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Makanda-Charambira PD, Mujuru HA, Ticklay I, Muchemwa L. Burden of Paediatric Kidney Diseases in a Tertiary Care Hospital in Harare, Zimbabwe. Clin Med Insights Pediatr 2023; 17:11795565231188940. [PMID: 37545479 PMCID: PMC10403983 DOI: 10.1177/11795565231188940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background The pattern of paediatric kidney diseases across different regions is influenced by genetic, racial, and environmental differences. Objectives The aim of this study was to review the current spectrum and outcome of childhood kidney diseases at Parirenyatwa Group of Hospitals and highlight the challenges of care. Design Retrospective observational study. Methods Data on all children below 16 years of age hospitalised for any kidney disease over an 8-month period (1 January-31 August 2022) were retrieved and retrospectively analysed. Kidney diseases were categorised as per standard definitions. Results Kidney disease accounted for 2.2% (n = 50) of all 2264 admissions in the paediatric unit, with males constituting 60% (n = 30). Age ranged from 2 weeks to 13 years (mean 5.5 ± 3.5 years) with 58.0% being under 5 years. The commonest diagnoses in the unit were acute kidney injury (AKI) (n = 16, 32%) nephrotic syndrome (n = 16, 32%), hypertension (n = 12, 24%) and end stage kidney disease (ESKD) (n = 11, 22%) with some children presenting with more than 1 diagnosis. Only 3 out of 11 children with ESKD and 3 out of 8 children with AKI who required dialysis could be offered dialysis due to limited resources. Overall mortality rate was 32% (16/50): 5 children with AKI, 2 with nephrotic syndrome and normal kidney function, 8 with ESKD and 1 with Fanconi syndrome. Conclusion Childhood kidney disease contributes significantly to hospitalisations at our institution with highest mortality among children with ESKD. The study highlighted the need for provision of essential drugs and kidney replacement therapy for children with kidney disease at our institution.
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Affiliation(s)
- PD Makanda-Charambira
- PD Makanda-Charambira, Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe.
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Alharbi SA, Alshenqiti AM, Asiri AH, Alqarni MA, Alqahtani SA. The Role of Genetic Testing in Pediatric Renal Diseases: Diagnostic, Prognostic, and Social Implications. Cureus 2023; 15:e44490. [PMID: 37664254 PMCID: PMC10471834 DOI: 10.7759/cureus.44490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/05/2023] Open
Abstract
Pediatric renal diseases vary widely and are linked to high morbidity and mortality; hence, early diagnosis is vital. Presently, genetic testing is being incorporated into the standard of care for children and their families with kidney disease, primarily as a diagnostic tool. In the present review, we aim to collect all potential evidence from relevant studies that reported the role of genetic testing in pediatric renal disease diagnostic, prognostic, and social implications. We have conducted both electronic and manual searches within PubMed, the Cochrane Library, Web of Science, and Scopus to find relevant studies. Studies from the years 2013-2023 were included. Case reports with limited sample sizes and no descriptive statistics, along with review papers and meta-analyses, were excluded from this review. Quality assessment for all included studies was performed. The pooled diagnostic yields were calculated using the common effect and random effect models utilizing the R program (R Foundation for Statistical Computing, Vienna, Austria). The pooled result for the diagnostic yield as per the common effect model is a pooled proportion of 0.42 (42%) 95% confidence interval (CI): [0.39,0.44], while with the random effects model the pooled proportion is 0.43 (43%) 95% CI: [0.31,0.57]. The diagnostic yield for the included studies ranged from 78.10% to 16.8%. The spectrum of kidney diseases included nephrolithiasis/nephrocalcinosis, glomerular diseases, cystic kidney disease, ciliopathies, tubulopathies, chronic kidney disease, and congenital anomalies of the kidneys and urinary tracts (CAKUT), while hematuria and proteinuria were reported by two studies and autosomal recessive and autosomal dominant idiopathic kidney disease was reported by only one study. Genetic testing validates clinical diagnosis and aids in tailoring management strategies; hence, a more precise treatment plan is developed and unnecessary investigations are avoided, which is crucial in the case of children during routine nephrology clinic visits. Genetic counselling is of the utmost importance, so all ethical and social concerns related to genetic testing are addressed in addition to patient satisfaction.
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Affiliation(s)
- Sultan A Alharbi
- Department of Pediatrics, Prince Mohammed Bin Abdulaziz Hospital, Madinah, SAU
| | | | - Ali H Asiri
- Department of Pediatrics, Khamis Mushait Maternity and Children Hospital, Khamis Mushait, SAU
| | - Musaed A Alqarni
- Department of Pediatrics, Khamis Mushait Maternity and Children Hospital, Khamis Mushait, SAU
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Ulasi II, Awobusuyi O, Nayak S, Ramachandran R, Musso CG, Depine SA, Aroca-Martinez G, Solarin AU, Onuigbo M, Luyckx VA, Ijoma CK. Chronic Kidney Disease Burden in Low-Resource Settings: Regional Perspectives. Semin Nephrol 2023; 42:151336. [PMID: 37058859 DOI: 10.1016/j.semnephrol.2023.151336] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The burden of chronic kidney disease (CKD) has increased exponentially worldwide but more so in low- and middle-income countries. Specific risk factors in these regions expose their populations to an increased risk of CKD, such as genetic risk with APOL1 among populations of West African heritage or farmers with CKD of unknown etiology that spans various countries across several continents to immigrant/indigenous populations in both low- and high-income countries. Low- and middle-income economies also have the double burden of communicable and noncommunicable diseases, both contributing to the high prevalence of CKD. The economies are characterized by low health expenditure, sparse or nonexistent health insurance and welfare programs, and predominant out-of-pocket spending for medical care. This review highlights the challenges in populations with CKD from low-resource settings globally and explores how health systems can help ameliorate the CKD burden.
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Affiliation(s)
- Ifeoma I Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; Renal Unit, Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Olugbenga Awobusuyi
- Department of Medicine, Faculty of Clinical Sciences, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Saurabh Nayak
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), Bhatinda, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Carlos G Musso
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia
| | - Santos A Depine
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Confederation of Dialysis Associations of the Argentine Republic (CADRA), Buenos Aires, Argentina
| | - Gustavo Aroca-Martinez
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia; Facultad de Ciencias de la Salud, Universidad del Norte, Barranquilla, Colombia
| | - Adaobi Uzoamaka Solarin
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Macaulay Onuigbo
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA; College of Business, University of Wisconsin MBA Consortium, Eau Claire, Wisconsin, USA; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Valerie A Luyckx
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Chinwuba K Ijoma
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Louzada CF, Ferreira AR. Evaluation of the prevalence and factors associated with acute kidney injury in a pediatric intensive care unit. J Pediatr (Rio J) 2021; 97:426-432. [PMID: 32919936 PMCID: PMC9432181 DOI: 10.1016/j.jped.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the prevalence of acute kidney injury in pediatric intensive care unit according to diagnostic criteria - pediatric risk, injury, failure, loss, end-stage renal disease, Acute Kidney Injury Network and Acute Kidney Injury Work Group, or Kidney Disease: Improving Global Outcomes -, and determining factors associated with acute kidney injury as well as its outcome. METHODOLOGY This was a cross-sectional monocentric observational study, including patients aged between 29 days and 17 years who were admitted to the pediatric intensive care unit between January 1, 2012 and December 31, 2016. To evaluate the association between the study variables and acute kidney injury, the log-binomial generalized univariate and multivariate linear models were adjusted. RESULTS The study included 1131 patients, with prevalence of acute kidney injury according to the Acute Kidney Injury Network and Kidney Disease: Improving Global Outcomes criteria of 12.6% and of 12.9% according to the pediatric risk, injury, failure, loss, end-stage renal disease. In the multivariate analysis of older children (PR 1.007, 95% CI: 1.005-1.009), sepsis (PR 1.641, 95% CI: 1.128-2.387), demand for ventilatory support (PR 1.547, 95% CI: 1.095-2.186), and use of vasoactive amines (PR 2.298, 95% CI: 1.681-3.142) constituted factors associated with statistical significance to the development of acute kidney injury. The mortality rate among those with acute kidney injury was 28.7%. CONCLUSION Older children, diagnosis of sepsis, demand for ventilatory support, and use of vasoactive amines were correlated with a higher risk of developing acute kidney injury. The mortality associated with acute kidney injury was elevated; it is crucial that all measures that ensure adequate renal perfusion are taken for patients with risk factors, to avoid the installation of the disease.
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Affiliation(s)
- Cibelle Ferreira Louzada
- Universidade Federal de Ouro Preto, Escola de Medicina, Departamento de Clínicas Pediátrica e do Adulto, Ouro Preto, MG, Brazil.
| | - Alexandre Rodrigues Ferreira
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
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Plumb L, Boother EJ, Caskey FJ, Sinha MD, Ben-Shlomo Y. The incidence of and risk factors for late presentation of childhood chronic kidney disease: A systematic review and meta-analysis. PLoS One 2020; 15:e0244709. [PMID: 33382793 PMCID: PMC7774987 DOI: 10.1371/journal.pone.0244709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND When detected early, inexpensive measures can slow chronic kidney disease progression to kidney failure which, for children, confers significant morbidity and impacts growth and development. Our objective was to determine the incidence of late presentation of childhood chronic kidney disease and its associated risk factors. METHODS We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library and CINAHL, grey literature and registry websites for observational data describing children <21 years presenting to nephrology services, with reference to late presentation (or synonyms thereof). Independent second review of eligibility, data extraction, and risk of bias was undertaken. Meta-analysis was used to generate pooled proportions for late presentation by definition and investigate risk factors. Meta-regression was undertaken to explore heterogeneity. RESULTS Forty-five sources containing data from 30 countries were included, comprising 19,339 children. Most studies (37, n = 15,772) described children first presenting in kidney failure as a proportion of the chronic kidney disease population (mean proportion 0.43, 95% CI 0.34-0.54). Using this definition, the median incidence was 2.1 (IQR 0.9-3.9) per million age-related population. Risk associations included non-congenital disease and older age. Studies of hospitalised patients, or from low- or middle-income countries, that had older study populations than high-income countries, had higher proportions of late presentation. CONCLUSIONS Late presentation is a global problem among children with chronic kidney disease, with higher proportions seen in studies of hospitalised children or from low/middle-income countries. Children presenting late are older and more likely to have non-congenital kidney disease than timely presenting children. A consensus definition is important to further our understanding and local populations should identify modifiable barriers beyond age and disease to improve access to care.
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Affiliation(s)
- Lucy Plumb
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- UK Renal Registry, The Renal Association, Bristol, United Kingdom
| | - Emily J. Boother
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Fergus J. Caskey
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- Department of Renal Medicine, North Bristol NHS Trust, Bristol, United Kingdom
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s British Heart Foundation Centre, King’s College London, London, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Abstract
Because of the lack of early recognition and referral, the incidence of pediatric acute kidney injury (AKI) in Asia still is underestimated. Although each diagnostic criteria has its own merits, the Kidney Disease Improving Global Outcomes classification now is widely accepted. In Asia, the spectrum of pediatric AKI is wide-ranging, from pediatric AKI in highly sophisticated tertiary-care pediatric intensive care units in resource-rich regions due to advanced procedures such as transplantation, cardiac surgery, and other hospital-acquired causes, to primary care preventable causes, such as infectious diseases, snakebite, and so forth in rural parts of the developing world. The development and application of novel biomarkers, concepts such as the Renal Angina Index and advanced renal replacement therapy have revolutionized the era of treating AKI, but the cost and feasibility are the key determinants, especially in rural areas. In view of availability and expenses, peritoneal dialysis should be the first choice in less-developed areas, however, because of various barriers, it still needs more effort. Effective educational steps to both medical carers and families are needed urgently.
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Affiliation(s)
- Ruochen Che
- Department of Nephrology, State Key Laboratory of Reproductive Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Mohammed Mazheruddin Quadri
- Department of Nephrology, State Key Laboratory of Reproductive Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Aihua Zhang
- Department of Nephrology, State Key Laboratory of Reproductive Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China.
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Ge H, Wang X, Deng T, Deng X, Mao H, Yuan Q, Xiao X. Clinical characteristics of acute glomerulonephritis with presentation of nephrotic syndrome at onset in children. Int Immunopharmacol 2020; 86:106724. [PMID: 32593976 DOI: 10.1016/j.intimp.2020.106724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Acute glomerulonephritis (AGN) is a common disease in children, which places a huge burden on developing countries. The prognosis of it may not always be good. However, the clinical characteristics of AGN with nephrotic syndrome (NS) at onset have not been fully clarified. METHODS One hundred and thirteen cases were analyzed retrospectively. Clinical data, pathological results and prognosis between AGN with NS (AGN-NS) and AGN without NS (AGN-no-NS) were compared. RESULTS Twenty (17.7%) of 113 patients were AGN-NS. The patients with AGN-NS were more likely to have hypertension (55.0% vs. 25.8%) and acute kidney injury (AKI) (50.0% vs. 17.2%). AKI was significantly related to the manifestation of AGN-NS in children (OR = 3.812, P = 0.040). Compared with the AGN-no-NS, the immunosuppressive treatments were more common in AGN-NS. A more severe pathological grade was significantly related to lower C3 fraction, estimated glomerular filtration rate (eGFR), and AKI, but not to the performance of AGN-NS. There was no difference in prognosis between the two groups. CONCLUSIONS AKI was significantly associated with AGN-NS. The prognosis of AGN-NS and AGN-no-NS in our study was almost good. Given the fact that AGN-NS patients are more likely to use immunosuppressive therapy, the long-term outcome of AGN-NS warrants further research.
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Affiliation(s)
- Huipeng Ge
- Department of Nephrology, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China
| | - Xiufen Wang
- Department of Nephrology, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China
| | - Tianci Deng
- Department of Nephrology, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China
| | - Xiaolu Deng
- Department of Pediatrics, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China
| | - Huaxiong Mao
- Department of Pediatrics, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China
| | - Qiongjing Yuan
- Department of Nephrology, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China.
| | - Xiangcheng Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, No. 87 of Xiangya Road, Changsha, Hunan 410008, China.
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Alhasan K, Aloudah NM, Bakhit AA, Alhamad YM, Chihabeddine KM, Alfaadhel TA, Aljohani TE, Alhozali HM, Alsuwaida AO. Renal histopathology spectrum in children with kidney diseases in Saudi Arabia, 1998-2017. Saudi Med J 2020; 41:369-375. [PMID: 32291423 PMCID: PMC7841618 DOI: 10.15537/smj.2020.4.24999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/09/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify the trends in the diagnostic frequency of glomerular disease subtypes by renal biopsy in children in Saudi Arabia over the last 20 years. METHODS In this retrospective observational study, we identified all patients aged less than 18 years for whom native kidney biopsy was performed between 1998 and 2017. The period during which biopsy was performed (1998-2004, 2005-2011, and 2012-2017) and the demographic information and their association with the prevalence of various glomerular disease subtypes were our primary outcomes. Results: A total of 326 cases with renal biopsy were analyzed; the mean age of participants being 11 years and 45.4% of them were girls. Unexpectedly, secondary glomerulonephritis accounted for 42.3% of the cases, and lupus nephritis was the most common cause noted in 20.7% of the cases. The minimal change and focal segmental glomerulosclerosis were the most common glomerulonephritis in 59% of the cases. The frequency of membranoproliferative glomerulonephritis and mesangioproliferative glomerulonephritis significantly decreased from 15% and 17% in the period prior to 2004 to 3.3% (p=0.003) and 1.7% in 2012-2017 (p less than 0.001). CONCLUSIONS We found a considerable shift in the frequency of many glomerular disease subtypes in 1998-2017, which make clinical predication of the underlying etiology challenging for clinician. Renal biopsy still remains a critical diagnostic procedure for managing a considerable proportion of renal diseases.
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Affiliation(s)
- Khalid Alhasan
- Department of Pediatric, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Akolly DAE, Tsevi YM, Djadou EK, Guedenon KM, Amekoudi EYM, Tsolenyanu E, Agbeko F, Takassi EO, Gbadoe AD, Atakouma Y. Profil étiologique et évolutif de l’insuffisance rénale de l’enfant en milieu hospitalier au Togo. Nephrol Ther 2019; 15:448-451. [DOI: 10.1016/j.nephro.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 10/26/2022]
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Proteinuric kidney disease in children at Queen Elizabeth Central Hospital, Malawi. BMC Nephrol 2018; 19:21. [PMID: 29385997 PMCID: PMC5793387 DOI: 10.1186/s12882-018-0832-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a paucity of data on paediatric kidney disease in developing countries such as Malawi. Descriptive research on kidney disease is essential to improving patient outcomes. METHODS We conducted a cross-sectional study at a tertiary hospital in Malawi from 2012 to 2013. Children under 14 years with proteinuric kidney disease were enrolled from paediatric wards and outpatient clinics at Queen Elizabeth Central Hospital (QECH). Demographic, clinical and laboratory data were collected from patients at enrolment and at 3 months review at which point clinical status and disease outcome were ascertained. RESULTS Thirty-four (22 male) patients were studied, mean age 8.54 (SD = 3.62 years). Glomerular disease (n = 25, 68%) was the most common presumed renal lesion at presentation. Nephritic syndrome (10) was characterised by a lower baseline complement C3 than nephrotic syndrome (p = 0.0027). Seven (47%) cases of nephrotic syndrome achieved complete remission. Eight (80%) cases of nephritic syndrome improved with supportive therapy. Nineteen (56%) patients presented with clinically significant renal damage with eGFR< 60 ml/min/1.73m2. Six patients presented in chronic kidney disease (CKD) stage 5 of unclear aetiology, five (83%) died. Three (9%) patients had impaired kidney function and obstructive uropathy demonstrated on ultrasound, two recovered after surgery and one died. Eight (24%) patients had acute kidney injury (AKI) due to primary kidney disease, three of these patients progressed to CKD stage G3a. Seven (21%) patients were lost to follow up. CONCLUSION Kidney disease is a significant cause of mortality and morbidity in children at QECH. Less than half of Nephrotic syndrome cases achieved complete remission. Mortality is highest in children with CKD of unclear cause. Some patients with AKI secondary to primary renal disease progressed to CKD. Understanding the aetiology of paediatric kidney disease and improving patient outcomes by developing enhanced diagnostic and clinical services are priorities at QECH and within Malawi.
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