A 46-year-old woman intentionally ingested ethylene glycol and overdosed on paracetamol. She had clinical and laboratory features suggestive of ethylene glycol poisoning, and examination of the urine revealed calcium oxalate monohydrate, or ‘picket fence’, crystals. She responded well to therapy that included haemodialysis. Clinicians should be aware that these crystals appear late during the evolution of ethylene glycol poisoning and, along with other clinical and laboratory findings, should prompt the initiation of haemodialysis.
{"title":"Urine ‘picket fence’ crystals in ethylene glycol poisoning","authors":"M. Chothia, Nabeel A Bapoo","doi":"10.21804/24-1-4638","DOIUrl":"https://doi.org/10.21804/24-1-4638","url":null,"abstract":"A 46-year-old woman intentionally ingested ethylene glycol and overdosed on paracetamol. She had clinical and laboratory features suggestive of ethylene glycol poisoning, and examination of the urine revealed calcium oxalate monohydrate, or ‘picket fence’, crystals. She responded well to therapy that included haemodialysis. Clinicians should be aware that these crystals appear late during the evolution of ethylene glycol poisoning and, along with other clinical and laboratory findings, should prompt the initiation of haemodialysis.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44879364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Faye, B. Ba, N. Keita, S. Ba, C. Coulibaly, I. Thioune, M. Faye, A. Lemrabott, A. Niang, Elhadji Fary Ka
Introduction: The aims of this study were to assess the impact of isonatraemic haemodialysis on reduction of interdialytic weight gain (IDWG) and blood pressure (BP) as well as its tolerability in our study population. Methods: This crossover trial, at the Aristide Le Dantec University Hospital in Senegal, was conducted on 32 patients with kidney failure who were stable on treatment with chronic haemodialysis. In the initial “control phase”, patients had nine haemodialysis sessions with a dialysate sodium (Na+) concentration (Na+ dialysate) of 138 mmol/L. The serum Na+ set point (SP) for each patient was calculated from three predialytic mid-week values. In the second phase, the “individualized phase”, patients had nine haemodialysis sessions with Na+ dialysate equal to their SP. Results: The mean age of the patients was 55.5 ± 12.1 years, with a male/female ratio of 1.3 and the most common cause of kidney disease was hypertension (47%). Mean predialytic serum Na+ concentration was 135.8 ± 1.9 mmol/L, with a mean intra-individual coefficient of variation of 2%. Mean interdialytic weight gain (IDWG) was 1.9 kg and 1.8 kg in the control and individualized phases, respectively (P = 0.75). A reduction in postdialytic systolic blood pressure (BP) was observed during the individualized phase (P = 0.04). A similar trend was noted in pre- and intradialytic BP but this was not statistically significant. Apart from headaches, which were more common in the individualized phase (P = 0.04), isonatraemic haemodialysis was well tolerated. Conclusions: IDWG as well as pre- and intradialytic BP were unaffected by isonatraemic haemodialysis. Postdialytic BP was significantly reduced. Introduction: Les objectifs de cette étude étaient d’évaluer l’impact de l’hémodialyse isonatrémique sur la réduction de la prise de poids inter-dialytique (PPID) et de la pression artérielle (PA) ainsi que sa tolérance dans notre population d’étude. Méthodes: Cet essai croisé a été mené au centre hospitalier universitaire Aristide Le Dantec de Dakar (Sénégal) chez des patients hémodialysés chroniques. Durant la première phase dite « phase contrôle », les patients ont eu neuf séances d’hémodialyse avec une concentration de sodium dans le dialysat (Na+ dialysat) de 138 mmol/L. Le set-point (SP) de la natrémie a été calculé pour chaque patient et correspondait à la moyenne de 3 natrémies pré-dialytiques en milieu de semaine. Durant la deuxième phase dite « phase individualisée », les patients ont eu neuf séances d’hémodialyse avec du Na+ dialysat égal à leur SP. Résultats: Trente-deux patients ont été inclus. L’âge moyen était de 55,5 ± 12,1 ans avec un ratio homme/femme de 1,3 et la néphropathie initiale la plus fréquente était l’hypertensive (47%). La natrémie pré-dialytique moyenne était de 135,8 ± 1,9 mmol/L, avec un coefficient de variation intra-individuel moyen de 2 %. La PPID moyenne était de 1,9 kg et 1,8 kg dans les phases de contrôle et individualisé, respectivement (P = 0,75
导言：本研究的目的是评估异域性血液透析对降低分析间体重增加（IDWG）和血压（BP）的影响，以及其在我们研究人群中的耐受性。方法：在塞内加尔Aristide Le Dantec大学医院对32名慢性血液透析治疗稳定的肾衰竭患者进行了交叉试验。在初始“对照阶段”，患者进行了九次血液透析，透析钠（Na+）浓度为138 mmol/l。根据三个周中透析前值计算每个患者的血清Na+设定点（SP）。在第二阶段，即“个体化阶段”，患者接受了九次Na+透析的血液透析，与他们的SP相同。结果：患者的平均年龄为55.5±12.1岁，男女比例为1.3，肾脏疾病的最常见原因是高血压（47%）。平均透析前血清Na+浓度为135.8±1.9 mmol/L，平均个体内变异系数为2%。在对照期和个体化期，平均分析间体重增加（IDWG）分别为1.9 kg和1.8 kg（p=0.75）。在个体化阶段观察到透析后收缩压（BP）降低（p=1.04）。在透析前和透析内BP中观察到类似趋势，但无统计学意义。除头痛（在个体化阶段更为常见）（p=0.04）外，异域性血液透析耐受性良好。结论：IDWG以及透析前和透析内BP均未受到异域血液透析的影响。透析后BP显著降低。导言：本研究的目的是评估异域血液透析对降低透析间体重增加（PPID）和血压（BP）的影响，以及我们研究人群的耐受性。方法：该交叉试验在达喀尔（塞内加尔）Aristide Le Dantec大学医院对慢性血液透析患者进行。在称为“对照期”的第一阶段，患者进行了九次血液透析，透析液（Na+透析液）中的钠浓度为138mmol/l。计算每个患者的钠血症设定点（SP），对应于周中3次透析前钠血症的平均值。在称为“个体化阶段”的第二阶段，患者接受了9次血液透析，Na+透析液等于其MS。结果：包括32名患者。平均年龄为55.5±12.1岁，男女比例为1.3，最常见的初始肾病为高血压（47%）。平均透析前钠浓度为135.8±1.9 mmol/L，平均个体内变异系数为2%。对照和个体化阶段的平均PPID分别为1.9 kg和1.8 kg（p=0.75）。在个体化阶段观察到透析后收缩压降低（p=0.04）。在透析前和透析内AP中观察到类似的无统计学意义的趋势。除个体化阶段更常见的头痛（p=0.04）外，异位血症血液透析耐受性良好。结论：异域血症血液透析不影响PPID、透析前和透析内PA。透析后AP显著降低。
{"title":"Isonatraemic haemodialysis in the management of salt and water overload: a crossover trial at an academic hospital in Dakar, Senegal","authors":"M. Faye, B. Ba, N. Keita, S. Ba, C. Coulibaly, I. Thioune, M. Faye, A. Lemrabott, A. Niang, Elhadji Fary Ka","doi":"10.21804/24-1-4484","DOIUrl":"https://doi.org/10.21804/24-1-4484","url":null,"abstract":"Introduction: The aims of this study were to assess the impact of isonatraemic haemodialysis on reduction of interdialytic weight gain (IDWG) and blood pressure (BP) as well as its tolerability in our study population. Methods: This crossover trial, at the Aristide Le Dantec University Hospital in Senegal, was conducted on 32 patients with kidney failure who were stable on treatment with chronic haemodialysis. In the initial “control phase”, patients had nine haemodialysis sessions with a dialysate sodium (Na+) concentration (Na+ dialysate) of 138 mmol/L. The serum Na+ set point (SP) for each patient was calculated from three predialytic mid-week values. In the second phase, the “individualized phase”, patients had nine haemodialysis sessions with Na+ dialysate equal to their SP. Results: The mean age of the patients was 55.5 ± 12.1 years, with a male/female ratio of 1.3 and the most common cause of kidney disease was hypertension (47%). Mean predialytic serum Na+ concentration was 135.8 ± 1.9 mmol/L, with a mean intra-individual coefficient of variation of 2%. Mean interdialytic weight gain (IDWG) was 1.9 kg and 1.8 kg in the control and individualized phases, respectively (P = 0.75). A reduction in postdialytic systolic blood pressure (BP) was observed during the individualized phase (P = 0.04). A similar trend was noted in pre- and intradialytic BP but this was not statistically significant. Apart from headaches, which were more common in the individualized phase (P = 0.04), isonatraemic haemodialysis was well tolerated. Conclusions: IDWG as well as pre- and intradialytic BP were unaffected by isonatraemic haemodialysis. Postdialytic BP was significantly reduced. Introduction: Les objectifs de cette étude étaient d’évaluer l’impact de l’hémodialyse isonatrémique sur la réduction de la prise de poids inter-dialytique (PPID) et de la pression artérielle (PA) ainsi que sa tolérance dans notre population d’étude. Méthodes: Cet essai croisé a été mené au centre hospitalier universitaire Aristide Le Dantec de Dakar (Sénégal) chez des patients hémodialysés chroniques. Durant la première phase dite « phase contrôle », les patients ont eu neuf séances d’hémodialyse avec une concentration de sodium dans le dialysat (Na+ dialysat) de 138 mmol/L. Le set-point (SP) de la natrémie a été calculé pour chaque patient et correspondait à la moyenne de 3 natrémies pré-dialytiques en milieu de semaine. Durant la deuxième phase dite « phase individualisée », les patients ont eu neuf séances d’hémodialyse avec du Na+ dialysat égal à leur SP. Résultats: Trente-deux patients ont été inclus. L’âge moyen était de 55,5 ± 12,1 ans avec un ratio homme/femme de 1,3 et la néphropathie initiale la plus fréquente était l’hypertensive (47%). La natrémie pré-dialytique moyenne était de 135,8 ± 1,9 mmol/L, avec un coefficient de variation intra-individuel moyen de 2 %. La PPID moyenne était de 1,9 kg et 1,8 kg dans les phases de contrôle et individualisé, respectivement (P = 0,75","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43945077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Boima, E. Tannor, C. Osafo, Y. Awuku, M. Mate-kole, M. R. Davids, D. Adu
There are few data on the treatment of kidney disease in sub-Saharan Africa and no formal reports of kidney replacement therapy (KRT) in Ghana. We report data from the newly established Ghana Renal Registry on the prevalence, causes, and modality of treatment of kidney disease in Ghana. Using the web-based data capture system of the African Renal Registry, data were obtained for patients who had KRT in Ghana between January and December 2017. A total of 201 patients started KRT, giving an incidence rate of 6.9 per million population (pmp). There were 687 patients on KRT, a prevalence rate of 23.6 pmp. The median age of prevalent patients was 45.5 years and 63.6% were male. Hypertensive kidney disease was the most common primary kidney disease, reported in 39.9%. The overwhelming majority of patients (96.2%) were treated with haemodialysis, 3.5% had a kidney transplant, and only two were on continuous ambulatory peritoneal dialysis. The incidence and prevalence of KRTtreated kidney failure in Ghana is low, and the patients are younger than those on KRT in high- and upper-middle income countries. The major cause of kidney failure is hypertensive kidney disease and the vast majority of the patients are treated with haemodialysis.
{"title":"The Ghana Renal Registry – a first annual report","authors":"V. Boima, E. Tannor, C. Osafo, Y. Awuku, M. Mate-kole, M. R. Davids, D. Adu","doi":"10.21804/24-1-4545","DOIUrl":"https://doi.org/10.21804/24-1-4545","url":null,"abstract":"There are few data on the treatment of kidney disease in sub-Saharan Africa and no formal reports of kidney replacement therapy (KRT) in Ghana. We report data from the newly established Ghana Renal Registry on the prevalence, causes, and modality of treatment of kidney disease in Ghana. Using the web-based data capture system of the African Renal Registry, data were obtained for patients who had KRT in Ghana between January and December 2017. A total of 201 patients started KRT, giving an incidence rate of 6.9 per million population (pmp). There were 687 patients on KRT, a prevalence rate of 23.6 pmp. The median age of prevalent patients was 45.5 years and 63.6% were male. Hypertensive kidney disease was the most common primary kidney disease, reported in 39.9%. The overwhelming majority of patients (96.2%) were treated with haemodialysis, 3.5% had a kidney transplant, and only two were on continuous ambulatory peritoneal dialysis. The incidence and prevalence of KRTtreated kidney failure in Ghana is low, and the patients are younger than those on KRT in high- and upper-middle income countries. The major cause of kidney failure is hypertensive kidney disease and the vast majority of the patients are treated with haemodialysis.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49185486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Limited data are available regarding the management of chronic kidney disease (CKD) outside the specialized nephrology services in Sudan. Methods: A retrospective cohort study was conducted at Dr Salma Centre for Kidney Diseases (DSCKD) in Khartoum, Sudan. We aimed to determine the timing and reasons for referral of patients to specialized nephrology services and to evaluate the management of CKD at primary care level. Newly referred adult patients with CKD were recruited between July and September 2018. Information was extracted from the referral notes, from follow-up records at DSCKD and via direct interview of patients. Data analysis was performed using SPSS. Results: A total of 244 patients were studied. Their mean age was 55 ± 13 years and 210 (86%) were on regular follow-up at primary care level. Hypertensive kidney disease and diabetic nephropathy were the leading causes of CKD. Most patients (78%) were timeously referred with CKD stage 3 or 4. Referrals were mostly due to elevated creatinine levels (35%), non-resolving nephrotic syndrome (27%) and upon patients’ request (28%). Most patients (60%) did not require significant m odifications to their ma nagement; 25 pa tients (1 1%) were late referrals and scheduled for urgent dialysis. Conclusions: The current study reflects a good level of awareness regarding the management of CKD at primary care level and appropriate timing of referrals in most cases.
{"title":"An analysis of patients with chronic kidney disease newly referred to a specialized renal service in Sudan","authors":"M. Shigidi, S. Ebrahim, Wieam Karrar","doi":"10.21804/24-1-4467","DOIUrl":"https://doi.org/10.21804/24-1-4467","url":null,"abstract":"Background: Limited data are available regarding the management of chronic kidney disease (CKD) outside the specialized nephrology services in Sudan. Methods: A retrospective cohort study was conducted at Dr Salma Centre for Kidney Diseases (DSCKD) in Khartoum, Sudan. We aimed to determine the timing and reasons for referral of patients to specialized nephrology services and to evaluate the management of CKD at primary care level. Newly referred adult patients with CKD were recruited between July and September 2018. Information was extracted from the referral notes, from follow-up records at DSCKD and via direct interview of patients. Data analysis was performed using SPSS. Results: A total of 244 patients were studied. Their mean age was 55 ± 13 years and 210 (86%) were on regular follow-up at primary care level. Hypertensive kidney disease and diabetic nephropathy were the leading causes of CKD. Most patients (78%) were timeously referred with CKD stage 3 or 4. Referrals were mostly due to elevated creatinine levels (35%), non-resolving nephrotic syndrome (27%) and upon patients’ request (28%). Most patients (60%) did not require significant m odifications to their ma nagement; 25 pa tients (1 1%) were late referrals and scheduled for urgent dialysis. Conclusions: The current study reflects a good level of awareness regarding the management of CKD at primary care level and appropriate timing of referrals in most cases.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48365478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute kidney injury is rarely the presenting feature of sarcoidosis. We report the case of a patient whose diagnosis was brought to light by the investigation of impaired kidney function. Concurrent hypercalcaemia was noted and prompted further investigation, which led to the diagnosis of sarcoidosis. This is a rare phenomenon and is an important consideration in the patient with acute kidney injury and hypercalcaemia, without an apparent explanation. Rapid improvement in both kidney function and hypercalcaemia occurred in response to treatment.
{"title":"Acute kidney injury as the presenting feature of sarcoidosis","authors":"S. Mehta, Akashdeep Singh, V. Makkar","doi":"10.21804/24-1-4459","DOIUrl":"https://doi.org/10.21804/24-1-4459","url":null,"abstract":"Acute kidney injury is rarely the presenting feature of sarcoidosis. We report the case of a patient whose diagnosis was brought to light by the investigation of impaired kidney function. Concurrent hypercalcaemia was noted and prompted further investigation, which led to the diagnosis of sarcoidosis. This is a rare phenomenon and is an important consideration in the patient with acute kidney injury and hypercalcaemia, without an apparent explanation. Rapid improvement in both kidney function and hypercalcaemia occurred in response to treatment.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48590753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Razafindrazoto, R. Rakotozafindrabe, T. Rabenjanahary
Background: Hepatorenal syndrome (HRS) is a frequent and serious complication in decompensated cirrhosis. The objective of this study was to describe the epidemiology, clinical profiles and outcomes of hepatorenal syndrome (HRS). Methods: This was a retrospective and descriptive study over a period of 75 months, from January 2011 to March 2017, carried out at the Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar. Results: The hospital prevalence of decompensated cirrhosis with HRS was 7.9% (41/519). The mean age of the patients was 49.8 ± 11.33 years (range 25–70 years). Male gender predominated at 83% (n = 34). History of alcohol (46.3%) and viral hepatitis B (34.1%) were the main aetiologies of cirrhotic disease. Most of our patients (88%) had a Child-Pugh C score. HRS occurred during the first decompensation (63.4%) and the first years of cirrhosis (81%). Spontaneous bacterial peritonitis (46%) and gastrointestinal bleeding (32%) were the main risk factors. HRS type-1 predominated at 66% (n = 27). The prognosis was poor with a mortality rate of 81% (100% in HRS type 1 and 42.9% in type 2). Most patients (n = 22; 67%) died within 14 days. Conclusion: The prevalence of HRS was 7.9%. It affects young people with advanced cirrhosis. The prognosis is grim with a mortality rate of 81%. Keywords: Acute kidney injury, liver cirrhosis, hepatorenal syndrome, Madagascar
{"title":"Hepatorenal syndrome in cirrhotic patients in Madagascar: epidemiology, clinical profile and in-hospital outcomes","authors":"C. Razafindrazoto, R. Rakotozafindrabe, T. Rabenjanahary","doi":"10.21804/24-1-4598","DOIUrl":"https://doi.org/10.21804/24-1-4598","url":null,"abstract":"Background: Hepatorenal syndrome (HRS) is a frequent and serious complication in decompensated cirrhosis. The objective of this study was to describe the epidemiology, clinical profiles and outcomes of hepatorenal syndrome (HRS). Methods: This was a retrospective and descriptive study over a period of 75 months, from January 2011 to March 2017, carried out at the Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar. Results: The hospital prevalence of decompensated cirrhosis with HRS was 7.9% (41/519). The mean age of the patients was 49.8 ± 11.33 years (range 25–70 years). Male gender predominated at 83% (n = 34). History of alcohol (46.3%) and viral hepatitis B (34.1%) were the main aetiologies of cirrhotic disease. Most of our patients (88%) had a Child-Pugh C score. HRS occurred during the first decompensation (63.4%) and the first years of cirrhosis (81%). Spontaneous bacterial peritonitis (46%) and gastrointestinal bleeding (32%) were the main risk factors. HRS type-1 predominated at 66% (n = 27). The prognosis was poor with a mortality rate of 81% (100% in HRS type 1 and 42.9% in type 2). Most patients (n = 22; 67%) died within 14 days. Conclusion: The prevalence of HRS was 7.9%. It affects young people with advanced cirrhosis. The prognosis is grim with a mortality rate of 81%. Keywords: Acute kidney injury, liver cirrhosis, hepatorenal syndrome, Madagascar","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"14 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanelisiwe Balfour, K. Petersen, Letlhogonolo Sepeng
Background: Acute kidney injury (AKI) is common in critically ill, hospitalised neonates. Epidemiological data on AKI in children are scarce in South Africa. This study aimed to determine the incidence and outcomes of AKI in critically ill neonates. Methods: This single-centre, prospective, observational study was conducted in the neonatal unit of the Chris Hani Baragwanath Academic Hospital, a tertiary-level hospital in Johannesburg, South Africa. Neonates with AKI, defined using the AKI Network criteria, were recruited over a three-month period in 2019. Risk factors and demographic data were collected for all study participants, who were followed up over the period to observe an outcome of either recovery or death. Results: Fifty-one cases of AKI were identified, representing 7.8% of all admissions (95% CI 5.9–10.2%). The overall mortality of enrolled patients was 29.4% (95% CI 26.3–56.1%). Mortality was significantly associated with extremely low birth weight (OR 11.4, p < 0.01), umbilical catheterisation (OR 6.3, p = 0.01), sepsis (OR 5.4, p = 0.01), phototherapy (OR 4.4, p = 0.03) and prematurity (p = 0.04). The most frequent risk factor associated with AKI was intravenous nephrotoxic medication. Conclusion: The incidence of AKI in our study was higher than expected. Further epidemiological and interventional studies are warranted to identify and improve the long-term outcome of AKI in the newborn in our setting.
背景:急性肾损伤(AKI)常见于危重住院新生儿。南非儿童AKI的流行病学数据很少。本研究旨在确定危重新生儿AKI的发生率和结局。方法:这项单中心、前瞻性、观察性研究在南非约翰内斯堡三级医院Chris Hani Baragwanath学术医院的新生儿病房进行。使用AKI网络标准定义的AKI新生儿在2019年的三个月内被招募。收集了所有研究参与者的风险因素和人口统计数据，并在此期间对他们进行了随访，以观察康复或死亡的结果。结果:51例AKI被确定，占所有入院患者的7.8% (95% CI 5.9-10.2%)。入组患者的总死亡率为29.4% (95% CI 26.3-56.1%)。死亡率与极低出生体重(OR 11.4, p < 0.01)、脐带插管(OR 6.3, p = 0.01)、败血症(OR 5.4, p = 0.01)、光疗(OR 4.4, p = 0.03)和早产(p = 0.04)显著相关。与AKI相关的最常见危险因素是静脉肾毒性药物。结论:本研究中AKI的发生率高于预期。需要进一步的流行病学和干预性研究来确定和改善本研究中新生儿AKI的长期预后。
{"title":"An observational study of acute kidney injury in critically ill neonates at Chris Hani Baragwanath Academic Hospital, South Africa","authors":"Sanelisiwe Balfour, K. Petersen, Letlhogonolo Sepeng","doi":"10.21804/24-1-4682","DOIUrl":"https://doi.org/10.21804/24-1-4682","url":null,"abstract":"Background: Acute kidney injury (AKI) is common in critically ill, hospitalised neonates. Epidemiological data on AKI in children are scarce in South Africa. This study aimed to determine the incidence and outcomes of AKI in critically ill neonates. Methods: This single-centre, prospective, observational study was conducted in the neonatal unit of the Chris Hani Baragwanath Academic Hospital, a tertiary-level hospital in Johannesburg, South Africa. Neonates with AKI, defined using the AKI Network criteria, were recruited over a three-month period in 2019. Risk factors and demographic data were collected for all study participants, who were followed up over the period to observe an outcome of either recovery or death. Results: Fifty-one cases of AKI were identified, representing 7.8% of all admissions (95% CI 5.9–10.2%). The overall mortality of enrolled patients was 29.4% (95% CI 26.3–56.1%). Mortality was significantly associated with extremely low birth weight (OR 11.4, p < 0.01), umbilical catheterisation (OR 6.3, p = 0.01), sepsis (OR 5.4, p = 0.01), phototherapy (OR 4.4, p = 0.03) and prematurity (p = 0.04). The most frequent risk factor associated with AKI was intravenous nephrotoxic medication. Conclusion: The incidence of AKI in our study was higher than expected. Further epidemiological and interventional studies are warranted to identify and improve the long-term outcome of AKI in the newborn in our setting.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Davies, Wesley van Hougenhouck-Tulleken, N. Diana, Yazied Chothia, J. Nel, N. Wearne, S. Wadee, S. Hariparshad
Safe and effective vaccination of patients living with chronic kidney disease requires an understanding of the unique immunological milieu of this population and of their potential for disease-specific side effects. This Position Statement, issued on behalf of the South African Nephrology Society, provides recommendations for local policy development and for individual practice administration and monitoring of SARS-CoV-2 vaccinations in patients living with chronic kidney disease.
{"title":"Vaccination of adult patients living with chronic kidney disease against SARS-CoV-2: a position statement by the South African Nephrology Society","authors":"M. Davies, Wesley van Hougenhouck-Tulleken, N. Diana, Yazied Chothia, J. Nel, N. Wearne, S. Wadee, S. Hariparshad","doi":"10.21804/24-1-4731","DOIUrl":"https://doi.org/10.21804/24-1-4731","url":null,"abstract":"Safe and effective vaccination of patients living with chronic kidney disease requires an understanding of the unique immunological milieu of this population and of their potential for disease-specific side effects. This Position Statement, issued on behalf of the South African Nephrology Society, provides recommendations for local policy development and for individual practice administration and monitoring of SARS-CoV-2 vaccinations in patients living with chronic kidney disease.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Mpekethu, Newnex Mongare, Victor Mutua, Marie-Claire Wangari, C. von Csefalvay, D. Ojuka
Background: Solid organ donation and transplantation remains grossly underdeveloped in most African countries. The knowledge and attitude of tomorrow’s professionals may be key to the improvement of these services. Methods: A sample of undergraduate medical students from all the medical schools in Kenya offering Bachelor of Medicine and Bachelor of Surgery degrees were surveyed using a self-administered, web-based questionnaire, between July and September 2018. Results: Of the 303 participants, 167 (55.1%) were female. Only 8.9% of the students had read the laws governing transplantation in Kenya. An even lower percentage (3.3%) felt that they had learned enough about solid organ donation and transplantation from their medical curriculum. More than half (53%) of the respondents would subscribe as solid organ donors, which reduced to 47% when it came to consenting to donating their relatives’ organs. Less than half of the students (40%) considered they would be comfortable introducing the topic or confident answering questions (23%) related to organ donation and transplantation. Only 9.9% of the sample had ever spoken to a patient about organ donation. There was no significant association between level of study (preclinical versus clinical) and comfort introducing the topic of organ donation (P = 0.206) or experience talking to a patient about the subject (P = 0.102). Conclusion: Undergraduate medical students have significant knowledge gaps regarding organ donation and transplantation and feel ill-prepared to approach a potential donor or transplant recipient.
{"title":"Knowledge and attitudes of undergraduate medical students in Kenya towards solid organ donation and transplantation: Are Africa’s future clinicians prepared?","authors":"N. Mpekethu, Newnex Mongare, Victor Mutua, Marie-Claire Wangari, C. von Csefalvay, D. Ojuka","doi":"10.21804/24-1-4843","DOIUrl":"https://doi.org/10.21804/24-1-4843","url":null,"abstract":"Background: Solid organ donation and transplantation remains grossly underdeveloped in most African countries. The knowledge and attitude of tomorrow’s professionals may be key to the improvement of these services. Methods: A sample of undergraduate medical students from all the medical schools in Kenya offering Bachelor of Medicine and Bachelor of Surgery degrees were surveyed using a self-administered, web-based questionnaire, between July and September 2018. Results: Of the 303 participants, 167 (55.1%) were female. Only 8.9% of the students had read the laws governing transplantation in Kenya. An even lower percentage (3.3%) felt that they had learned enough about solid organ donation and transplantation from their medical curriculum. More than half (53%) of the respondents would subscribe as solid organ donors, which reduced to 47% when it came to consenting to donating their relatives’ organs. Less than half of the students (40%) considered they would be comfortable introducing the topic or confident answering questions (23%) related to organ donation and transplantation. Only 9.9% of the sample had ever spoken to a patient about organ donation. There was no significant association between level of study (preclinical versus clinical) and comfort introducing the topic of organ donation (P = 0.206) or experience talking to a patient about the subject (P = 0.102). Conclusion: Undergraduate medical students have significant knowledge gaps regarding organ donation and transplantation and feel ill-prepared to approach a potential donor or transplant recipient.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: There is an epidemic of chronic kidney disease (CKD) in Africa and human immunodeficiency virus (HIV) infection is among the major drivers. However, the burden of CKD in HIV-infected patients in Africa varies widely by country and study, ranging from 0.5–59.3%. Published data on the prevalence of CKD in the Namibian HIV-infected population are scarce. In this study, we aimed to estimate the prevalence of CKD and associated factors in HIV-infected adults on antiretroviral therapy in northern Namibia. Methods: We conducted a cross-sectional study in the four regions of northern Namibia, using existing electronic records used in the management of HIV-infected patients. Variables captured included the two most recent serum creatinine measurements, date of birth, sex, date of initiating antiretroviral therapy, current antiretroviral treatment, and most recent HIV viral load results. We used standardised serum creatinine measurements to estimate the glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. CKD was defined as estimated GFR (eGFR) < 60 mL/min/1.73 m2 on two occasions at least three months apart. Factors associated with CKD were assessed using logistic regression. Results: We included 1 993 participants, of whom 1 362 (68%) were female and mean age was 44.5 ± 11.5 years.The proportion of participants who were virally suppressed was 97% (95% CI 96, 98%) and the median durationon antiretroviral therapy was 107 months (IQR 62–149). The prevalence of CKD was 1.4% (95% CI 1.0, 2.0%).CKD cases were 13 times more likely to be 45 years or older and 3.5 times more likely to be male than those without CKD. Conclusions: Our findings suggest a low prevalence of CKD among the HIV-infected population in northern Namibia. Patients older than 45 years may need additional monitoring for kidney function using eGFR.
{"title":"Prevalence of chronic kidney disease among HIV-infected adults on antiretroviral therapy in northern Namibia: a cross-sectional study","authors":"Michael Mboko","doi":"10.21804/24-1-4702","DOIUrl":"https://doi.org/10.21804/24-1-4702","url":null,"abstract":"Introduction: There is an epidemic of chronic kidney disease (CKD) in Africa and human immunodeficiency virus (HIV) infection is among the major drivers. However, the burden of CKD in HIV-infected patients in Africa varies widely by country and study, ranging from 0.5–59.3%. Published data on the prevalence of CKD in the Namibian HIV-infected population are scarce. In this study, we aimed to estimate the prevalence of CKD and associated factors in HIV-infected adults on antiretroviral therapy in northern Namibia. Methods: We conducted a cross-sectional study in the four regions of northern Namibia, using existing electronic records used in the management of HIV-infected patients. Variables captured included the two most recent serum creatinine measurements, date of birth, sex, date of initiating antiretroviral therapy, current antiretroviral treatment, and most recent HIV viral load results. We used standardised serum creatinine measurements to estimate the glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. CKD was defined as estimated GFR (eGFR) < 60 mL/min/1.73 m2 on two occasions at least three months apart. Factors associated with CKD were assessed using logistic regression. Results: We included 1 993 participants, of whom 1 362 (68%) were female and mean age was 44.5 ± 11.5 years.The proportion of participants who were virally suppressed was 97% (95% CI 96, 98%) and the median durationon antiretroviral therapy was 107 months (IQR 62–149). The prevalence of CKD was 1.4% (95% CI 1.0, 2.0%).CKD cases were 13 times more likely to be 45 years or older and 3.5 times more likely to be male than those without CKD. Conclusions: Our findings suggest a low prevalence of CKD among the HIV-infected population in northern Namibia. Patients older than 45 years may need additional monitoring for kidney function using eGFR.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68365020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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