Background: Acute kidney injury (AKI) in HIV-infected patients in sub-Saharan Africa is a common cause of hospitalisation and is associated with high morbidity and mortality. There is a paucity of comparative data regarding the outcomes of AKI in those patients with and without HIV infection from the African continent. Methods: This was a single-centre retrospective study of all consecutive adult patients with AKI referred to the renal unit at Tygerberg Hospital for the period January 2015 to December 2016. The diagnosis of AKI required evidence of the following: a recent normal serum creatinine and/or normal kidney sizes on ultrasound examination and/or granular casts on urine microscopy. Kaplan–Meier curves and logistic regression were used to assess survival and identify factors predicting mortality. Results: We identified a total of 291 patients with AKI of whom 116 (40%) were HIV positive. HIV-positive patients had a mortality rate of 34.5% vs. 29.1% in the HIV-negative patients (P = 0.34). At hospital admission, HIV-positive patients had a higher admission serum creatinine (551 μmol/L vs. 190 μmol/L, P < 0.01). Of those who died, the HIV-positive patients were younger (41 vs. 52 years, P < 0.01), predominantly Black (87.5% vs. 23.5%, P < 0.01) and were mostly admitted to medical wards (92.5% vs. 41.2%, P < 0.01). There was no difference in mortality related to the use of renal replacement therapy (P = 0.50). Logistic regression identified mixed ancestry (OR 2.47, P = 0.02), HIV infection (OR 2.69, P < 0.01) and surgical ward admission (OR 2.05, P = 0.03) as predictors of death. Conclusions: In-hospital mortality of AKI was high, and HIV infection was associated with a greater risk of death. This may be the result of late presentation of both the AKI as well as the HIV infection.
{"title":"In-hospital mortality of HIV-positive patients with acute kidney injury a decade after the roll-out of anti-retroviral therapy in Cape Town, South Africa","authors":"M. Chothia, Nikash Ramsunder","doi":"10.21804/22-1-3423","DOIUrl":"https://doi.org/10.21804/22-1-3423","url":null,"abstract":"Background: Acute kidney injury (AKI) in HIV-infected patients in sub-Saharan Africa is a common cause of hospitalisation and is associated with high morbidity and mortality. There is a paucity of comparative data regarding the outcomes of AKI in those patients with and without HIV infection from the African continent. Methods: This was a single-centre retrospective study of all consecutive adult patients with AKI referred to the renal unit at Tygerberg Hospital for the period January 2015 to December 2016. The diagnosis of AKI required evidence of the following: a recent normal serum creatinine and/or normal kidney sizes on ultrasound examination and/or granular casts on urine microscopy. Kaplan–Meier curves and logistic regression were used to assess survival and identify factors predicting mortality. Results: We identified a total of 291 patients with AKI of whom 116 (40%) were HIV positive. HIV-positive patients had a mortality rate of 34.5% vs. 29.1% in the HIV-negative patients (P = 0.34). At hospital admission, HIV-positive patients had a higher admission serum creatinine (551 μmol/L vs. 190 μmol/L, P < 0.01). Of those who died, the HIV-positive patients were younger (41 vs. 52 years, P < 0.01), predominantly Black (87.5% vs. 23.5%, P < 0.01) and were mostly admitted to medical wards (92.5% vs. 41.2%, P < 0.01). There was no difference in mortality related to the use of renal replacement therapy (P = 0.50). Logistic regression identified mixed ancestry (OR 2.47, P = 0.02), HIV infection (OR 2.69, P < 0.01) and surgical ward admission (OR 2.05, P = 0.03) as predictors of death. Conclusions: In-hospital mortality of AKI was high, and HIV infection was associated with a greater risk of death. This may be the result of late presentation of both the AKI as well as the HIV infection.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47419124","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: Hyponatraemia is the most common electrolyte abnormality in hospitalized patients and is associated with poor prognosis and high mortality. There is a paucity of data on hyponatraemia in Ghana. We set out to describe the prevalence of this condition, its associations and the outcomes in terms of in-hospital mortality and length of hospital stay. Methods: We conducted a retrospective study of all admissions from October 2017 to April 2018 on the medical ward at the Komfo Anokye Teaching Hospital (KATH). Demographic information, medical diagnoses as well as clinical and laboratory data were documented. Means (± standard deviation) were recorded for normally distributed data, whereas non-normally distributed data were recorded as medians [interquartile range (IQR)]. Chi-squared and Fisher’s exact tests were used to test categorical variables. ANOVA and Kruskal-Wallis tests were used for the analysis of hyponatraemia severity; a p value of < 0.05 was considered statistically significant. Results: Within the study period, 406 patients with hyponatraemia were identified in 1477 medical admissions, a prevalence of 27.6%. Their mean age was 51.5 ± 19.0 years. There were 217 males (53.5%). The mean serum sodium was 128.7 ± 6.5 mmol/L. Two hundred and forty (59%) had mild hyponatraemia, 106 (26%) had moderate hyponatraemia and 60 (15%) had severe hyponatraemia. The most common associated medical conditions were infections (26%), chronic liver disease (17%), hyperglycaemia (17%), chronic kidney disease (16%) and chronic heart failure (8%). In-hospital mortality was 31.8% and varied with the severity of the hyponatremia. The median length of hospital stay was 7 days (IQR 4–10 days) and did not vary with the severity of hyponatraemia. Mortality was associated with serum sodium concentration (p = 0.007) and lower levels of consciousness (Glasgow Coma Scale, GCS, ≤ 13) at presentation (p < 0.001). Conclusions: Hyponatraemia is common in medical admissions in Ghana, and is mostly associated with infections, and chronic liver, kidney and heart diseases. It is associated with high in-hospital mortality, especially when hyponatraemia is more severe or accompanied by relatively low GCS scores.
{"title":"Outcomes in medical admissions with hyponatraemia in Ghana – a single-centre study","authors":"E. Tannor, E. Akumiah, B. Norman","doi":"10.21804/22-1-3306","DOIUrl":"https://doi.org/10.21804/22-1-3306","url":null,"abstract":"Introduction: Hyponatraemia is the most common electrolyte abnormality in hospitalized patients and is associated with poor prognosis and high mortality. There is a paucity of data on hyponatraemia in Ghana. We set out to describe the prevalence of this condition, its associations and the outcomes in terms of in-hospital mortality and length of hospital stay. Methods: We conducted a retrospective study of all admissions from October 2017 to April 2018 on the medical ward at the Komfo Anokye Teaching Hospital (KATH). Demographic information, medical diagnoses as well as clinical and laboratory data were documented. Means (± standard deviation) were recorded for normally distributed data, whereas non-normally distributed data were recorded as medians [interquartile range (IQR)]. Chi-squared and Fisher’s exact tests were used to test categorical variables. ANOVA and Kruskal-Wallis tests were used for the analysis of hyponatraemia severity; a p value of < 0.05 was considered statistically significant. Results: Within the study period, 406 patients with hyponatraemia were identified in 1477 medical admissions, a prevalence of 27.6%. Their mean age was 51.5 ± 19.0 years. There were 217 males (53.5%). The mean serum sodium was 128.7 ± 6.5 mmol/L. Two hundred and forty (59%) had mild hyponatraemia, 106 (26%) had moderate hyponatraemia and 60 (15%) had severe hyponatraemia. The most common associated medical conditions were infections (26%), chronic liver disease (17%), hyperglycaemia (17%), chronic kidney disease (16%) and chronic heart failure (8%). In-hospital mortality was 31.8% and varied with the severity of the hyponatremia. The median length of hospital stay was 7 days (IQR 4–10 days) and did not vary with the severity of hyponatraemia. Mortality was associated with serum sodium concentration (p = 0.007) and lower levels of consciousness (Glasgow Coma Scale, GCS, ≤ 13) at presentation (p < 0.001). Conclusions: Hyponatraemia is common in medical admissions in Ghana, and is mostly associated with infections, and chronic liver, kidney and heart diseases. It is associated with high in-hospital mortality, especially when hyponatraemia is more severe or accompanied by relatively low GCS scores.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46175862","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}
Atypical haemolytic-uraemic syndrome (aHUS) is a rare cause of thrombotic microangiopathy (TMA). The typical form occurs most frequently in children following infection with Shiga-like toxin-producing bacteria, whereas in the atypical form genetic mutations affecting complement regulatory proteins involved in the alternative complement pathway may be identified. The clinical features of aHUS may mimic other causes of TMA such as thrombotic thrombocytopenic purpura and malignant hypertension. We present a case of a 67-year-old woman who presented with a TMA and discuss the diagnostic challenges that were confronted due to the many overlapping clinical and laboratory features of the different causes of this syndrome. Clinicians should be aware of the varied clinical manifestations of TMAs to ensure early diagnosis and initiation of appropriate treatment.
{"title":"The many faces of atypical haemolytic-uraemic syndrome: a diagnostic challenge","authors":"M. Chothia, L. Coetzee, M. Amirali","doi":"10.21804/22-1-3467","DOIUrl":"https://doi.org/10.21804/22-1-3467","url":null,"abstract":"Atypical haemolytic-uraemic syndrome (aHUS) is a rare cause of thrombotic microangiopathy (TMA). The typical form occurs most frequently in children following infection with Shiga-like toxin-producing bacteria, whereas in the atypical form genetic mutations affecting complement regulatory proteins involved in the alternative complement pathway may be identified. The clinical features of aHUS may mimic other causes of TMA such as thrombotic thrombocytopenic purpura and malignant hypertension. We present a case of a 67-year-old woman who presented with a TMA and discuss the diagnostic challenges that were confronted due to the many overlapping clinical and laboratory features of the different causes of this syndrome. Clinicians should be aware of the varied clinical manifestations of TMAs to ensure early diagnosis and initiation of appropriate treatment.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45013272","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}
A. Busari, C. Amira, B. Bello, N. Okubadejo, Ismail A Abdusalam, F. Ojini
Background: Chronic kidney disease (CKD) and stroke constitute worldwide public health problems with rising incidence, prevalence and poor outcomes. While the link between renal dysfunction and myocardial infarction is well established, the link with stroke has been less well investigated. In this study, the prevalence and prognostic implication of renal dysfunction in patients admitted with acute stroke was assessed. Methods: This was a prospective observational study of 130 patients with first-ever stroke admitted within 7 days of stroke onset and followed up for 30 days. The study outcome measure was 30-day mortality. Stroke subtype was verified by a computerized tomography (CT) scan of the brain. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the 4-variable Modification of Diet in Renal Disease (MDRD) equation. Renal dysfunction was defined as eGFR 70 years, haemorrhagic stroke subtype, CNS score 7.8 mmol/L. Conclusions: Renal dysfunction is common among adult Nigerian patients with acute stroke. Both reduced eGFR and proteinuria were independent predictors of 30-day mortality in these patients.
{"title":"Renal dysfunction and 30-day mortality risk in patients with acute stroke","authors":"A. Busari, C. Amira, B. Bello, N. Okubadejo, Ismail A Abdusalam, F. Ojini","doi":"10.21804/22-1-3291","DOIUrl":"https://doi.org/10.21804/22-1-3291","url":null,"abstract":"Background: Chronic kidney disease (CKD) and stroke constitute worldwide public health problems with rising incidence, prevalence and poor outcomes. While the link between renal dysfunction and myocardial infarction is well established, the link with stroke has been less well investigated. In this study, the prevalence and prognostic implication of renal dysfunction in patients admitted with acute stroke was assessed. Methods: This was a prospective observational study of 130 patients with first-ever stroke admitted within 7 days of stroke onset and followed up for 30 days. The study outcome measure was 30-day mortality. Stroke subtype was verified by a computerized tomography (CT) scan of the brain. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the 4-variable Modification of Diet in Renal Disease (MDRD) equation. Renal dysfunction was defined as eGFR 70 years, haemorrhagic stroke subtype, CNS score 7.8 mmol/L. Conclusions: Renal dysfunction is common among adult Nigerian patients with acute stroke. Both reduced eGFR and proteinuria were independent predictors of 30-day mortality in these patients.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45265708","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}
Vincent Bioma, V. Ganu, D. Dey, Ernest Yorke, P. Adjei, M. Mate-kole, C. Mate-Kole
Background: The prevalence of chronic kidney disease (CKD) is high in sub-Saharan Africa and affects the productive workforce. CKD has been associated with psychological problems such as anxiety and depression; however, there is little published information on the burden of psychological problems among the CKD population in African countries. Our study assessed psychological changes in two groups of patients, one group with end-stage renal disease receiving chronic haemodialysis, and a second with CKD not on dialysis. Methods: A cross-sectional study involving patients on chronic haemodialysis and patients with CKD stages 3–5 (the “CKD” patients) was conducted at the Renal Unit of the Korle-Bu Teaching Hospital in Accra, Ghana. One hundred and sixty-eight participants (82 CKD and 86 haemodialysis patients) were recruited. Demographic, clinical and laboratory information was captured, the Revised Quick Cognitive Screening Test (RQCST) was used to assess cognitive function and the Brief Symptoms Inventory-18 (BSI-18) was used to screen for anxiety, somatization and depression. Results: CKD patients were older than those on haemodialysis, with mean ages of 53.3 and 46.6 years, respectively. Two-thirds (113/167) were male. The median glomerular filtration rate (GFR) of the CKD patients was 21 mL/min/1.73 m 2 (interquartile range 9–34). Most of the haemodialysis patients (78.6%) were receiving two sessions of haemodialysis per week and their mean kT/V was 1.16 ± 0.23. The RQCST global scores in the two groups of patients were similar, with almost 90% of haemodialysis patients and 85% of CKD patients obtaining scores above 50. Haemodialysis patients had better scores for immediate recall memory. The haemodialysis patients also had higher BSI-18 global scores than the CKD patients (mean of 0.83 vs 0.70, p = 0.033). Mean anxiety and somatization scores were also higher in the haemodialysis patients. Conclusions: Haemodialysis patients demonstrated higher anxiety and somatization scores than the CKD patients. Clinical psychological support should therefore be included in the treatment of our patients, and especially for those on chronic haemodialysis.
背景:慢性肾脏疾病(CKD)在撒哈拉以南非洲的患病率很高，并影响到生产劳动力。慢性肾病与焦虑和抑郁等心理问题有关;然而，关于非洲国家慢性肾病人群心理问题负担的出版信息很少。我们的研究评估了两组患者的心理变化，一组是接受慢性血液透析的终末期肾病患者，另一组是不接受透析的CKD患者。方法:在加纳阿克拉Korle-Bu教学医院肾科进行了一项横断面研究，涉及慢性血液透析患者和CKD 3-5期患者(“CKD”患者)。168名参与者(82名CKD患者和86名血液透析患者)被招募。收集人口统计学、临床和实验室信息，使用修订快速认知筛查测试(RQCST)评估认知功能，使用简短症状量表-18 (BSI-18)筛查焦虑、躯体化和抑郁。结果:CKD患者比血液透析患者年龄大，平均年龄分别为53.3岁和46.6岁。三分之二(113/167)为男性。CKD患者的中位肾小球滤过率(GFR)为21 mL/min/1.73 m2(四分位数范围9-34)。大多数血液透析患者(78.6%)每周接受两次血液透析，平均kT/V为1.16±0.23。两组患者的RQCST总体评分相似，几乎90%的血液透析患者和85%的CKD患者得分在50以上。血液透析患者在即时回忆记忆方面得分更高。血液透析患者的BSI-18整体评分也高于CKD患者(平均0.83 vs 0.70, p = 0.033)。血液透析患者的平均焦虑和躯体化得分也较高。结论:血液透析患者的焦虑和躯体化评分高于CKD患者。因此，临床心理支持应包括在治疗我们的病人，特别是那些慢性血液透析。
{"title":"Psychological changes in Africans with kidney disease in Ghana: a comparison of haemodialysis patients and patients with chronic kidney disease not on dialysis","authors":"Vincent Bioma, V. Ganu, D. Dey, Ernest Yorke, P. Adjei, M. Mate-kole, C. Mate-Kole","doi":"10.21804/22-1-3268","DOIUrl":"https://doi.org/10.21804/22-1-3268","url":null,"abstract":"Background: The prevalence of chronic kidney disease (CKD) is high in sub-Saharan Africa and affects the productive workforce. CKD has been associated with psychological problems such as anxiety and depression; however, there is little published information on the burden of psychological problems among the CKD population in African countries. Our study assessed psychological changes in two groups of patients, one group with end-stage renal disease receiving chronic haemodialysis, and a second with CKD not on dialysis. Methods: A cross-sectional study involving patients on chronic haemodialysis and patients with CKD stages 3–5 (the “CKD” patients) was conducted at the Renal Unit of the Korle-Bu Teaching Hospital in Accra, Ghana. One hundred and sixty-eight participants (82 CKD and 86 haemodialysis patients) were recruited. Demographic, clinical and laboratory information was captured, the Revised Quick Cognitive Screening Test (RQCST) was used to assess cognitive function and the Brief Symptoms Inventory-18 (BSI-18) was used to screen for anxiety, somatization and depression. Results: CKD patients were older than those on haemodialysis, with mean ages of 53.3 and 46.6 years, respectively. Two-thirds (113/167) were male. The median glomerular filtration rate (GFR) of the CKD patients was 21 mL/min/1.73 m 2 (interquartile range 9–34). Most of the haemodialysis patients (78.6%) were receiving two sessions of haemodialysis per week and their mean kT/V was 1.16 ± 0.23. The RQCST global scores in the two groups of patients were similar, with almost 90% of haemodialysis patients and 85% of CKD patients obtaining scores above 50. Haemodialysis patients had better scores for immediate recall memory. The haemodialysis patients also had higher BSI-18 global scores than the CKD patients (mean of 0.83 vs 0.70, p = 0.033). Mean anxiety and somatization scores were also higher in the haemodialysis patients. Conclusions: Haemodialysis patients demonstrated higher anxiety and somatization scores than the CKD patients. Clinical psychological support should therefore be included in the treatment of our patients, and especially for those on chronic haemodialysis.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44486993","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}
J. Vigan, S. Ahoui, B. Agboton, K. Sabi, W. M. Tia, Fb Rodolphe Tchaba, F. Djrolo
Introduction: Diabetic nephropathy is a frequent and dreaded complication of diabetes mellitus. The purpose of this work was to study the role of serum cystatin C in the early detection of diabetic nephropathy among type 2 diabetic patients. Methods: This was a cross-sectional study conducted in Cotonou over a period of six months. Blood samples were tested at the regional food safety testing analysis laboratory. Type 2 diabetic patients older than 15 years, who gave their informed consent, were included in the study. Patients with proven proteinuria, acute kidney injury, haematuria, a positive urine test for nitrite, or reduced glomerular filtration rate <60 mL/min/1.73 m 2 were excluded from the study. All patients were subjected to serum cystatin C and microalbuminuria assays. Results: Eighty-eight patients were included in the study. Their average age was 50.7 ± 9.6 years and the male to female ratio was 1.4:1. Twenty-four-hour microalbuminuria was positive in 53 (60%) cases whereas serum cystatin C tested positive in only 2 cases. Sensitivity and specificity tests applied to cystatin C showed very low sensitivity (4%) with a positive predictive value of 100% and high specificity (100%) with a negative predictive value of 41%. Conclusions: When compared with 24-hour microalbuminuria, serum cystatin C assay was not sensitive enough to prove suitable for screening for diabetic nephropathy. Serum cystatin C would therefore not be useful for the early detection of nephropathy among type 2 diabetic patients.
{"title":"Assessment of serum cystatin C in the early detection of type 2 diabetic nephropathy in Cotonou, Benin","authors":"J. Vigan, S. Ahoui, B. Agboton, K. Sabi, W. M. Tia, Fb Rodolphe Tchaba, F. Djrolo","doi":"10.21804/22-1-2541","DOIUrl":"https://doi.org/10.21804/22-1-2541","url":null,"abstract":"Introduction: Diabetic nephropathy is a frequent and dreaded complication of diabetes mellitus. The purpose of this work was to study the role of serum cystatin C in the early detection of diabetic nephropathy among type 2 diabetic patients. Methods: This was a cross-sectional study conducted in Cotonou over a period of six months. Blood samples were tested at the regional food safety testing analysis laboratory. Type 2 diabetic patients older than 15 years, who gave their informed consent, were included in the study. Patients with proven proteinuria, acute kidney injury, haematuria, a positive urine test for nitrite, or reduced glomerular filtration rate <60 mL/min/1.73 m 2 were excluded from the study. All patients were subjected to serum cystatin C and microalbuminuria assays. Results: Eighty-eight patients were included in the study. Their average age was 50.7 ± 9.6 years and the male to female ratio was 1.4:1. Twenty-four-hour microalbuminuria was positive in 53 (60%) cases whereas serum cystatin C tested positive in only 2 cases. Sensitivity and specificity tests applied to cystatin C showed very low sensitivity (4%) with a positive predictive value of 100% and high specificity (100%) with a negative predictive value of 41%. Conclusions: When compared with 24-hour microalbuminuria, serum cystatin C assay was not sensitive enough to prove suitable for screening for diabetic nephropathy. Serum cystatin C would therefore not be useful for the early detection of nephropathy among type 2 diabetic patients.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21804/22-1-2541","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47339085","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}
A case of drug-induced melanonychia due to cyclophosphamide is described in a patient with lupus nephritis. This resolved completely at 20 weeks after stopping the drug. Clinicians should be aware of the causes of melanonychia, and, if drug-induced melanonychia is suspected, the offending drug should be stopped whenever possible.
{"title":"Cyclophosphamide-induced melanonychia","authors":"M. Amirali, M. Chothia","doi":"10.21804/22-1-3331","DOIUrl":"https://doi.org/10.21804/22-1-3331","url":null,"abstract":"A case of drug-induced melanonychia due to cyclophosphamide is described in a patient with lupus nephritis. This resolved completely at 20 weeks after stopping the drug. Clinicians should be aware of the causes of melanonychia, and, if drug-induced melanonychia is suspected, the offending drug should be stopped whenever possible.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49476482","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: Hypernatraemia is a common electrolyte problem in hospitalized patients and is associated with a high mortality rate. We aimed to determine the incidence, causes, management, and outcomes of hypernatraemia in adult hospitalized patients at a large South African tertiary hospital. Methods : A retrospective study was conducted at Tygerberg Hospital in Cape Town, South Africa. Adult patients with hypernatraemia (at least one serum sodium concentration ≥150 mmol/L) during a 3-month period in 2014 were identified from our laboratory database for inclusion. Results : There were 204 patients with hypernatraemia, an incidence of 1.5%. Of these patients, 101 (49.5%) were male, and the mean age was 53 years. There were 66 patients (32.4%) who had hypernatraemia on admission, and 138 who developed it during the course of their hospital stay. The overall in-hospital mortality was 38.7%, with higher rates for older patients and those with more severe degrees of hypernatraemia. Contributory causes which were most commonly present included dehydration/hypovolaemia (45%), followed by sepsis (39%). Net sodium gain, rather than water deficit, was identified as the main mechanism in most of the patients who developed hypernatraemia in the intensive care units. We found little evidence of any diagnostic work-up and also found that the details of fluid therapy and intake-output charting were poorly documented. Conclusions : There is a very high mortality rate in our hospitalized patients with hypernatraemia. The diagnostic work-up and therapy was often inadequate or poorly documented. The management of this important condition needs to be improved with the aid of standardized protocols.
{"title":"Hypernatraemia in South African hospitalised patients","authors":"Ali Abohajir, M. Rensburg, M. R. Davids","doi":"10.21804/22-1-3285","DOIUrl":"https://doi.org/10.21804/22-1-3285","url":null,"abstract":"Background: Hypernatraemia is a common electrolyte problem in hospitalized patients and is associated with a high mortality rate. We aimed to determine the incidence, causes, management, and outcomes of hypernatraemia in adult hospitalized patients at a large South African tertiary hospital. Methods : A retrospective study was conducted at Tygerberg Hospital in Cape Town, South Africa. Adult patients with hypernatraemia (at least one serum sodium concentration ≥150 mmol/L) during a 3-month period in 2014 were identified from our laboratory database for inclusion. Results : There were 204 patients with hypernatraemia, an incidence of 1.5%. Of these patients, 101 (49.5%) were male, and the mean age was 53 years. There were 66 patients (32.4%) who had hypernatraemia on admission, and 138 who developed it during the course of their hospital stay. The overall in-hospital mortality was 38.7%, with higher rates for older patients and those with more severe degrees of hypernatraemia. Contributory causes which were most commonly present included dehydration/hypovolaemia (45%), followed by sepsis (39%). Net sodium gain, rather than water deficit, was identified as the main mechanism in most of the patients who developed hypernatraemia in the intensive care units. We found little evidence of any diagnostic work-up and also found that the details of fluid therapy and intake-output charting were poorly documented. Conclusions : There is a very high mortality rate in our hospitalized patients with hypernatraemia. The diagnostic work-up and therapy was often inadequate or poorly documented. The management of this important condition needs to be improved with the aid of standardized protocols.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21804/22-1-3285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43843470","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}
On behalf of the Editorial Board of the African Journal of Nephrology (AJN), I wish all readers, contributors and reviewers a happy and successful 2019. We have successfully completed our third year as an online Journal. We sincerely thank everyone who contributed to this achievement. With your support, we will achieve more milestones. I wish to take this opportunity to remind all our readers and contributors that AJN is the official journal of the African Association of Nephrology (AFRAN). During 2019, AFRAN, in partnership with the Kenya Renal Association, will convene its biennial congress in Mombasa, Kenya, from 25–29 September. Let us give Professor Were, AFRAN President-Elect, and the Kenya Renal Association all the support they need. Through our participation, we will ensure that the AFRAN congress is a great success. This year, the nephrology calendar is fully loaded. Besides various local and regional congresses, including the AFRAN Congress, at the global level the World Congress of Nephrology will be held in Melbourne, Australia, from 12–15 April 2019. World Kidney Day is also fast approaching. It will be celebrated as usual, on the second Thursday of March, 14 March 2019. The theme this year is “Kidney Health for Everyone Everywhere”. In Volume 21 in 2018, AJN published excellent original articles from various regions of Africa, including East, West and Southern Africa. The proceedings of the 2018 South African Renal Congress are also part of AJN Volume 21. Of note, also in Volume 21, the publication of the 2016 South Africa Renal Registry Annual Report gives a picture of renal replacement therapy in an African country. In 2019, in Volume 22, AJN expects to continue to publish excellent original articles as well as review articles to display research outputs from our contributors. We invite researchers to continue to submit their best work, and nephrology societies to submit the proceedings of their local and regional congresses. Once again, Happy 2019 and we look forward to seeing you in Melbourne in April and Mombasa in September! KARIBUNI SANA AFRAN Congress in Kenya! Alain G Assounga Editor-in-Chief
我代表《非洲肾脏病杂志》（AJN）编委会，祝所有读者、撰稿人和审稿人2019年快乐、成功。我们已经成功地完成了作为在线期刊的第三年。我们衷心感谢为这一成就作出贡献的每一个人。在您的支持下，我们将实现更多的里程碑。我想借此机会提醒我们所有的读者和撰稿人，《AJN》是非洲肾脏病协会（AFRAN）的官方期刊。2019年，AFRAN将与肯尼亚肾脏协会合作，于9月25日至29日在肯尼亚蒙巴萨召开两年一度的大会。让我们给予非洲肾脏研究所当选主席Were教授和肯尼亚肾脏协会所需的一切支持。通过我们的参与，我们将确保非洲区域网络大会取得巨大成功。今年，肾脏科的日历已经满了。除了包括AFRAN大会在内的各种地方和地区大会外，世界肾脏病大会将于2019年4月12-15日在澳大利亚墨尔本举行。世界肾脏日也即将到来。它将在2019年3月14日的第二个星期四照常庆祝。今年的主题是“人人享有肾脏健康”。在2018年的第21卷中，AJN发表了来自非洲各个地区的优秀原创文章，包括东非、西非和南部非洲。2018年南非肾脏大会的会议记录也是AJN第21卷的一部分。值得注意的是，同样在第21卷中，2016年南非肾脏登记年度报告的发布展示了一个非洲国家的肾脏替代疗法。2019年，AJN预计将在第22卷继续发表优秀的原创文章和评论文章，以展示我们贡献者的研究成果。我们邀请研究人员继续提交他们的最佳作品，并邀请肾脏病学会提交其地方和地区大会的会议记录。再次，2019年快乐，我们期待着4月在墨尔本和9月在蒙巴萨与您见面！KARIUNI SANA AFRAN大会在肯尼亚举行！Alain G Assounga主编
{"title":"Editorial note: welcome to Volume 22 and the year 2019","authors":"A. Assounga","doi":"10.21804/22-1-3362","DOIUrl":"https://doi.org/10.21804/22-1-3362","url":null,"abstract":"On behalf of the Editorial Board of the African Journal of Nephrology (AJN), I wish all readers, contributors and reviewers a happy and successful 2019. We have successfully completed our third year as an online Journal. We sincerely thank everyone who contributed to this achievement. With your support, we will achieve more milestones. I wish to take this opportunity to remind all our readers and contributors that AJN is the official journal of the African Association of Nephrology (AFRAN). During 2019, AFRAN, in partnership with the Kenya Renal Association, will convene its biennial congress in Mombasa, Kenya, from 25–29 September. Let us give Professor Were, AFRAN President-Elect, and the Kenya Renal Association all the support they need. Through our participation, we will ensure that the AFRAN congress is a great success. This year, the nephrology calendar is fully loaded. Besides various local and regional congresses, including the AFRAN Congress, at the global level the World Congress of Nephrology will be held in Melbourne, Australia, from 12–15 April 2019. World Kidney Day is also fast approaching. It will be celebrated as usual, on the second Thursday of March, 14 March 2019. The theme this year is “Kidney Health for Everyone Everywhere”. In Volume 21 in 2018, AJN published excellent original articles from various regions of Africa, including East, West and Southern Africa. The proceedings of the 2018 South African Renal Congress are also part of AJN Volume 21. Of note, also in Volume 21, the publication of the 2016 South Africa Renal Registry Annual Report gives a picture of renal replacement therapy in an African country. In 2019, in Volume 22, AJN expects to continue to publish excellent original articles as well as review articles to display research outputs from our contributors. We invite researchers to continue to submit their best work, and nephrology societies to submit the proceedings of their local and regional congresses. Once again, Happy 2019 and we look forward to seeing you in Melbourne in April and Mombasa in September! KARIBUNI SANA AFRAN Congress in Kenya! Alain G Assounga Editor-in-Chief","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49079408","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}
Traditional randomised controlled trials that rely on research staff to collect data are becoming increasingly expensive. As a result, the number of interventions that can be scrutinised for effectiveness will be limited. Further, while results from such trials have high internal validity, they will have limited external validity – generalisability to the real-world population. One solution is to adopt a more pragmatic approach and embed randomisation into routine healthcare databases such as registries. There are a number of ways that this can be done. Most commonly, registries simply provide extended follow-up to traditional explanatory trials, but with the necessary permissions more novel approaches are possible. Registries can be used to identify potentially eligible participants, provide the baseline data and provide all of the follow-up data. Proportionate to the risk associated with the intervention, routine healthcare databases can also provide some of the safety monitoring data, greatly reducing the burden and cost of the trial. To illustrate the opportunities and challenges, a number of reported and ongoing registry trials are presented.
{"title":"Embedding randomised controlled trials in renal registries","authors":"F. Caskey, T. Jardine, M. R. Davids","doi":"10.21804/22-1-3766","DOIUrl":"https://doi.org/10.21804/22-1-3766","url":null,"abstract":"Traditional randomised controlled trials that rely on research staff to collect data are becoming increasingly expensive. As a result, the number of interventions that can be scrutinised for effectiveness will be limited. Further, while results from such trials have high internal validity, they will have limited external validity – generalisability to the real-world population. One solution is to adopt a more pragmatic approach and embed randomisation into routine healthcare databases such as registries. There are a number of ways that this can be done. Most commonly, registries simply provide extended follow-up to traditional explanatory trials, but with the necessary permissions more novel approaches are possible. Registries can be used to identify potentially eligible participants, provide the baseline data and provide all of the follow-up data. Proportionate to the risk associated with the intervention, routine healthcare databases can also provide some of the safety monitoring data, greatly reducing the burden and cost of the trial. To illustrate the opportunities and challenges, a number of reported and ongoing registry trials are presented.","PeriodicalId":32934,"journal":{"name":"African Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46437627","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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