Pediatrics

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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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    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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    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.
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    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.