Pediatrics
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Item Factors associated with mortality and long-term outcomes of pediatric acute kidney injury in a resource limited setting(Karger AG, Basel, 2023) Alao, M. A.; Ibrahim, O. R.; Ademola, A. D.; Asinobi, A. O.Introduction: Despite being a leading cause of morbidity and mortality globally, acute kidney injury (AKI) is worse in resource-limited areas. This study explores AKI incidence, in-hospital mortality, and long-term outcomes in resource limited settings. Methods: This was a prospective study of children with AKI from2014 to 2019. KDIGO 2012 defined AKI. We assessed the etiology, in-hospital mortality, and long-term outcome of AKI in a mission hospital. Results: Only 169 of 201 AKI patients had complete data. The ages ranged from 1.08 months to 17.5 years; 65.7% were male and 65.1% were from lower socioeconomic class. The incidence of AKI was 59.6 cases per 1,000 persons (95%CI: 5.42, 47.1). Most patients had stage 1 KDIGO AKI (91; 53.8%). 1–5 years old had the highest incidence of AKI (65; 38.5%); sepsis (26.6%), severe malaria (15.4%), and nephrotic syndrome (14.8%) were common AKI causes. Fever (72.8%), pallor (52.1%), and vomiting (45.6%) were the most common symptoms. Thirty two (27.8%) patients had high blood pressure. In-hospital mortality was 14.8% (95% CI: 9.8, 21.1). The cumulative incidence of AKI-related mortality was 93.2 per 1,000 person years. Poor outcome was associated with breathlessness, hyponatremia, and leukocytosis. Kaplan-Meier survival curve showed 81% (CI: 74–87%) survival after 5 years of AKI. On Cox proportional-hazards analysis, the absence of breathlessness (HR: 2.537, 95%: CI 1.210–5.317) and hyponatremia (HR: 2.914, 95% CI: 1.343–6.324) were associated with increased survival. Conclusion: In resource-limited settings, infectious diseases and nephrotic syndrome are common causes of AKI. Factors associated with mortality include breathlessness and hyponatremiaItem Cardiovascular risk factor burden and association with CKD in Ghana and Nigeria(Elsevier Inc., 2023)Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD); however, the burden of cardiovascular risk factors in patients with CKD in Africa is not well characterized. We determined the prevalence of selected cardiovascular risk factors, and association with CKD in the Human Heredity for Health in Africa Kidney Disease Research Network study. Methods: We recruited patients with and without CKD in Ghana and Nigeria. CKD was defined as estimated glomerular filtration rate of <60 ml/min per 1.73 m2 and/or albuminuria as albumin-to-creatinine ratio <3.0 mg/mmol (<30 mg/g) for $3 months. We assessed self-reported (physician-diagnosis and/or use of medication) hypertension, diabetes, and elevated cholesterol; and self-reported smoking as cardiovascular risk factors. Association between the risk factors and CKD was determined by multivariate logistic regression. Results: We enrolled 8396 participants (cases with CKD, 3956), with 56% females. The mean age (45.5 _ 15.1 years) did not differ between patients and control group. The prevalence of hypertension (59%), diabetes (20%), and elevated cholesterol (9.9%), was higher in CKD patients than in the control participants (P < 0.001). Prevalence of risk factors was higher in Ghana than in Nigeria. Hypertension (adjusted odds ratio [aOR] ¼ 1.69 [1.43–2.01, P < 0.001]), elevated cholesterol (aOR ¼ 2.0 [1.39–2.86, P < 0.001]), age >50 years, and body mass index (BMI) <18.5 kg/m2 were independently associated with CKD. The association of diabetes and smoking with CKD was modified by other risk factors. Conclusion: Cardiovascular risk factors are prevalent in middle-aged adult patients with CKD in Ghana and Nigeria, with higher proportions in Ghana than in Nigeria. Hypertension, elevated cholesterol, and underweight were independently associated with CKD.Item Kidney transplantation(Nigerian Association of Nephrology, 2023) Bamgboye, E. L.; Umeizudike, T.; Okwuonu, C. G.; Olatise, O. O.; Ademola, A. D.; Oguntola, S. O.Item Childhood nephrotic syndrome in Africa: Epidemiology, treatment trends, and outcomes(Elsevier Inc., 2022) Ademola, A. D.; Asinobi, A. O.; Alao, M. A.; Olowu, W. A.Nephrotic syndrome is a common childhood glomerular disease that is associated with massive proteinuria and edema. Children with nephrotic syndrome are at risk of chronic kidney disease, disease-related complications, and treatment-related complications. Patients with frequently relapsing disease or steroid toxicity may require newer immunosuppressive medications. However, access to these medications is limited in many African countries owing to prohibitive cost, the need for frequent therapeutic drug monitoring, and a lack of appropriate facilities. This narrative review examines the epidemiology of childhood nephrotic syndrome in Africa, including trends in treatment and patient outcomes. In most of North Africa, as well as among White and Indian populations in South Africa, the epidemiology and treatment of childhood nephrotic syndrome closely resembles that of European and North American populations. Historically, secondary causes of nephrotic syndrome (eg, quartan malaria nephropathy and hepatitis B−associated nephropathy) were predominant among Blacks in Africa. Over time, the proportion of secondary cases has decreased, along with rates of steroid resistance. However, focal segmental glomerulosclerosis increasingly has been reported among patients with steroid resistance. There is a need for consensus guidelines for the management of childhood nephrotic syndrome in Africa. Furthermore, establishing an African nephrotic syndrome registry could facilitate monitoring of disease and treatment trends, and provide opportunities for advocacy and research to improve patient outcomes.Item Paediatric dialysis at a tertiary hospital in South-West Nigeria: A 4-year report(Karger AG, Basel, 2022) Ademola, A. D.; Asinobi, A. O.; Alao, M. A.; Wade, A. W.Introduction: Dialysis is potentially lifesaving in children with acute kidney injury (AKI) or chronic kidney disease (CKD), but availability is limited in low-income countries and lower-middle-income countries (LMICs). Methods: In the present study, we perform a 4-year study of patients who received peritoneal dialysis (PD) or haemodialysis (HD) at the Paediatric Nephrology Unit of the University College Hospital Ibadan, Nigeria. Subgroup analysis was performed on patients with sepsis or malaria AKI who underwent HD or PD for predictors of in-hospital mortality. Results: A total of 167 children aged 7 days to 18 years, median 7 (interquartile range 3–12) years, (60.5% males) were studied. In total, 129 (77.2%) had AKI, while 38 had CKD. Regarding AKI, 83 children (64.3%) received HD only, 42 underwent PD only, while 4 underwent both HD and PD. Malaria AKI was treated with HD in 43 (51.8%) or PD in 8 (10.5%), while sepsis AKI was treated with HD in 20 (21.4%) or PD in 33 (78.6%). Mortality in AKI was 16.3% overall, 10.8% in children on HD only, and 26.2% in children on PD only. Patients with sepsis AKI had higher mortality compared to patients with malaria AKI (RR 7.96) [1.70–37.37]). Subgroup analysis showed that age, diagnosis, and dialysis modality were not independent risk factors for mortality. The aetiology of CKD was glomerulonephritis in 26 (68.4%): treatment was HD in 36 and PD in 2 with mortality being 26.3%. Conclusions: PD for AKI showed relatively good outcomes in a LMIC. However, funding and support for a formal dialysis program for the management of AKI and CKD are needed.Item Zinc phosphide (rodenticide) poisoning: A case report of deliberate self-harm in an eleven-year-old(Paediatric Association of Nigeria, 2022) Akinlolu, A. A.; Asinobi, A. O.; Ademola, A. D.; Akinyinka, O. O.; Abioye, O.; Adelaja, A.; Philip, O. R.Zinc Phosphide(Zn3P2) is a common rodenticide freely available in Nigeria for use against rodents. Occasionally human consumption occurs either accidentally or intentionally with potential consequences of multiorgan toxicity and death. An 11-year-old boy consumed an unknown quantity of zinc phosphide marketed as Push Out with the intention of committing suicide and killing some members of the family as his response to chastisement for a misdemeanour. Patient presented in the hospital 4 days after ingestion of zinc phosphide with a history of profound vomiting and abdominal pain. Laboratory evaluation showed evidence of hepatic dysfunction, acute kidney injury and elevated serum amylase. He was managed conservatively and discharged home after two weeks of admission. We report this case to emphasise the need for Paediatricians to consider ingestion of rodenticides as a differential diagnosis of hepatoxicity and pancreatic enzyme elevation, as well as to highlight the possibility of suicide among children. There is need to control the indiscriminate use of rodenticides, strengthen public health education on poisoning as well as establish Poison Information Centres in our environment.Item Congenital pelviureteric junction obstruction and peculiarities of management in a low resource setting: a narrative review(Prime Medics Journal, 2021) Ademola A. D.; Asinobi A. O.Item 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 KTsItem 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.Item 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.