Pediatrics

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A case report of suspected angioedema in a child after administration of mebendazole, cotrimoxazole and leaf extracts
(Association of Resident Doctors (ARD), UCH, Ibadan, 2016) Ashubu, O. F.; Ademola, A. D.; Asinobi, O. A.
Acute kidney injury among paediatric emergency room admissions in a tertiary hospital in South West Nigeria: a cohort study
(Oxford University Press, 2019) Ademola, A. D.; Asinobi, A. O.; Ekpe-Adewuyi, E.; Ayede, A. I.; Ajayi, S. O.; Raji, Y. R.; Salako, B. L.; James, M.; Zappitelli, M.; Samuel, S. M.
Background. Epidemiological data on paediatric acute kidney injury (AKI) in sub-Saharan Africa are limited and largely retrospective. We performed a prospective study of AKI among patients admitted through the emergency room. Methods. Children admitted to the post-neonatal emergency room of the University College Hospital, Ibadan, Nigeria between February 2016 and January 2017 were studied. AKI was defined by Kidney Disease: Improving Global Outcomes serum creatinine criteria. AKI ascertainment relied on serum creatinine measurements carried out in routine care by post admission Day 1. We compared in-hospital mortality by post-admission Day 7 for patients with and without AKI (no-AKI). Results. Of the 1344 children admitted to the emergency room, 331 were included in the study. AKI occurred in 112 patients (33.8%) with a median age of 3.1 years [interquartile range (IQR) 0.9–9.4] and was Stage 3 in 50.5% of the cases. The no-AKI group had a median age of 1.8 (IQR 0.7–5.8) years. The underlying diagnoses in patients with AKI were sepsis (33.0%), malaria (12.5%) and primary renal disorders (13.4%). Twenty-four of the patients with AKI underwent dialysis: haemodialysis in 20 and peritoneal dialysis in 4. By Day 7 of admission, 7 of 98 (7.1%) patients in the AKI group had died compared with 5 of 175 (2.9%) patients in the no-AKI group [odds ratio 2.6 (95% confidence interval 0.8–8.5)]. Outcome data were not available for 58 (17.5%) patients. Conclusions. AKI is common among paediatric emergency room admissions in a tertiary care hospital in sub-Saharan Africa. It is associated with high mortality risk that may be worse in settings without dialysis.
An Audit of the Use of Renal Function Tests among Paediatric Mortalities
(Sciencedomain International, 2016) Asinobi, A. O.; Ademola, A. D.; Ogunku, O. O.
Background: Acute kidney injury is a frequent and serious complication encountered in critically ill children and is an independent risk factor for mortality. Major causes of childhood mortality in our environment are conditions frequently complicated by kidney failure, yet kidney failure is conspicuously absent in many of the reports. The actual proportion of these critically ill children subjected to renal function tests is not known. In view of the low representation of kidney failure as a cause of mortality in our environment, we sought to know what proportion of critically ill/dying patients had renal functions tests done and to identify any cases of missed diagnosis. Methods: This was a descriptive study of the mortalities in the Department of Paediatrics, University College Hospital, Ibadan, between August 2004 and May 2006, particularly those due to kidney failure. Data from the departmental mortality database collected on a weekly basis were analyzed. Results: Out of 4,941 admissions, there were 542 mortalities (age 1day -13 years) giving a mortality rate of 11%. Low birth weight, malaria, severe perinatal asphyxia, meningitis and neonatal tetanus were the leading five causes of death. Over 80% of the mortalities were under-fives
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.
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.
Childhood acute glomerulonephritis in Ibadan Nigeria
(Paediatric Association of Nigeria, 2020) Asinobi, A. O.; Ademola, A. D.; Nwankwo, A. F.
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.
CHILDHOOD NEPHROTIC SYNDROME IN KADUNA STATE
(1985-01) ABDURRAHMAN, M. B. M. B.
The clinicopathological features of childhood nephritic syndrome in tropical Africa are different from those in temperate countries of Europe and America. However, detailed clinicopathological features of the disease have not been comprehensively described in all parts of Africa. Plasmodium malariae has been shown to be strongly associated with the disease in some parts of Africa, and the association has been postulated to be causal. Childhood nephrotic syndrome was studied in Kaduna State of Nigeria in an attempt to define the clinicopathological features of the disease. In particular, the study set out to assess the role of P. malariae in the aetiology or pathogenesis of childhood nephrotic syndrome, and to look for other possible aetiological factors. One hundred consecutive children with nephrotic syndrome who had had no treatment previously were studied. In addition to routine biochemical and haematological investigations, malaria parasitaemia, protein selectivity index, serum hepatitis B surface antigen and percutaneous renal biopsy were done. As described in other parts of tropical Africa, children with nephrotic syndrome presented with massive oedema, prominent ascites, and very low serum proteins. P. malariae parasitaemia was present in 31% of nephrotic children, compared with 7% in the control group of children. The frequency of P. malariae parasitaemia was 40% in patients with membranoproliferative glomerulonephritis, 40% in quartan malarial nephropathy, and 21% in proliferative glomerolunephritis. Serum hepatitis B surface antigen was positive in the sera of 31% of patients compared with 30% in control but the concentration of antigen was stronger in the patients. Schistosoma mansoni ova were found in the stool or rectal snip of six patients: histology of renal biopsy showed membranoproliferative glomerulonephritis in four of these patients. Protein selectivity index was determined by comparing the clearances of albumin and immunoglobulin IgG. The index was good in 34% of patients. However, the test was not found useful in identifying those lesions likely to respond to corticosteroid therapy. Percutaneous rena1 biopsy was successful in 98 of the 1OO patients. By light microscopy, the most common histological diagnoses were membranopro 1iferative glomerulonephritis (25 cases), quartan malarial nephropathy (20), and proliferative glomerulonephritis (19 cases). Together they formed 65% of the biopsies. Immunofluorescence was abnormal in 92%: there were deposits of immunoglobulins, C3, P. malariae and hepatitis B surface antigen. Schistosome antigens were not looked for. Short-term prognosis of the disease was not as good as in children in Europe or North America, but did not seem to be as poor as in children studied in Ibadan. Quartan malarial nephropathy was not the predominant type of childhood nephritic syndrome seen in Kaduna State, since it accounted for less than a quarter of the cases studied. This is in contrast to the finding in Ibadan where quartan malarial nephropathy was responsible for over 80% of cases of childhood nephrotic syndrome. There was some evidence that hepatitis B surface antigen could also play a role in the aetiology or pathogenesis of the disease in Kaduna State. There is still no satisfactory treatment for childhood nephrotic syndrome in tropical Africa. Eradication or control of infectious diseases should result in reduced incidence of the disease.
Childhood nephrotic syndrome in tropical Africa: then and now
(Taylor and Francis, 2017) Olowu, W. A.; Ademola, A. D.; Ajite, A. B.; Saad, Y. M.
This descriptive and comparative review examines the changing epidemiology, treatment, renal and patient outcome of childhood nephrotic syndrome (NS) in tropical Africa (TpAfr). In the 1960s to 1980s, corticosteroid-resistant non-minimal change disease (nMCD) including quartan malaria nephropathy (QMN) was the dominant renal histopathology type. The overall incidence of NS was 0.35–1.34% of hospital admissions. Median age at onset of NS ranged between 4.0 and 12.0 years while the mean (SD) age range was 5.8 (3.8) to 10.3 (4.8) years across studies. The male: female ratio was 1.6:1.0. The overall mean (SD) incidence of idiopathic minimal change disease (MCD) [21.6 (18.6%)] compared with idiopathic nMCD [59.1 (25.7%)] demonstrates significant dominance of the latter (p = 0.0001). Post-1989, the following mean (SD) incidences of histopathological types were: MCD 20.4 (17.7%), focal segmental glomerulosclerosis 39.0 (26.3%), membranoproliferative glomerulonephritis 25.4 (16.8%), proliferative glomerulonephritis 16.7 (27.0%) and membranous nephropathy 7.4 (4.5%). While the mean (SD) proportion of steroid resistance (SR) [73.5 (19.2%)] was significantly greater than the mean complete remission (CR) [26.5 (19.2%)] during 1960-1989 (p=0.005), mean (SD) SR [27.4 (25.3%)] was significantly lower than mean (SD) CR [66.1 (28.0%)] post-1989 (p < 0.001). Unlike QMN, hepatitis B virus, HIV infection, sickle cell disease and systemic lupus erythematosus are now increasingly being associated with NS in TpAfr. Mean (SD) renal survival post-1989 was 58.3 (37.0%) while all-cause mortality was 9.8%. Children with NS now survive better than before, reflecting improved access to healthcare and transition to a clinical pattern favouring idiopathic NS and increased sensitivity to corticosteroids.
Congenital anomalies in Ibadan, Nigeria
(Spectrum Books. Publisher, Ibadan Nigeria, 2016) Ayede, A. I.; Adeleye, A. O.; Olusanya, A. A.; Ademola, A. D.; Olayemi, O.; Ogbole, G. I.; Akinmoladun, J. A.; Agunloye, A. M.; Akinrinoye, O. O.; Takure, A. O.; Oyewole, O. B.; Oluwatosin, O. M.; Omokhodion, S. I.
Background: There is a need for a multidisciplinary database that can be used as a potential source for developing a protocol and a guideline for a possible nationwide prospective surveillance of congenital anomalies in Nigeria. Methods: This five-year cross-sectional retrospective survey of data from January 2009 to December 2013 was done at the University College Hospital, Ibadan. Data were collected from the admission records on the wards in 8 specialty units with the most workable documented clinical records of congenital anomalies in their care using a predesigned proforma. Proportions of congenital anomalies were determined based on systemic classification of the anomalies and the descriptive terms used were according to the ICD_10-chapter XVIII_RCPCH extension. Result: The total number of patients with congenital anomalies whose records were obtained from the ward registers was 1311, there were 75 (5.7%) missing case notes while information was obtained on 1236 (94.3%) patients. There were a total of 1479 anomalies with multiple anomalies seen in 16.1% of the patients. The male/female ratio was 2:1 and multiple births as well as positive family history of birth defects were seen in about 2.4% and 2.2% of cases respectively. Prenatal diagnosis of the anomalies was documented in only 11 cases (0.9%). Only about one in five cases presented within the neonatal period, and defects of the abdominal wall as well as the cranial-facial-orbital regions were the most prevalent. Next were those in the cardiovascular, spinal column, anorectal and genital, as well as musculoskeletal systems. Conclusion: The size and pan-systemic profiles of the birth defects documented in this study calls for further action on this all-important cause of childhood mortality and significant life-long morbidity in our country.
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.
Diagnosing renal failure due to diethylene glycol in children in a resource-constrained setting
(Springer International Publishing, 2012) "Akuse, R. M.; Anyiam, J.; Eke, F. U.; Ademola, A. D.; Fajolu, I. B.; Gbelee, H. O.; Ihejiahi, U.; Bugaje, M. A.; Anochie, I. C.; Asinobi, A. O.; Okafor, H. U.; Adeleke, S. I.; Audu, L. I.; Otuneye, A.; Disu, E.; Idris, H.; Aikhonbare, H.; Yakubu, A.; Ogala, W.; Ogunrinde, O.; Wammanda, R.; Orogade, A.; Eseigbe, E.; Umar, L.; Musa, H.; Onalo, R.; West, B.; Paul, N.; Lesi, F.; Ladapo, T.; Boyede, O.; Okeowo, R.; Mustapha, A.; Akinola, I.; Chima-Oduko, O.; Awobusuyi O.
Background In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource constrained countries, this study investigated whether AKI associated with DEG could be identified by other means. Methods: This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children withAKI over a 6-month period were reviewed. Results Sixty (50.4%) of 119 children ingested “My pikin” teething syrup. Compared to children who had not ingested it, they were significantly (p<0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management. Conclusions Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.
Enabling the genomic revolution in Africa: H3Africa is developing capacity for health-related genomics research in Africa
(American Association for the Advancement of Science, 2014) Rotimi, C.; Abayomi, A.; Abimiku, A.; Adabayeri, V. M.; Adebamowo, C.; Adebiyi, E.; Ademola, A. D.
Factors associated with medication nonadherence among hypertensives in Ghana and Nigeria
(Hindawi Publishing Corporation, 2015) Boima, V.; Ademola, A. D.; Odusola, A. O.; Agyekum, F.; Nwafor, C. E.; Cole, H.; Salako, B. L.; Ogedegbe, G.; Tayo, B. O.
Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication non-adherence (MNA); our study therefore aimed to determine factors associated withMNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (𝑛 = 120), Ghana; and University of Port Harcourt Teaching Hospital, (𝑛 = 73) Apapa General Hospital Lagos (𝑛 = 79) and University College Hospital Ibadan (𝑛 = 85), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (𝑟 = −0.208, 𝑃 < 0.001), concern about medications (𝑟 = −0.0347, 𝑃 = 0.002), and knowledge of hypertension (𝑟 = 0.14, 𝑃 = 0.006). MNA was associated with formal education (𝑃 = 0.001) and use of herbal preparation (𝑃 = 0.014). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (𝑃 = 0.032). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (𝑃 = 0.006). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation.
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 hyponatremia
Genomic approaches to the burden of kidney disease in Sub-Saharan Africa: the Human Heredity and Health in Africa (H3Africa) kidney disease research network
(International Society of Nephrology., 2016) Osafo, C.; Raji, Y. R.; Olanrewaju, T.; Mamven, M.; Arogundade, F.; Ajayi, S.; Ulasi, I.; Salako, B.; Plange-Rhule, J.; Mengistu, Y.; Mc’Ligeyo, S. O.; Moturi, G.; Winkler, C. A.; Moxey-Mims, M. M.; Rasooly, R. S.; Kimmel, P.; Adu, D.; Ojo, A.; Parekh, R. S.; Ademola, A. D.
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.
Haemodialysis for paediatric acute kidney injury in a low resource setting: experience from a tertiary hospital in South West Nigeria
(Oxford University Press, 2016) Asinobi, A. O.; Ademola, A. D.; Alao, M. A.
Background: Acute kidney injury (AKI) is an important cause of preventable mortality among children. Management of AKI may require renal replacement therapy (RRT) but access to RRT for children in low resource settings is limited. Our study explored the role of haemodialysis in the management of children with AKI in a low resource setting in terms of aetiology and outcomes. Methods: A review of patients managed in the Paediatric Nephrology Unit, University College Hospital Ibadan, South-West Nigeria, who underwent haemodialysis for AKI from January 2006 to December 2014. Results: Sixty-eight patients (55.9% males), aged 3–16 (mean ± standard deviation, 9.0 ± 3.4) years were studied. The causes of AKI were sepsis (22.1%), malaria (17.6%) and glomerulonephritis (17.6%), intravascular haemolysis—cause unknown (16.2%), G6PDH deficiency (7.4%), malignancy (8.8%) and haemoglobinopathy (5.9%). The number of sessions of haemodialysis ranged from 1 to 10 (mode = 2 sessions) over a period of 1–55 days. Mortality was 27.9% (n = 19) and was related to the aetiology of AKI (P = 0.000): no deaths among patients with intravascular haemolysis or malaria, six deaths among patients with sepsis (40%), six (50%) among the patients with glomerulonephritis, while all the patients with malignancies died. Conclusions: The outcome of haemodialysis for AKI in Nigeria is relatively good and is related to the underlying aetiology of AKI. In addition to peritoneal dialysis, intermittent haemodialysis may have a role in the management of paediatric AKI in low resource settings and should be supported.
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.
Human heredity and Health (H3) in Africa kidney disease research network: a focus on methods in Sub-Saharan Africa
(American Society of Nephrology, 2015) Osafo, C.; Raji, Y. R.; Burke, D.; Bamidele, O. T.; Tiffin,N.; Moxey-Mims, M. M.; Rasooly, R. S.; Kimmel, P. L.; Ojo, A.; Adu, D.; Parekh, R. S.; Ademola, A. D.
CKD affects an estimated 14% of adults in sub-Saharan Africa, but very little research has been done on the cause, progression, and prevention of CKD there. As part of the Human Heredity and Health in Africa (H3Africa) Consortium, the H3Africa Kidney Disease Research Network was established to study prevalent forms of kidney disease in sub-Saharan Africa and increase the capacity for genetics and genomics research. The study is performing comprehensive phenotypic characterization and analyzing environmental and genetic factors from nine clinical centers in four African countries (Ghana, Nigeria, Ethiopia, and Kenya) over a 5-year period. Approximately 4000 participants with specified kidney disease diagnoses and 4000 control participants will be enrolled in the four African countries. In addition, approximately 50 families with hereditary glomerular disease will be enrolled. The study includes both pediatric and adult participants age <1 to 74 years across a broad spectrum of kidney diseases secondary to hypertension-attributed nephropathy, diabetes, HIV infection, sickle cell disease, biopsy-proven glomerular disease, and CKD of unknown origin. Clinical and demographic data with biospecimens are collected to assess clinical, biochemical, and genetic markers of kidney disease. As of March 2015, a total of 3499 patients and controls have been recruited and 1897 had complete entry data for analysis. Slightly more than half (50.2%) of the cohort is female. Initial quality control of clinical data collection and of biosample and DNA analysis is satisfactory, demonstrating that a clinical research infrastructure can be successfully established in Africa. This study will provide clinical, biochemical, and genotypic data that will greatly increase the understanding of CKD in sub-Saharan Africa.