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Paasi G, Okalebo CB, Ongodia P, Namayanja C, Eregu EEI, Abongo G, Olupot M, Amorut D, Muhindo R, Okiror W, Ndila C, Olupot-Olupot P. PARIST study protocol: a phase I/II randomised, controlled clinical trial to assess the feasibility, safety and effectiveness of paracetamol in resolving acute kidney injury in children with severe malaria. BMJ Open 2023; 13:e068260. [PMID: 37524553 PMCID: PMC10391814 DOI: 10.1136/bmjopen-2022-068260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) has in the past been considered a rare complication of malaria in children living in high-transmission settings. More recently, however, a growing number of paediatric case series of AKI in severe malaria studies in African children have been published (Artesunate vs Quinine in the Treatment of Severe P. falciparum Malaria in African children and Fluids Expansion as Supportive Therapy trials). The Paracetamol for Acute Renal Injury in Severe Malaria Trial (PARIST) therefore, aims to assess feasibility, safety and determine the effective dose of paracetamol, which attenuates nephrotoxicity of haemoproteins, red-cell free haemoglobin and myoglobin in children with haemoglobinuric severe malaria. METHODS PARIST is a phase I/II unblinded randomised controlled trial of 40 children aged >6 months and <12 years admitted with confirmed haemoglobinuric severe malaria (blackwater fever), a positive blood smear for P. falciparum malaria and either serum creatinine (Cr) increase by ≥0.3 mg/dL within 48 hours or to ≥1.5 times baseline and elevated blood urea nitrogen (BUN) >20 mg/dL. Children will be randomly allocated on a 1:1 basis to paracetamol intervention dose arm (20 mg/kg orally 6-hourly for 48 hours) or to a control arm to receive standard of care for temperature control (ie, tepid sponging for 30 min if fever persists give rescue treatment). Primary outcome is renal recovery at 48 hours as indicated by stoppage of progression and decrease of Cr level below baseline, BUN (<20 mg/dL). Data analysis will be on the intention-to-treat principle and a per-protocol basis.Results from this phase I/II clinical trial will provide preliminary effectiveness data of this highly potential treatment for AKI in paediatric malaria (in particular for haemoglobinuric severe malaria) for a larger phase III trial. ETHICS AND DISSEMINATION Ethical and regulatory approvals have been granted by the Mbale Hospital Institutional Ethics Review Committee (MRRH-REC OUT 002/2019), Uganda National Council of Science and Technology (UNCST-HS965ES) and the National drug Authority (NDA-CTC 0166/2021). We will be disseminating results through journals, conferences and policy briefs to policy makers and primary care providers. TRIAL REGISTRATION NUMBER ISRCTN84974248.
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Affiliation(s)
- George Paasi
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Charles Benard Okalebo
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Paul Ongodia
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - Cate Namayanja
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
- Department of Paediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Egiru Emma Isaiah Eregu
- Department of Paediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Grace Abongo
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - Moses Olupot
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - Denis Amorut
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - Rita Muhindo
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - William Okiror
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Carolyne Ndila
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - Peter Olupot-Olupot
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
- Faculty of Health Sciences, Department of Community and Public Health, Busitema University, Tororo, Uganda
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Zinga C, Taba K, Mesia G, Sumaili E, Tona G, Muyembe JJ, Kindala J, Nseka N. Use of Medicinal Plants in Africa: A Case Study From the Democratic Republic of Congo (DRC). Semin Nephrol 2023; 42:151319. [PMID: 36809743 DOI: 10.1016/j.semnephrol.2023.151319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Although medicinal plants are beneficial, they also can be important risk factors for the development of acute and chronic kidney injury, as well toxicity of other solid organs. There are a lack of reports of adverse kidney events and drug interactions resulting from medicinal plants owing to a lack of professional surveillance and specific data on kidney toxicity, especially in low-resource settings. Within the context of increased medicinal plant use and lack of effective regulatory control, safety is a key priority issue. We review the benefits and adverse effects of medicinal plants with particular reference to nephrotoxicity encountered in the Democratic Republic of Congo in sub-Saharan Africa.
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Affiliation(s)
- Chantal Zinga
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Université de Kinshasa, Kinshasa, XI, Democratic Republic of Congo; Unit of Clinical Pharmacology and Pharmacovigilance, Faculty of Medicine and Pharmaceutical Sciences, Université de Kinshasa, Kinshasa, XI, Democratic Republic of Congo; Organic Chemistry and Energetic Laboratory, Department of Chemistry and Industry, Faculty of Science, Université de Kinshasa, Kinshasa, XI, Democratic Republic of Congo.
| | - Kalulu Taba
- Organic Chemistry and Energetic Laboratory, Department of Chemistry and Industry, Faculty of Science, Université de Kinshasa, Kinshasa, XI, Democratic Republic of Congo
| | - Gauthier Mesia
- Unit of Clinical Pharmacology and Pharmacovigilance, Faculty of Medicine and Pharmaceutical Sciences, Université de Kinshasa, Kinshasa, XI, Democratic Republic of Congo
| | - Ernest Sumaili
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Université de Kinshasa, Kinshasa, XI, Democratic Republic of Congo
| | - Gaston Tona
- Unit of Clinical Pharmacology and Pharmacovigilance, Faculty of Medicine and Pharmaceutical Sciences, Université de Kinshasa, Kinshasa, XI, Democratic Republic of Congo
| | - Jean-Jacques Muyembe
- Institut National de Recherche Biomédicale, Division of Microbiology, Medical Biology, Faculty of Medicine, Université de Kinshasa, Kinshasa, XI, Democratic Republic of Congo
| | - Junior Kindala
- Organic Chemistry and Energetic Laboratory, Department of Chemistry and Industry, Faculty of Science, Université de Kinshasa, Kinshasa, XI, Democratic Republic of Congo
| | - Nazaire Nseka
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Université de Kinshasa, Kinshasa, XI, Democratic Republic of Congo
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Batte A, Menon S, Ssenkusu J, Kiguli S, Kalyesubula R, Lubega J, Mutebi EI, Opoka RO, John CC, Starr MC, Conroy AL. Acute kidney injury in hospitalized children with sickle cell anemia. BMC Nephrol 2022; 23:110. [PMID: 35303803 PMCID: PMC8933904 DOI: 10.1186/s12882-022-02731-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/08/2022] [Indexed: 01/06/2023] Open
Abstract
Background Children with sickle cell anemia (SCA) are at increased risk of acute kidney injury (AKI) that may lead to death or chronic kidney disease. This study evaluated AKI prevalence and risk factors in children with SCA hospitalized with a vaso-occlusive crisis (VOC) in a low-resource setting. Further, we evaluated whether modifications to the Kidney Disease: Improving Global Outcomes (KDIGO) definition would influence clinical outcomes of AKI in children with SCA hospitalized with a VOC. Methods We prospectively enrolled 185 children from 2 – 18 years of age with SCA (Hemoglobin SS) hospitalized with a VOC at a tertiary hospital in Uganda. Kidney function was assessed on admission, 24–48 h of hospitalization, and day 7 or discharge. Creatinine was measured enzymatically using an isotype-dilution mass spectrometry traceable method. AKI was defined using the original-KDIGO definition as ≥ 1.5-fold change in creatinine within seven days or an absolute change of ≥ 0.3 mg/dl within 48 h. The SCA modified-KDIGO (sKDIGO) definition excluded children with a 1.5-fold change in creatinine from 0.2 mg/dL to 0.3 mg/dL. Results Using KDIGO, 90/185 (48.7%) children had AKI with 61/185 (33.0%) AKI cases present on admission, and 29/124 (23.4%) cases of incident AKI. Overall, 23 children with AKI had a 1.5-fold increase in creatinine from 0.2 mg/dL to 0.3 m/dL. Using the sKDIGO-definition, 67/185 (36.2%) children had AKI with 43/185 (23.2%) cases on admission, and 24/142 (16.9%) cases of incident AKI. The sKDIGO definition, but not the original-KDIGO definition, was associated with increased mortality (0.9% vs. 7.5%, p = 0.024). Using logistic regression, AKI risk factors included age (aOR, 1.10, 95% CI 1.10, 1.20), hypovolemia (aOR, 2.98, 95% CI 1.08, 8.23), tender hepatomegaly (aOR, 2.46, 95% CI 1.05, 5.81), and infection (aOR, 2.63, 95% CI 1.19, 5.81) (p < 0.05). Conclusion These results demonstrate that AKI is a common complication in children with SCA admitted with VOC. The sKDIGO definition of AKI in children with SCA was a better predictor of clinical outcomes in children. There is need for promotion of targeted interventions to ensure early identification and treatment of AKI in children with SCA.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, P.O Box 6717, Kampala, Uganda.
| | - Sahit Menon
- San Diego School of Medicine, University of California, San Diego, USA
| | - John Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Joseph Lubega
- Pediatric Hematology and Oncology, Baylor College of Medicine, Texas, USA
| | | | - Robert O Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle C Starr
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrea L Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
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Batte A, Berrens Z, Murphy K, Mufumba I, Sarangam ML, Hawkes MT, Conroy AL. Malaria-Associated Acute Kidney Injury in African Children: Prevalence, Pathophysiology, Impact, and Management Challenges. Int J Nephrol Renovasc Dis 2021; 14:235-253. [PMID: 34267538 PMCID: PMC8276826 DOI: 10.2147/ijnrd.s239157] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/26/2021] [Indexed: 01/02/2023] Open
Abstract
Acute kidney injury (AKI) is emerging as a complication of increasing clinical importance associated with substantial morbidity and mortality in African children with severe malaria. Using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI, an estimated 24–59% of African children with severe malaria have AKI with most AKI community-acquired. AKI is a risk factor for mortality in pediatric severe malaria with a stepwise increase in mortality across AKI stages. AKI is also a risk factor for post-discharge mortality and is associated with increased long-term risk of neurocognitive impairment and behavioral problems in survivors. Following injury, the kidney undergoes a process of recovery and repair. AKI is an established risk factor for chronic kidney disease and hypertension in survivors and is associated with an increased risk of chronic kidney disease in severe malaria survivors. The magnitude of the risk and contribution of malaria-associated AKI to chronic kidney disease in malaria-endemic areas remains undetermined. Pathways associated with AKI pathogenesis in the context of pediatric severe malaria are not well understood, but there is emerging evidence that immune activation, endothelial dysfunction, and hemolysis-mediated oxidative stress all directly contribute to kidney injury. In this review, we outline the KDIGO bundle of care and highlight how this could be applied in the context of severe malaria to improve kidney perfusion, reduce AKI progression, and improve survival. With increased recognition that AKI in severe malaria is associated with substantial post-discharge morbidity and long-term risk of chronic kidney disease, there is a need to increase AKI recognition through enhanced access to creatinine-based and next-generation biomarker diagnostics. Long-term studies to assess severe malaria-associated AKI’s impact on long-term health in malaria-endemic areas are urgently needed.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Zachary Berrens
- Department of Pediatrics, Pediatric Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kristin Murphy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ivan Mufumba
- CHILD Research Laboratory, Global Health Uganda, Kampala, Uganda
| | | | - Michael T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea L Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
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Mzumara G, Leopold S, Marsh K, Dondorp A, Ohuma EO, Mukaka M. Identifying prognostic factors of severe metabolic acidosis and uraemia in African children with severe falciparum malaria: a secondary analysis of a randomized trial. Malar J 2021; 20:282. [PMID: 34172046 PMCID: PMC8234663 DOI: 10.1186/s12936-021-03785-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/27/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Severe metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings. METHODS A retrospective analysis of the 'Artesunate versus quinine in the treatment of severe falciparum malaria in African children' (AQUAMAT) trial was conducted to identify clinical features of severe metabolic acidosis and uraemia in 5425 children from nine African countries. Separate models were fitted for uraemia and severe metabolic acidosis. Separate univariable and multivariable logistic regression were performed to identify prognostic factors for severe metabolic acidosis and uraemia. Both analyses adjusted for the trial arm. A forward selection approach was used for model building of the logistic models and a threshold of 5% statistical significance was used for inclusion of variables into the final logistic model. Model performance was assessed through calibration, discrimination, and internal validation with bootstrapping. RESULTS There were 2296 children identified with severe metabolic acidosis and 1110 with uraemia. Prognostic features of severe metabolic acidosis among them were deep breathing (OR: 3.94, CI 2.51-6.2), hypoglycaemia (OR: 5.16, CI 2.74-9.75), coma (OR: 1.72 CI 1.17-2.51), respiratory distress (OR: 1.46, CI 1.02-2.1) and prostration (OR: 1.88 CI 1.35-2.59). Features associated with uraemia were coma (3.18, CI 2.36-4.27), Prostration (OR: 1.78 CI 1.37-2.30), decompensated shock (OR: 1.89, CI 1.31-2.74), black water fever (CI 1.58. CI 1.09-2.27), jaundice (OR: 3.46 CI 2.21-5.43), severe anaemia (OR: 1.77, CI 1.36-2.29) and hypoglycaemia (OR: 2.77, CI 2.22-3.46) CONCLUSION: Clinical and laboratory parameters representing contributors and consequences of severe metabolic acidosis and uraemia were independently associated with these outcomes. The model can be useful for identifying patients at high risk of these complications where laboratory assessments are not routinely available.
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Affiliation(s)
- Grace Mzumara
- Malawi Liverpool Wellcome Trust, Queen Elizabeth Central Hospital College of Medicine, Chichiri 3, P.O. Box 30096, Blantyre, Malawi.
- University of Malawi, College of Medicine, Blantyre, Malawi.
- University of Oxford, Oxford, UK.
- Centre for Tropical Medicine and Global Health, Oxford, UK.
| | - Stije Leopold
- Centre for Tropical Medicine and Global Health, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Arjen Dondorp
- Centre for Tropical Medicine and Global Health, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Eric O Ohuma
- University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Oxford, UK
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Mavuto Mukaka
- University of Malawi, College of Medicine, Blantyre, Malawi
- University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
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6
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Randrianarisoa RMF, Ranivoharisoa EM, Ahmed M, Ramilitiana B, Rakotomalala NL, Randria MJDD, Randriamarotia WFH. [Acute kidney injury and severe malaria in adults: A monocentric descriptive study in Madagascar using KDIGO criteria]. Nephrol Ther 2021; 17:434-440. [PMID: 34045125 DOI: 10.1016/j.nephro.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Acute Kidney Injury (AKI) is one of the criteria for severe malaria with a varied incidence. Our objectives are to determine the prevalence of malaria-associated AKI and to report the characteristics of patients with the evolution of cases. PATIENTS AND METHOD This is a 5-year retrospective descriptive study from January 1, 2015 to December 31, 2019 in the Infectious Diseases department of the University Hospital Center of Befelatanana Antananarivo. Among 379 patients diagnosed, 103 patients (27,18%) with associated AKI were included. We used the criteria of Kidney Disease Improving Global Outcomes group to define AKI. RESULTS The prevalence of AKI was 27.18%. The mean age of patients was 34.92 years and the sex-ratio was 3.68. Plasmodium falciparum was the causative agent in 98.06% of cases followed by Plasmodium vivax. Diuresis was preserved in 69.86% of cases. Jaundice was the main sign of severity associated (49.51%). The mean creatinine level was 466.93μmol/L. The evolution was favorable under antimalarial drug and rehydration. Dialysis was required in 25.24% of cases. Thirteen patients had died, a rate of 12.62%, of which 8 patients (61.54%) had dialysis criteria but had not been purged for economic reasons. CONCLUSION AKI is a frequent complication of malaria. It is responsible for significant mortality despite improved care in the fight against malaria.
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Affiliation(s)
| | | | - Mohamed Ahmed
- Service de médecine interne, centre hospitalier Joseph Raseta Befelatanana, Andrefan'Ambohijanahary, Antananarivo, Madagascar
| | - Benja Ramilitiana
- Service de néphrologie, centre hospitalier Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | - Mamy Jean de Dieu Randria
- Service des maladies infectieuses, centre hospitalier Joseph Raseta Befelatanana, Antananarivo, Madagascar
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McCulloch M, Luyckx VA, Cullis B, Davies SJ, Finkelstein FO, Yap HK, Feehally J, Smoyer WE. Challenges of access to kidney care for children in low-resource settings. Nat Rev Nephrol 2020; 17:33-45. [PMID: 33005036 DOI: 10.1038/s41581-020-00338-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 12/11/2022]
Abstract
Kidney disease is a global public health concern across the age spectrum, including in children. However, our understanding of the true burden of kidney disease in low-resource areas is often hampered by a lack of disease awareness and access to diagnosis. Chronic kidney disease (CKD) in low-resource settings poses multiple challenges, including late diagnosis, the need for ongoing access to care and the frequent unavailability of costly therapies such as dialysis and transplantation. Moreover, children in such settings are at particular risk of acute kidney injury (AKI) owing to preventable and/or reversible causes - many children likely die from potentially reversible kidney disease because they lack access to appropriate care. Acute peritoneal dialysis (PD) is an important low-cost treatment option. Initiatives, such as the Saving Young Lives programme, to train local medical staff from low-resource areas to provide care for AKI, including acute PD, have already saved hundreds of children. Future priorities include capacity building for both educational purposes and to provide further resources for AKI management. As local knowledge and confidence increase, CKD management strategies should also develop. Increased awareness and advocacy at both the local government and international levels will be required to continue to improve the diagnosis and treatment of AKI and CKD in children worldwide.
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Affiliation(s)
- Mignon McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
| | - Valerie A Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland.,Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Pediatric and Adult Renal Units, University of Cape Town, Cape Town, South Africa
| | - Brett Cullis
- Pediatric and Adult Renal Units, University of Cape Town, Cape Town, South Africa.,Nelson Mandela School of Medicine, University of Kwazulu Natal, Durban, South Africa
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Hui Kim Yap
- Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Kent Ridge, Singapore
| | - John Feehally
- International Society of Nephrology, Brussels, Belgium
| | - William E Smoyer
- Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
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Nkoy AB, Ndiyo YM, Matoka TT, Odio BM, Kazadi OK, Aloni MN, Collard L, McCulloch M, Ngiyulu RM, Gini JLE, Lepira FB, van den Heuvel LP, Levtchenko E, Ekulu PM. A promising pediatric peritoneal dialysis experience in a resource-limited setting with the support of saving young lives program. Perit Dial Int 2020; 40:504-508. [PMID: 32063192 DOI: 10.1177/0896860819887286] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the Democratic Republic of Congo (DRC), acute kidney injury (AKI) contributes to the high rate of child mortality owing to the conjunction of poverty, deficiency of qualified health-care providers in pediatric nephrology, and the lack of pediatric dialysis programs. We aimed to describe the recent experience of the first pediatric acute peritoneal dialysis (PD) program in DRC. This is a retrospective cohort study on epidemiology, clinical features and outcomes of children admitted from January 2018 to January 2019 at the University Hospital of Kinshasa for AKI and treated with PD. This pediatric PD program started by a team of one physician and one nurse who were trained in the local production of PD fluids and bedside catheter insertion technique in Benin Republic. The training was jointly supported by the Flemish Inter-University Council (VLIR) TEAM project and Saving Young Lives (SYL) program of ISN, ISPD, EuroPD, and IPNA. From January 2018 to January 2019, 49 children (aged 4 months-15 years) were admitted for AKI mainly due to severe malaria and sepsis. Dialysis was indicated in 35 of 49 (71.4%), 32 of 35 (91.4%) were treated with PD, two with hemodialysis (HD) in adult ward and one died at admission. Data of the two patients transferred for HD were not available for follow-up. The main indications were uremia and prolonged anuria. Of 32 dialyzed patients, 24 (75%) recovered normal renal function 3 months after discharge. Peritonitis was observed in 2 of 32 (6.2%) patients and the mortality was 18.7%. This promising experience proves that with simple means including use of locally produced dialysis fluids and low peritonitis rates, we can effectively save lives of children suffering from AKI.
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Affiliation(s)
- Agathe B Nkoy
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Yoli M Ndiyo
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Therance T Matoka
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Bienvenu M Odio
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Orly K Kazadi
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Michel N Aloni
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Laure Collard
- Division of Nephrology, Department of Pediatrics, Clinique de l'Espérance, CHC, Liège, Belgium
| | - Mignon McCulloch
- Division of Paediatric Nephrology, Department of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, 37716University of Cape Town, South Africa
| | - Rene M Ngiyulu
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Jean-Lambert E Gini
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - François B Lepira
- Division of Nephrology, Department of Internal Medicine, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Lambertus P van den Heuvel
- Department of Pediatric Nephrology, 26657KU Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Belgium
| | - Elena Levtchenko
- Department of Pediatric Nephrology, 26657KU Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Belgium
| | - Pepe M Ekulu
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo.,Department of Pediatric Nephrology, 26657KU Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Belgium
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9
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Exploring association between MBL2 gene polymorphisms and the occurrence of clinical blackwater fever through a case-control study in Congolese children. Malar J 2020; 19:25. [PMID: 31941497 PMCID: PMC6964107 DOI: 10.1186/s12936-020-3100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background Blackwater fever (BWF), one of the most severe and life-threatening forms of falciparum malaria, is characterized by acute massive intravascular haemolysis, often leading to acute renal failure. Thus far, the genetics of the underlying susceptibility to develop BWF is not fully elucidated. Deficiency in the MBL protein, an important component of the innate immune system, has previously been suggested to be a susceptibility factor for the development of severe malaria. This study aimed to evaluate the association between MBL2 gene polymorphisms, known to affect the MBL protein level/activity, and the occurrence of BWF among Congolese children. Methods This is a case–control study. Cases were patients with BWF, whereas controls, matched for gender and age, had uncomplicated malaria (UM). Dried blood spot was collected for genotyping. Results A total of 129 children were screened, including 43 BWF and 86 UM. The common allele in BWF and UM was A, with a frequency of 76.7 and 61.0%, respectively (OR: 2.67 (0.87–829) and p = 0.079). The frequency of the C allele was 18.6 and 29.1% in BWF and UM groups, respectively, with p = 0.858. Not a single D allele was encountered. Genotype AA was at higher risk for BWF whereas genotypes A0 (AB and AC) were over-represented in UM group (OR: 0.21 (0.06–0.78)) with p = 0.019. Nine haplotypes were observed in this study: 3 high MBL expression haplotypes and 6 low MBL expression haplotype. One new haplotype HYPC was observed in this study. None of these haplotypes was significantly associated with BWF. Conclusion This pilot study is a preliminary research on MBL2 gene and infectious diseases in DRC. The study results show a higher risk for BWF in AA. This suggests that future studies on BWF should further investigate the contribution of a strong immune response to the occurrence of BWF.
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Okyere P, Okyere I, Ndanu TA, Osafo C, Amankwaa B. Factors associated with acute kidney injury recovery in a tertiary hospital in Ghana: a prospective study. Pan Afr Med J 2019; 33:236. [PMID: 31692655 PMCID: PMC6814901 DOI: 10.11604/pamj.2019.33.236.15507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/08/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a challenging problem in developing countries due to late presentation of its victims to health care facilities. Data on the pattern of AKI, its outcome and factors associated with its recovery is scanty in developing countries therefore impeding AKI management. Aim: to study AKI recovery rate and its associated factors. METHODS An observational study conducted from September 2013 to June 2014 at Korle-Bu Teaching Hospital (KBTH). Participants were adults, admitted with AKI at KBTH. Kidney Disease: Improving Global Outcomes (KDIGO) criteria was used to diagnose and stage AKI. RESULTS Mean age (SD) of the participants was 41.9 (± 19.2) years. About a third of the patients (34.6%) were less than 29 years with 30-39 years and 40-60 years constituting 23.0% and 23.6% respectively. Females were in the majority (56.0%). AKI stages I, II and III accounted for 11.0%, 6.8% and 70.7% respectively. Majority, 82.2% of the patients recovered their kidney function. Stage III AKI was significantly associated with decreasing odds of recovery [OR = 0.4, 95%CI = 0.4-2.6, p = 0.002]. In addition, normal blood sodium was associated with recovery from AKI [OR, 95%CI = 2.3, (1.1-5.3), p = 0.043]. Almost half (45.5%) presented with fever whereas 32.5% and 22.5% presented with peripheral oedema and pulmonary oedema respectively. CONCLUSION The study demonstrated high kidney function recovery following AKI. Dominant clinical features were fever, peripheral and pulmonary oedema. Advanced stage was associated with poor recovery whereas normal serum sodium level improves kidney function recovery.
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Affiliation(s)
- Perditer Okyere
- Department of Medicine, Kwame Nkrumah University of Science and Technology (KNUST) and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Isaac Okyere
- Department of Surgery, Kwame Nkrumah University of Science and Technology (KNUST) and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Charlotte Osafo
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Bright Amankwaa
- Department of Medicine, Kwame Nkrumah University of Science and Technology (KNUST) and Komfo Anokye Teaching Hospital, Kumasi, Ghana
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11
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Ademola AD, Asinobi AO, Ekpe-Adewuyi E, Ayede AI, Ajayi SO, Raji YR, Salako BL, James M, Zappitelli M, Samuel SM. Acute kidney injury among paediatric emergency room admissions in a tertiary hospital in South West Nigeria: a cohort study. Clin Kidney J 2018; 12:521-526. [PMID: 31384443 PMCID: PMC6671520 DOI: 10.1093/ckj/sfy120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Adebowale D Ademola
- Department of Pediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Oyo State, Nigeria
| | - Adanze O Asinobi
- Department of Pediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Oyo State, Nigeria
| | - Esther Ekpe-Adewuyi
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Adejumoke I Ayede
- Department of Pediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Oyo State, Nigeria
| | - Samuel O Ajayi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Oyo State, Nigeria
| | - Yemi R Raji
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Oyo State, Nigeria
| | - Babatunde L Salako
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Oyo State, Nigeria
| | - Matthew James
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Zappitelli
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan M Samuel
- Section of Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Evans RDR, Docherty M, Seeley A, Craik A, Mpugna M, Mann S, Dube Q, Dreyer G, Hemmila U. Incidence, Etiology, and Outcomes of Community-Acquired Acute Kidney Injury in Pediatric Admissions in Malawi. Perit Dial Int 2018; 38:405-412. [PMID: 30257995 DOI: 10.3747/pdi.2017.00253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/22/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The epidemiology of acute kidney injury (AKI) in children in sub-Sahara Africa (SSA) is poorly described. The aim of this study was to establish the incidence, etiology, and outcomes of community-acquired AKI in pediatric admissions in Southern Malawi. METHODS We conducted a prospective observational study of pediatric admissions to a tertiary hospital in Blantyre between 5 February and 30 April 2016. Children were screened for kidney disease on admission with measurement of serum creatinine and assessment of urine output. The clinical presentation, etiology, and management of children with AKI were documented. RESULTS A total of 412 patients (median age 4 years, 52.6% male, and 7.5% human immunodeficiency virus [HIV] infected) were included in the study. Forty-five patients (10.9%) had AKI (Kidney Disease: Improving Global Outcomes [KDIGO] criteria), which was stage 3 in 16 (35.6%) patients. Sepsis and hypoperfusion, most commonly due to malaria (n = 19; 42.2%), were the causes of AKI in 38 cases (84.4%). Three patients (6.7%) underwent peritoneal dialysis (PD) for AKI: 2 of them recovered kidney function, and the other one died. In-hospital mortality was 20.5% in AKI and 2.9% if no kidney disease was present (p < 0.0001). Seventeen (47.2%) patients with kidney disease had persistent kidney injury on hospital discharge. CONCLUSION Acute kidney injury occurs in 10.9% of pediatric admissions in Malawi and is primarily due to infections, particularly malaria. Acute kidney injury results in significantly increased in-hospital mortality. Urgent interventions are required to eliminate preventable causes of death in this region.
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Affiliation(s)
- Rhys D R Evans
- College of Medicine, Blantyre, Malawi .,UCL Centre for Nephrology, London, UK.,Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Marie Docherty
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Anna Seeley
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Alison Craik
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Martha Mpugna
- Paediatric Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Shawna Mann
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Queen Dube
- Paediatric Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Gavin Dreyer
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Department of Nephrology, Bart's Health NHS Trust, London, UK
| | - Ulla Hemmila
- College of Medicine, Blantyre, Malawi.,Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
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Plewes K, Turner GD, Dondorp AM. Pathophysiology, clinical presentation, and treatment of coma and acute kidney injury complicating falciparum malaria. Curr Opin Infect Dis 2018; 31:69-77. [PMID: 29206655 PMCID: PMC5768231 DOI: 10.1097/qco.0000000000000419] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Cerebral impairment and acute kidney injury (AKI) are independent predictors of mortality in both adults and children with severe falciparum malaria. In this review, we present recent advances in understanding the pathophysiology, clinical features, and management of these complications of severe malaria, and discuss future areas of research. RECENT FINDINGS Cerebral malaria and AKI are serious and well recognized complications of severe malaria. Common pathophysiological pathways include impaired microcirculation, due to sequestration of parasitized erythrocytes, systemic inflammatory responses, and endothelial activation. Recent MRI studies show significant brain swelling in both adults and children with evidence of posterior reversible encephalopathy syndrome-like syndrome although targeted interventions including mannitol and dexamethasone are not beneficial. Recent work shows association of cell-free hemoglobin oxidation stress involved in the pathophysiology of AKI in both adults and children. Paracetamol protected renal function likely by inhibiting cell-free-mediated oxidative stress. It is unclear if heme-mediated endothelial activation or oxidative stress is involved in cerebral malaria. SUMMARY The direct causes of cerebral and kidney dysfunction remain incompletely understood. Optimal treatment involves prompt diagnosis and effective antimalarial treatment with artesunate. Renal replacement therapy reduces mortality in AKI but delayed diagnosis is an issue.
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Affiliation(s)
- Katherine Plewes
- Faculty of Tropical Medicine, Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gareth D.H. Turner
- Department of Cellular Pathology, John Radcliffe Hospital
- Nuffield Department of Clinical Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Arjen M. Dondorp
- Faculty of Tropical Medicine, Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Clinical Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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14
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Lameire N, Van Biesen W, Vanholder R. Epidemiology of acute kidney injury in children worldwide, including developing countries. Pediatr Nephrol 2017; 32:1301-1314. [PMID: 27307245 DOI: 10.1007/s00467-016-3433-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 01/06/2023]
Abstract
In this review we summarize the world-wide epidemiology of acute kidney injury (AKI) in children with special emphasis on low-income countries, notably those of the sub-Saharan continent. We discuss definitions and classification systems used in pediatric AKI literature. At present, despite some shortcomings, traditional Pediatric Risk Injury Failure Loss and End Stage Kidney Disease (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) systems are the most clinically useful. Alternative definitions, such as monitoring serum cystatin or novel urinary biomarkers, including cell cycle inhibitors, require more long-term studies in heterogenous pediatric AKI populations before they can be recommended in routine clinical practice. A potentially interesting future application of some novel biomarkers could be incorporation into the "renal angina index", a concept recently introduced in pediatric nephrology. The most reliable epidemiological data on AKI in children come from high-outcome countries and are frequently focused on critically ill pediatric intensive care unit populations. In these patients AKI is often secondary to other systemic illnesses or their treatment. Based on a recent literature search performed within the framework of the "AKI 0by25" project of the International Society of Nephrology, we discuss the scarce and often inaccurate data on AKI epidemiology in low-income countries, notably those on the African continent. The last section reflects on some of the many barriers to improvement of overall health care in low-income populations. Although preventive strategies for AKI in low-income countries should essentially be the same as those in high-income countries, we believe any intervention for earlier detection and better treatment of AKI must address all health determinants, including educational, cultural, socio-economic and environmental factors, specific for these deprived areas.
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Affiliation(s)
- Norbert Lameire
- Renal Division, Department of Medicine, University Hospital, De Pintelaan 285, 9000, Gent, Belgium.
| | - Wim Van Biesen
- Renal Division, Department of Medicine, University Hospital, De Pintelaan 285, 9000, Gent, Belgium
| | - Raymond Vanholder
- Renal Division, Department of Medicine, University Hospital, De Pintelaan 285, 9000, Gent, Belgium
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Vasudevan A, Phadke K, Yap HK. Peritoneal dialysis for the management of pediatric patients with acute kidney injury. Pediatr Nephrol 2017; 32:1145-1156. [PMID: 27796620 DOI: 10.1007/s00467-016-3482-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 12/31/2022]
Abstract
Renal replacement therapy (RRT) is the most important supportive measure used in the management of acute kidney injury (AKI). Peritoneal dialysis (PD) is a safe, simple and inexpensive procedure and has been used in pediatric AKI patients, ranging from neonates to adolescents. It is the modality of choice for RRT in developing countries with cost constraints and limited resources. However, its use has declined with the availability of newer types of extracorporeal modalities for RRT in the developed world. Much controversy exists regarding the dosing and adequacy of PD in the management of AKI. Data in infants and children have shown that PD can provide adequate clearance, ultrafiltration and correction of metabolic abnormalities even in those who are critically ill. Although there are no prospective studies in children, data from retrospective studies reveal no differences in mortality rates between different modalities of RRT. In this review, we discuss the advantages and limitations of PD, indications for acute PD, strategies to improve the efficiency of acute PD and outcomes of PD in children with AKI.
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Affiliation(s)
- Anil Vasudevan
- Department of Pediatric Nephrology, St. John's Medical College Hospital, Bengaluru, Karnataka, India, 560034.
| | | | - Hui-Kim Yap
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
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Cerdá J, Mohan S, Garcia-Garcia G, Jha V, Samavedam S, Gowrishankar S, Bagga A, Chakravarthi R, Mehta R. Acute Kidney Injury Recognition in Low- and Middle-Income Countries. Kidney Int Rep 2017; 2:530-543. [PMID: 29034358 PMCID: PMC5637391 DOI: 10.1016/j.ekir.2017.04.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Acute kidney injury (AKI) is increasingly common around the world. Because of the low availability of effective therapies and resource limitations, early preventive and therapeutic measures are essential to decrease morbidity, mortality, and cost. Timely recognition and diagnosis of AKI requires a heightened degree of suspicion in the appropriate clinical and environmental context. In low- and middle-income countries (LMICs), early detection is impaired by limited resources and low awareness. In this article, we report the consensus recommendations of the 18th Acute Dialysis Quality Initiative meeting in Hyderabad, India, on how to improve recognition of AKI. We expect these recommendations will lead to an earlier and more accurate diagnosis of AKI, and improved research to promote a better understanding of the epidemiology, etiology, and histopathology of AKI in LMICs.
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Affiliation(s)
- Jorge Cerdá
- Department of Medicine, Division of Nephrology, Albany Medical College, Albany, New York, USA
- Correspondence: Jorge Cerdá, MD, MS, FACP, FASN, Division of Nephrology, Department of Medicine, Albany Medical College, Albany, NY 12209.Division of NephrologyDepartment of MedicineAlbany Medical CollegeAlbanyNY 12209
| | - Sumit Mohan
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara “Fray Antonio Alcalde,” Hospital 278, Guadalajara, Mexico
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi and University of Oxford, Oxford, UK
| | | | | | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ravindra Mehta
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
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Community-acquired acute kidney injury in adults in Africa. Clin Nephrol 2017; 86 (2016):48-52. [PMID: 27469159 PMCID: PMC6103464 DOI: 10.5414/cnp86s121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 01/05/2023] Open
Abstract
Aims: We review recent published data on demographics, causes, diagnoses, treatment, and outcome of acute kidney injury (AKI) in Africa. Methods: A review of the incidence, etiology, diagnoses, and treatment of AKI in adults in Africa from studies published between the years 2000 and 2015. Results: The incidence of AKI in hospitalized patients in Africa ranges from 0.3 to 1.9% in adults. Between 70 and 90% of cases of AKI are community acquired. Most patients with AKI are young with a weighted mean age of 41.3 standard deviation (SD) 9.3 years, and a male to female ratio of 1.2 : 1.0. Medical causes account for between 65 and 80% of causes of AKI. This is followed by obstetric causes in 5 – 27% of cases and surgical causes in 2 – 24% of cases. In the reported studies, between 17 and 94% of patients who needed dialysis received this. The mortality of AKI in adults in Africa ranged from 11.5 to 43.5%. Conclusions: Most reported cases of AKI in Africa originate in the community. The low incidence of hospital-acquired AKI is likely to be due to under ascertainment. Most patients with AKI in Africa are young and have a single precipitating cause. Prominent among these are infection, pregnancy complications and nephrotoxins. Early treatment can improve clinical outcomes.
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Ajite AB, Aladekomo TA, Aderounmu T, Olowu WA. Burden of Hypertension and Abnormal Glomerular Permeability in Hypertensive School Children. Nephrourol Mon 2016; 8:e37568. [PMID: 27703956 PMCID: PMC5039781 DOI: 10.5812/numonthly.37568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/25/2016] [Accepted: 03/30/2016] [Indexed: 01/19/2023] Open
Abstract
Background Childhood hypertension has been associated with target-organ damage in young adults. It is often asymptomatic in both children and adolescents; when persistent, and long-standing, it could be a significant risk factor for kidney damage and increased glomerular permeability. Objectives Burden of hypertension and its impact on glomerular permeability were prospectively determined in randomly recruited primary school children. Patients and Methods Blood pressure (BP) measurement was performed by the auscultation method, and abnormal glomerular permeability was assessed by dipstick testing of urine for persistent proteinuria and/or hematuria for ≥ three months in hypertensive children. Results Of 1,335 pupils aged 10.0 ± 2.4 (6.0 - 14.0) years, 33 (2.5%) were hypertensive. Overall mean systolic/diastolic BP was 125.6 ± 6.5/81.7 ± 3.3 (range: 114.0 - 140.0/80.0 - 90.0) mmHg. Nine (27.3%) had combined systolic and diastolic hypertension, 126.7 ± 5.7/80.0 - 80.0 ± 0.0 (120.0 - 130.0/80.0 - 80.0) mmHg. Isolated systolic hypertension, 125.4 ± 6.7 (114.0 - 140.0) mmHg, was present in 14 (42.4%), whereas 10 (30.3%) had isolated diastolic hypertension, 82.0 ± 3.5 (80.0 - 90.0) mmHg. Mean systolic and diastolic BP were 131.0 ± 3.3 (130.0 - 140.0) mmHg and 86.5 ± 4.43 (80.0 - 90.0) mmHg, respectively. According to the dipstick test, none of the hypertensive pupils showed urinalysis evidence of proteinuria and/or hematuria after three months of testing. Conclusions Although the burden of hypertension was 2.5%, the dipstick method did not detect any hypertension-related abnormal glomerular permeability in the school children.
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Affiliation(s)
- Adebukola B Ajite
- Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Theophilus A Aladekomo
- Paediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Temilade Aderounmu
- Paediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Wasiu A Olowu
- Paediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- Corresponding author: Wasiu A Olowu, Paediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, State of Osun, Nigeria. Tel: +234-8037218742, Fax: +234-36230141, E-mail:
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Olowu WA, Niang A, Osafo C, Ashuntantang G, Arogundade FA, Porter J, Naicker S, Luyckx VA. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review. LANCET GLOBAL HEALTH 2016; 4:e242-50. [DOI: 10.1016/s2214-109x(15)00322-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 11/25/2022]
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Matata SN, Nkidiaka ED, Aloni MN. The prevalence of acute kidney injury in neonates with birth asphyxia is higher in the Democratic Republic of Congo than in Western countries. Acta Paediatr 2015; 104:1274-7. [PMID: 26014304 DOI: 10.1111/apa.13049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/09/2015] [Accepted: 05/19/2015] [Indexed: 11/30/2022]
Abstract
AIM There is very little data on acute kidney injury in neonates in Africa. The aim of this study was to describe the frequency of acute kidney injury and the outcome in neonates admitted to hospital for asphyxia in the Democratic Republic of Congo. METHODS A descriptive study was conducted in the country's capital Kinshasa. Acute kidney injury was diagnosed within three days of life when the creatinine clearance was ≤16 mL/min/1.73 m². RESULTS Acute kidney injury occurred in 54.3% of the 35 neonates with severe perinatal asphyxia and 31.4% of the 35 neonates with moderate perinatal asphyxia, and this rate was higher than the prevalence reported in Western countries. Prerenal acute kidney injury occurred in 12 (40%) of the 30 neonates with acute kidney injury. The frequency of oliguria was significantly higher in neonates with severe perinatal asphyxia than moderate perinatal asphyxia (73.7% vs. 45.5%), and mortality was also higher in neonates with severe rather than moderate perinatal asphyxia (57.9% vs. 36.4%). CONCLUSION The prevalence of acute kidney injury was higher in asphyxiated patients in the Democratic Republic of Congo than in Western countries. It was also higher in neonates with severe rather than moderate perinatal asphyxia.
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Affiliation(s)
- Sébastien Ngilima Matata
- Division of Hemato-oncology and Nephrology; Department of Pediatrics; University Hospital of Kinshasa; Kinshasa DRC
- Faculty of Medicine; University of Kinshasa; Kinshasa DRC
- Departement of Pediatrics; Goma Provincial Hospital; Goma DRC
| | - Emmanuel Dimbu Nkidiaka
- Faculty of Medicine; University of Kinshasa; Kinshasa DRC
- Division of Neonatology; Department of Pediatrics; University Hospital of Kinshasa; Kinshasa DRC
| | - Michel Ntetani Aloni
- Division of Hemato-oncology and Nephrology; Department of Pediatrics; University Hospital of Kinshasa; Kinshasa DRC
- Faculty of Medicine; University of Kinshasa; Kinshasa DRC
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Asinobi AO, Ademola AD, Alao MA. Haemodialysis for paediatric acute kidney injury in a low resource setting: experience from a tertiary hospital in South West Nigeria. Clin Kidney J 2015; 9:63-8. [PMID: 26798463 PMCID: PMC4720192 DOI: 10.1093/ckj/sfv112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/08/2015] [Indexed: 01/12/2023] Open
Abstract
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.
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Affiliation(s)
- Adanze O Asinobi
- Department of Paediatrics, College of Medicine, University of Ibadan, Oyo State, Nigeria; Department of Paediatrics, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Adebowale D Ademola
- Department of Paediatrics, College of Medicine, University of Ibadan, Oyo State, Nigeria; Department of Paediatrics, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Michael A Alao
- Department of Paediatrics , Bowen University Teaching Hospital , Ogbomoso, Oyo State , Nigeria
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Kayange NM, Smart LR, Tallman JE, Chu EY, Fitzgerald DW, Pain KJ, Peck RN. Kidney disease among children in sub-Saharan Africa: systematic review. Pediatr Res 2015; 77:272-281. [PMID: 25420180 PMCID: PMC4426498 DOI: 10.1038/pr.2014.189] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 08/26/2014] [Indexed: 11/09/2022]
Abstract
The global burden of kidney disease is increasing, and several etiologies first begin in childhood. Risk factors for pediatric kidney disease are common in Africa, but data regarding its prevalence are lacking. We completed a systematic review of community-based studies describing the prevalence of proteinuria, hematuria, abnormal imaging, or kidney dysfunction among children in sub-Saharan Africa (SSA). Medline and Embase were searched. Five hundred twenty-three references were reviewed. Thirty-two references from nine countries in SSA were included in the qualitative synthesis. The degree of kidney damage and abnormal imaging varied widely: proteinuria 32.5% (2.2-56.0%), hematuria 31.1% (0.6-67.0%), hydronephrosis 11.3% (0.0-38.0%), hydroureter 7.5% (0.0-26.4%), and major kidney abnormalities 0.1% (0.0-0.8%). Serum creatinine was reported in four studies with insufficient detail to identify the prevalence renal dysfunction. A majority of the studies were performed in Schistosoma haematobium endemic areas. A lower prevalence of kidney disease was observed in the few studies from nonendemic areas. Published data on pediatric kidney disease in SSA are highly variable and dependent on S. haematobium prevalence. More community-based studies are needed to describe the burden of pediatric kidney disease, particularly in regions where S. haematobium infection is nonendemic.
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Affiliation(s)
- Neema M. Kayange
- Department of Pediatrics, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Luke R. Smart
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | | | - Emily Y. Chu
- Cornell University, Ithaca, New York, United States of America
| | - Daniel W. Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Kevin J. Pain
- Samuel J. Wood Library/CV Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, United States of America
| | - Robert N. Peck
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
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Diarrassouba G, Adonis-Koffy L, Niamien E, Yaokreh JB, Coulibaly PA. Acute Peritoneal Dialysis in African Pediatric Area Experience of Pediatric Nephrology Unit of Yopougon University Hospital (Abidjan, Côte d'Ivoire). Blood Purif 2015; 39:141-4. [DOI: 10.1159/000368938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Acute kidney injury (AKI) is a diagnostic emergency threatening patients in a major way. Pediatric renal extra purification methods are limited in African countries due to the nonavailability of resources. Peritoneal dialysis (PD) seems to be the modality that is the most practiced for children with acute renal failure (ARF). Methodology: We conducted a retrospective study on 5 years of records of children from 1 month to 15 years who have suffered an ARF and benefited from PD while being treated at the pediatric nephrology unit of the Chu of Yopougon. ARF is defined as the condition that exists when the serum creatinine level is high or equal to 200 µmol/l outside any underlying uropathies. Results: Out of the hospitalized 88 children for AKI, 33 were on PD. Twenty-two children have been on dialysis while 9 children had to discontinue treatment due to financial problems. The sex ratio was 0.46 and the average age was 8.1. The etiologies of the AKI were predominantly glomerular diseases (45%), malaria (31.8%), and secondary interstitial nephritis of toxic origin. The indications of the PD are anuria (31%), hyperkalemia (18%), acute edema of lung (13%), and hyperuremia (13%). Eight children had automated peritoneal dialysis, 02 children underwent manual PD, and 9 children had both methods of treatment. We recorded 31 mechanical complications and 10 infections. While 8 children died, 10 recovered from AKI. Conclusion: Trained surgical medical personnel and favorable economic statuses of patients are the factors that will determine the success of PD in our country.
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Jenssen GR, Hovland E, Bangstad H, Nygård K, Vold L, Bjerre A. The incidence and aetiology of acute kidney injury in children in Norway between 1999 and 2008. Acta Paediatr 2014; 103:1192-7. [PMID: 25039408 PMCID: PMC4480659 DOI: 10.1111/apa.12742] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/18/2014] [Accepted: 07/08/2014] [Indexed: 11/26/2022]
Abstract
Aim Primary acute kidney injury (AKI) is a direct cause of hospitalisation in children, but can also result from other conditions. There is limited information on the epidemiology of this condition. Our aim was to describe the national incidence rate and aetiology of acute kidney injury in children under the age of 16 in Norway from 1999 to 2008. Methods We carried out a retrospective study of medical records provided by all 18 of the paediatric hospital departments that specialise in treating paediatric patients with AKI. Results We identified 315 cases of AKI (53% male), with an estimated average annual incidence rate of 3.3 cases per 100 000 children and a median annual occurrence of 33 cases. Most cases (43%) were in children under five. We identified 53 aetiologies and classified these into 30 aetiological groups: 24% of the cases were prerenal (n = 75), 74% were intrinsic/renal (n = 234) and 2% were postrenal (n = 5). Nephritic syndromes was the major cause (44%) of AKI, followed by haemolytic-uraemic syndrome (HUS) (15%). Conclusion Nephritic syndromes and HUS are the most common aetiologies of AKI in Norway. Although our results could indicate a low incidence of paediatric AKI in Norway, the lack of other national studies makes comparisons difficult.
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Affiliation(s)
- Gaute Reier Jenssen
- Department of Infectious Disease Epidemiology Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt) Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Eirik Hovland
- Department of Infectious Disease Epidemiology Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt) Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | | | - Karin Nygård
- Department of Infectious Disease Epidemiology Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt) Oslo Norway
| | - Line Vold
- Department of Infectious Disease Epidemiology Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt) Oslo Norway
| | - Anna Bjerre
- Department of Pediatrics Oslo University Hospital Oslo Norway
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Aloni MN, Ngiyulu RM, Gini-Ehungu JL, Nsibu CN, Ekila MB, Lepira FB, Nseka NM. Renal function in children suffering from sickle cell disease: challenge of early detection in highly resource-scarce settings. PLoS One 2014; 9:e96561. [PMID: 24810610 PMCID: PMC4014510 DOI: 10.1371/journal.pone.0096561] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/08/2014] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of Sickle cell disease is extremely high in Democratic Republic of Congo. Despite this high prevalence of the disease, data on renal abnormalities in children are rare. Method The study proposed to assess blood pressure, glomerular function, urea and uric acid levels in 65 steady state Congolese children with homozygous sickle cell disease and 67 normal controls. Results In Hb-SS group, blood pressure level tended to be lower than Hb-AA groups but there was no statistically significant difference (p>0.05) between the two groups. The absolute values for GFR corrected for BSA were significantly higher in Hb-SS group compared to Hb-AA group (130.5±34.1 ml/min/1.73 m2 vs 113.7±24.5 ml/min/1.73 m2; p = 0.004). Children with Hb-SS were more likely to hyperfiltrate (30.8% of subjects) than children with Hb-AA (6.1% of subjects). Proteinuria was found in 4 (6.2%) children with Hb-SS. Uric acid level was significantly increased in children with Hb-SS compared to corresponding values in control group (4.4±1.3 mg/dl vs 3.5±1.1 mg/dl; p<0.001). Urea level was significantly decreased compared to corresponding values in Hb-AA group (15.3±8.3 mg/dl vs 22.9±10.1 mg/dl; p<0.001). Conclusion Hyperfiltration, low creatinine, lower urea and high uric acid are more common in children with sickle cell disease than in normal controls.
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Affiliation(s)
- Michel Ntetani Aloni
- Division of Hemato-oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - René Makwala Ngiyulu
- Division of Hemato-oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Lambert Gini-Ehungu
- Division of Hemato-oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Célestin Ndosimao Nsibu
- Intensive Care Division, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Mathilde Bothale Ekila
- Department of Internal Medicine, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - François Bompeka Lepira
- Division of Nephrology and Dialysis, Department of Internal Medicine, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nazaire Mangani Nseka
- Division of Nephrology and Dialysis, Department of Internal Medicine, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Blackwater fever in Congolese children: a report of clinical, laboratory features and risk factors. Malar J 2013; 12:205. [PMID: 23767699 PMCID: PMC3691643 DOI: 10.1186/1475-2875-12-205] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 06/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background Blackwater fever (BWF) is one of the severe forms of malaria. This complication was first described among non-immune European expatriates in the malaria endemic areas. Recently, resurgence of this form of malaria has been reported among the indigenous populations. The objective of this study was to investigate the risk factors among BWF patients. Methods A case–control study was conducted between in four hospitals located in Kinshasa, Democratic Republic of Congo from January 2010 to December 2011. One hundred and twenty nine children were recruited with 43 (cases) and 86 (control). Results No significant difference in the gender and age distribution was observed between the case and control). The sex-ratio male to female in the case group and control group was respectively 1:1.0 and 1:1.1. The mean age was 8.62 years (SD = 3.84) in patients with haemoglobinuria and 8.55 years (SD = 3.77) in the control group. No difference in frequency of co-infection with Plasmodium falciparum and Plasmodium malariae was observed between the two groups. Significant differences in haemoglobin, haematocrit, creatinine, urea and platelets levels were observed between the two groups (p < 0.001), but not for blood group and lactate dehydrogenase (LDH) level. Majority of the BWF cases occurred during the rainy season (88.4%). Treatment with quinine (95.3%) was significantly associated with cases (p < 0.001). Seven (16.2%) of the haemoglobinuric children developed acute renal failure. Conclusion Rainy season, low parasitaemia and quinine ingestion were the major risk factors significantly associated with haemoglobinuria. Acute renal failure was observed as the major complication of BWF.
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Kunuanunua TS, Nsibu CN, Gini-Ehungu JL, Bodi JM, Ekulu PM, Situakibanza H, Nseka NM, Magoga K, Aloni MN. [Acute renal failure and severe malaria in Congolese children living in Kinshasa, Democratic Republic of Congo]. Nephrol Ther 2013; 9:160-5. [PMID: 23402997 DOI: 10.1016/j.nephro.2013.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 12/05/2012] [Accepted: 01/03/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Data on acute renal failure in complicated malaria in children in the Democratic Republic of Congo are sparse. The objective of this study was to document the profile of acute renal failure in severe malaria in admitted patients in pediatric hospitals from Kinshasa. METHODS A prospective cohort study was conducted from January 2008 to December 2008 in children admitted in emergency units of five hospitals in Kinshasa for severe malaria. RESULTS In our series, 378 children with severe malaria were included. There were 226 boys and 152 girls (sex ratio 1.49). One hundred and ninety four (194) of these patients were under 5 years old. Acute renal failure was observed in 89 children (23.6%) and 87 of them had blackwater fever (BWF). This form of severe malaria was predominant in children older than 5 years. Quinine was the commonest antimalarial drug involved in the genesis of BWF. Dialysis was indicated in 23 children (24.0%) and was effective (acute peritoneal dialysis) in 21 patients. The death rate in children with ARF was 12.6% (n=87). Recovery of renal function was obtained by conservative treatment in the remained group. CONCLUSION This study confirmed the emergence of BWF in seemed protected autochthon children older than 5 years. BWF remained the leading cause of acute renal failure in complicated malaria among Congolese children in Kinshasa.
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Affiliation(s)
- Thomas Sengua Kunuanunua
- Unité de Néphrologie Pédiatrique, Département de Pédiatrie, Cliniques Universitaires de Kinshasa, Faculté de Médecine, Université de Kinshasa, BP 123 Kinshasa XI, République démocratique du Congo
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