children biopsied, pathological findings were 38% [95% CI: 36–40%] minimal change, 24% [95% CI: 22–25%] FSGS, and 38% [95% CI: 36–40%] secondary causes of nephrotic syndrome. Interpretation: Few African countries reported on the prevalence of childhood nephrotic syndrome. Steroid-sensitive disease is more common than steroid-resistant disease although prevalence of steroid-resistant nephrotic syndrome is higher than reported globally. Pathology findings suggest minimal change and secondary causes are common. Scarcity of data in Africa prevents appropriate healthcare resource allocation to diagnose and treat this treatable childhood kidney disease to prevent poor health outcomes. Funding: Funding was provided by the Canadian Institute for Health Research (CIHR) and the National Institute of Health (NIH) for the H3 Africa Kidney Disease Research Network. This research was undertaken, in part, from the Canada Research Chairs program.
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    HIV Viremia Is associated With APOL1 Variants and Reduced JC-Viruria
    (Frontiers Media SA, 2021) Kruzel-Davila, E.; Sankofi, B. M.; Amos-Abanyie, E. K.; Ghansah, A.; Nyarko, A.; Agyemang, S.; Awandare, G. A.; Szwarcwort-Cohen, M.; Reiner-Benaim, A.; Hijazi, B.; Ulasi, I.; Raji, Y. R.; Boima, V.; Osafo, C.; Adabayeri, V. M.; Matekole, M.; Olanrewaju, T. O.; Ajayi, S.; Mamven, M.; Antwi, S. |; Ademola, A. D.; Plange-Rhule, J.; Arogundade, F. A.; Akyaw, P. A.; Winkler, C. A.; Salako, B. L.; Ojo, A.; Skorecki, K.; Adu, D.
    Variants in the Apolipoprotein L1 (APOL1) gene (G1-rs60910145, rs73885319, G2-rs71785313) are common in Africans and in individuals of recent African ancestry and are associated with an increased risk of non-diabetic chronic kidney disease (CKD) and in particular of HIV associated nephropathy (HIVAN). In light of the significantly increased risk of HIVAN in carriers of two APOL1 risk alleles, a role in HIV infectivity has been postulated in the mechanism of APOL1 associated kidney disease. Herein, we aim to explore the association between HIV viremia and APOL1 genotype. In addition, we investigated interaction between BK and JC viruria, CKD and HIV viremia. A total of 199 persons living with HIV/AIDS (comprising 82 CKD cases and 117 controls) from among the participants in the ongoing Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network case control study have been recruited. The two APOL1 renal risk alleles (RRA) genotypes were associated with a higher risk of CKD (OR 12.6, 95% CI 3.89–40.8, p < 0.0001). Even a single APOL1 RRA was associated with CKD risk (OR 4.42, 95% CI 1.49–13.15, p = 0.007). The 2 APOL1 RRA genotypes were associated with an increased probability of having HIV viremia (OR 2.37 95% CI 1.0–5.63, p = 0.05). HIV viremia was associated with increased CKD risk (OR 7.45, 95% CI 1.66–33.35, P = 0.009) and with a significant reduction of JC virus urine shedding (OR 0.35, 95% CI 0.12–0.98, p = 0.046). In contrast to prior studies, JC viruria was not associated with CKD but was restricted in patients with HIV viremia, regardless of CKD status. These findings suggest a role of APOL1 variants in HIV infectivity and emphasize that JC viruria can serve as biomarker for innate immune system activation.
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    Management of idiopathic childhood nephrotic syndrome in sub-Saharan Africa: Ibadan consensus statement
    (International Society of Nephrology, 2020) Esezobor, C.; Ademola, A. D.; Adetunji, A. E.; Anigilaje, E. A.; Batte, A.; Jiya-Bello, F. N.; Furia, F. F.; Muoneke, U.; McCulloch, M.; Nourse, P.; Obiagwu, P.; Odetunde, O.; Okyere, P.; Solarin, A.; Tannor, E. K.; Noone, D.; Gbadegesin, R.; Parekh, R. S.
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    Childhood acute glomerulonephritis in Ibadan Nigeria
    (Paediatric Association of Nigeria, 2020) Asinobi, A. O.; Ademola, A. D.; Nwankwo, A. F.
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    Guidelines for the Management of Hypertension in Nigeria
    (Nigerian Association of Nephrology, 2020) Kadiri, S.; Arogundade, F. A.; Arije, A.; Omotoso, A.; Onwubere, B.; Aderibigbe, A.; Isah, A.; Mbakwem, A.; Salako, B.; Isezuo, S.; Ogun, S.; Sani, M.; Ulasi, I.; Familoni, O.; Ogbera, A.; Ogah, O.; Ademola, A. D.; Opadeyi, A.; Asinobi, A.
    Background: Hypertension, defined as blood pressure > 140/90 mmHg, has assumed greater public health importance in Nigeria in the last 2 decades. Many reports put the adult prevalence rates at 20-40%, with some major ones specifically reporting 27.8% and 28.9%. Low detection and reporting rates, inadequate investigation and treatment rates all combine to increase the burden. The guidelines provide updated information. Recommendations: The traditional risk factors, with the addition of high income and education status, are highlighted. Recommendations regarding the use of devices and the setting, including home and ambulatory, in the measurement of the blood pressure, are updated. The importance of total cardiovascular risk assessment and risk stratification, employed in initiating and guiding therapy, is emphasized. Lifestyle modifications are prescribed for all; they are described with estimates of BP responses and with a greater reference to local conditions. Attention is drawn to the early use of medicine therapy in those with high CV risk and multi-medicine therapy in those with BP > 160/100 mmHg. The use of single pill combinations, wherever feasible, is recommended, and the prediction is made of most patients eventually requiring multi-medicine therapy. Considerations of cost, availability, tolerance and patient-specific factors influence the choice of medicines, and although any of the several medicine classes could be used for initial therapy, thiazide and thiazide-like diuretics and calcium channel blockers are recommended for single or dual-medicine therapy. Alternatively, any of these and any of angiotensin converting enzyme inhibitor, angiotensin receptor blocker, centrally acting agent, beta-blocker or alphablocker could be used for combination therapy. Effective and recommended combinations and a list of the commonly available medicines in Nigeria are listed. Aspirin for secondary prevention and statin therapy should be used as required. The goal of treatment is commonly <140/90 mmHg, but could be lower in patients with diabetes, chronic kidney disease. Patient counselling, follow-up and treatment monitoring are emphasised. Outlines of treatment in special groups or situations including diabetes, chronic kidney disease, haemoglobinopathies, HIV-infection, paediatric patients, patients with sexual dysfunction, resistant hypertension, hypertension emergency, community control and prevention are provided.
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    The use of an improvised Nasogastric Tube as a Peritoneal Dialysis Catheter and challenges of adaptation-A case report
    (African Paediatric Nephrology Association, 2019) Ademola, A. D.; Asinobi, A. O.; Akuse, R. M.
    Background: Paediatric dialysis for acute kidney injury (AKI) in developing countries may be a challenge because of limited access to standard gadgets. Adapted gadgets such as nasogastric tubes have been used to provide peritoneal dialysis (PD)in such settings. The nasogastric tube is usually inserted by the trocar or surgical technique which is cumbersome. We describe passage of the nasogastric tube for PD at the bedside by a technique that is considered easier than the trocar or surgical method. Case report and Treatment: A two- and-a-half-year-old girl presented with oliguric AKI secondary to malaria and intravascular haemolysis with suspected uraemic encephalopathy. Her serum creatinine on admission was 9.4mg/dl. A nasogastric tube was adapted as PD catheter, and was inserted by the modified Seldinger technique on post-admission day 1. Results: She received 39 cycles of PD over 5 days. Complications of PD included catheter outflow obstruction on post admission day 2 on account of which the catheter was replaced. She also developed Klebsiella pneumoniae peritonitis and on account of which the procedure was discontinued on post admission day 6. She regained normal urine output on post admission day 7. She was managed with iv meropenem based on the antibiotic sensitivity pattern with resolution of peritonitis. She showed significant improvement and her serum creatinine on post admission day 15 was 0.5 mg/dl.She was discharged home on post admission day 18. Conclusion: Nasogastric tube, adapted as PD catheter and inserted by modified Seldinger technique may be life-saving in patients with AKI in developing countries.
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    Association between Perfluoroalkyl substance exposure and renal function in children with CKD enrolled in H3Africa Kidney Disease Research Network
    (Elsevier Inc., 2019) Sood, S.; Ojo, A. O.; Adu, D.; Kannan, K.; Ghassabian, A.; Koshy, T.; Vento, S. M.; Pehrson, L. J.; Gilbert, J. F.; Arogundade, F. A.; Ademola, A. D.; Salako, B. O.; Raji, Y.; Osafo, C.; Antwi, S.; Trachtman, H.; Trasande, L.
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    Predictors and outcome of acute kidney injury after non-cardiac paediatric surgery
    (Springer Science+Business Media, 2019) Lawal, T. A.; Raji, Y. R.; Ajayi, S. O.; Ademola, A. D.; Ademola, A. F.; Ayandipo, O. O.; Adigun, T.; Ogundoyin, O. O.; Olulana, D. I.; Asinobi, A. O.; Salako, B. L.
    Background: It is necessary to define the problem of acute kidney injury (AKI) after non-cardiac surgery in order to design interventions to prevent AKI. The study aimed to evaluate the occurrence, determinants and outcome of AKI among children undergoing general (non-cardiac) surgery. Methods: This was a prospective cohort study of patients aged ≤ 15 years who had general surgery over 18 months period at a tertiary hospital in Nigeria. AKI was evaluated at 6 and 24 h and within 7 days of surgery. Data were analysed using SPSS version 21. Results: A total of 93 patients were studied with age ranging from 3 days to 15 years (median = 4 years). AKI occurred within 24 h of surgery in 32 (34.4%) and cumulatively over 7 days in 33 (35.5%). Patients who had sepsis were nearly four times as likely as others to develop perioperative AKI (OR = 3.52, 95% CI 1.21, 10.20, p = 0.021). Crude mortality rate was 12.1% (4/33); no mortality was recorded among those without AKI, p = 0.014. Conclusion: Perioperative AKI occurred in 35.5% of children who underwent general (non-cardiac) surgery. Patients who had sepsis were four times more likely than others to develop AKI. Mortality was documented only in patients who had AKI.
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    Steroid response in primary childhood nephrotic syndrome in a tropical African environment
    (Medical and Dental Consultants' Association of Nigeria, 2020) Asinobi, A. O.; Ademola, A. D.; Ogunkunle, O. O.
    Background: Earlier studies on childhood nephrotic syndrome (NS) in tropical Africa showed steroid resistance in the majority. More recent studies show a variable picture, necessitating a re‑evaluation. This study was aimed at determining the current pattern of steroid response in childhood NS, in an environment known to be dominated by steroid resistance. Patients and Methods: This prospective study of consecutive children who received steroid therapy for primary NS was carried out at the University College Hospital, Ibadan, Nigeria between 2006 and 2013. The outcomes of interest were steroid sensitivity and death. The recruited patients received a 4-6 weeks’ course of prednisolone at 60 mg/m2/day followed by alternate day doses of 40 mg/m2 up to total steroid therapy duration of 6 months in steroid sensitive patients. Statistical analysis was carried out using STATA version 12.0. P value <0.05 was considered significant. Results: Of 109 children that received steroids for at least 8 weeks, whose mean (SD) age was 7.9 (3.7) years, 69 (63.3%) were steroid sensitive. Those aged ≥6 years responded as well as those aged <6 years (P = 0.78). Boys were more likely to be steroid‑sensitive than girls, 65.2% versus 34.8% (P = 0.039). There was zero mortality among the patients studied. Conclusion: This study has shown a better steroid sensitivity of 63.3% in children with primary NS compared with the previously reported 36.8-42.9% in patients with highly selective proteinuria. This improved steroid response and zero mortality show a remarkable departure from the past.