Evaluation of eGFR methods in a sub-Saharan African community-based pediatric population.

BACKGROUND: Accurate assessment of the estimated glomerular filtration rate (eGFR) plays a pivotal role in the early detection, management, and optimal medication dosing for chronic kidney disease (CKD). However, validation of eGFR, utilizing cystatin C-based equations, is limited in African children and adolescents with CKD. We evaluate the agreement of eGFR equations incorporating both cystatin C and creatinine in this specific population. METHODS: This community-based study assessed CKD in children (2-15 years) using cystatin C and serum creatinine. eGFR agreement with the reference was evaluated with Bland-Altman plots, ROC curves, and Lin's CCC, using the Under-25 serum creatinine-cystatin C equation as the reference standard. Pairwise ROC comparisons assess the statistical differences in estimation equation agreement. RESULTS: Among 666 children (mean age, 7.8 ± 3.8 years; 48.6% male), CKD prevalence was 11.6% (95% CI, 9.2-14.2%). Notably, the Chehade equation, using combined biomarkers, aligned best with the reference, displaying the lowest mean deviation (- 0.59; 95% CI, - 1.19 to 0.01), superior agreement (P10, 91.0%; P30, 96.70%), and highest discriminatory power (0.989). In contrast, CKD-EPI 2012 cystatin C had the highest mean deviation (- 35.90) and lowest discriminatory power (0.79). Equations combining creatinine and cystatin C (Schwartz, Chehade, Full Age Spectrum) demonstrated strong positive Lin's CCC with CKiD U25 creatinine-cystatin C, while Bouvet showed a notably weak correlation (Lin's CCC, 0.22). CONCLUSION: In African children with CKD, the Chehade, CKiD Under 25 creatinine-based equations, and the Full Age Spectrum equations show promise for CKD diagnosis. However, a measured GFR is essential to identifying the most accurate eGFR equation in this population.

Urinary schistosomiasis in Boko Haram-related internally displaced Nigerian children.

We aimed to determine the prevalence of urinary schistosomiasis among internally displaced children in Maiduguri, Nigeria. Data on the children's sociodemographic characteristics and risk factors for schistosomiasis were collected, over a period of six months, using an interview-based questionnaire. Ten milliliter of urine sample was collected from each child and investigated for hematuria and ova of Schistosoma haematobium. Two hundred and thirty-eight of 385 children had urinary schistosomiasis (62.0%); of this, 125 (53.0%) were males, with a male:female ratio of 1.1:1. Urinary schistosomiasis was the most common among 5-9 years' age group, low social class children, and children of farmers, P <0.05. Stunting was significantly associated with urinary schistosomiasis, P <0.05. It is concluded that urinary schistosomiasis in children was more frequently associated with stunting and low social class. It was a very common disease among internally displaced children in Nigeria.

Pre-treatment considerations in childhood hypertension due to chronic kidney disease.

Hypertension (HTN) develops very early in childhood chronic kidney disease (CKD). It is linked with rapid progression of kidney disease, increased morbidity and mortality hence the imperative to start anti-hypertensive medication when blood pressure (BP) is persistently > 90(th) percentile for age, gender, and height in non-dialyzing hypertensive children with CKD. HTN pathomechanism in CKD is multifactorial and complexly interwoven. The patient with CKD-associated HTN needs to be carefully evaluated for co-morbidities that frequently alter the course of the disease as successful treatment of HTN in CKD goes beyond life style modification and anti-hypertensive therapy alone. Chronic anaemia, volume overload, endothelial dysfunction, arterial media calcification, and metabolic derangements like secondary hyperparathyroidism, hyperphosphataemia, and calcitriol deficiency are a few co-morbidities that may cause or worsen HTN in CKD. It is important to know if the HTN is caused or made worse by the toxic effects of medications like erythropoietin, cyclosporine, tacrolimus, corticosteroids and non-steroidal anti-inflammatory drugs. Poor treatment response may be due to any of these co-morbidities and medications. A satisfactory hypertensive CKD outcome, therefore, depends very much on identifying and managing these co-morbid conditions and HTN promoting medications promptly and appropriately. This review attempts to point attention to factors that may affect successful treatment of the hypertensive CKD child and how to attain the desired therapeutic BP target.

Epidemiology and clinicopathologic outcome of pediatric chronic kidney disease in Nigeria, a single cenetr study.

INTRODUCTION: Due to dearth of data, chronic kidney disease (CKD) outcome in African children has been dismal owing to poor understanding of its etiology, manifestations and management. METHODS: We retrospectively analyzed the records of 154 CKD children and adolescents who were managed at Obafemi Awolowo University Teaching Hospitals Complex between 2000 and 2009 to evaluate the epidemiology and clinicopathologic outcome of pediatric CKD in Nigeria. RESULTS: Overall mean incidence was 11 (6-20) per million children population (pmcp)/year while prevalence averaged 48 (8-101) pmcp. There were 86 males (55.8%). Median age was 10.0 (0.2-15.5) years with 83.8%≥5 years old. Etiologies were glomerular disease (GMD, 90.26%), congenital and acquired urinary tract (7.79%) and hereditary disorders (1.95%). CKD stages at diagnosis were 45.5% CKD-1, 22.7% CKD-2, 10.4% CKD-3, 2.6% CKD-4 and 18.8% CKD-5. Median progression time through the CKD stages was 24.0 (3-108) months. Mean dialysis incidence and prevalence were 1 (0-4) pmcp/year and 4 (1-12) pmcp, respectively. Hypertension, heart failure (HF), malnutrition, anemia, acute-on-CKD, need for dialysis, azotemia, hypercreatininemia, and high calcium-phosphorous product (≥55 mg2/dL2) were mortality risk factors. CKD-1 survived significantly better than CKD stages 3-5 (p<0.05) but not CKD-2 (p=0.1). Hypertensive CKDs without HF survived better (73.0%) than hypertensive CKDs with HF (16.0%) [Hazard ratio (HR): 0.34, 95% CI: 0.14-0.83]. GMD survived better (68.5%) than non-GMD patients (33.0%) [HR: 2.87, 95% CI: 1.16-7.06]. CONCLUSION: CKD was commoner among school than pre-school age children. GMD was the predominant etiology with better outcome than non-GMD. Comorbidity prevalence increased significantly with increasing severity of CKD stage.

Hospital-acquired acute kidney injury in critically ill children and adolescents.

This study determined the (1) hospital incidence, prevalence and etiology; (2) frequency of each of the acute kidney injury (AKI) stages and (3) the 60-day outcome. Retrospective analysis of clinico-laboratory data of Nigerian children/adolescents with hospital-acquired acute kidney injury (hAKI) was performed. AKI occurred in 103 (3.13%) of 3,286 childhood and adolescent admissions. Twenty-eight (27.2%) were hAKI while 72.8% were community-acquired AKI (cAKI). Annual hAKI incidence and prevalence rates were 0.17% (or 3.7 per million children population [pmcp]/year) and 0.84% (or 18.3 pmcp), respectively. Male (20):female (8) ratio was 2.5:1. In the hAKI group, median age was 5 (0.063-15.0) years. AKI stages 1, 2 and 3 accounted for 14.3%, 25.0% and 60.7%, respectively. AKI stage 3 was most anuric, with high dialysis requirement (P = 0.0329). Nephrotoxics (42.87%) were a leading cause of hAKI. Seventy-five percent of the recorded deaths were in the first 28 hAKI days. Median survival time was 23.5 admission (11-52) days. The means values of maximum serum creatinine (Scr) for survivors (486.0 ± 382.0 µmol/L or 5.5 ± 4.3 mg/dL) and for non-survivors (353.0 ± 160.0 µmol/L or 4.0 ± 1.8 mg/dL) were similar (P > 0.20). The 60-day cumulative mortality was 36.7%. Scr severity may not be a reliable mortality determinant among AKI patients. The maximal mortality in the first 28 days of hAKI onset and overall high mortality rate indicate that high level of clinical vigilance and informed therapeutic intervention will be critical to survival during this period. Cause of death was multi-factorial.

Focal segmental glomerulosclerosis and nephrotic syndrome in a child with embryonal rhabdomyosarcoma.

A case of nephrotic syndrome (NS) and acute renal failure (ARF) associated with embryonal rhabdomyosarcoma (RMS) in a 10-year-old boy is reported. Ultrasound revealed irregular, echogenic, circumferential urinary bladder base mass, bilateral hydroureter and hydronephrosis. Histopathology of percutaneous renal and urethrocystoscopic biopsy specimens, respectively, revealed focal segmental glomerulosclerosis (FSGS) and embryonal RMS. Tumour remission was induced with pulse doses of intravenous vincristine, cyclophosphamide, methotrexate and actinomycin D over a 15-month period. He has been followed-up for 28 months and has maintained a drug-free tumour and proteinuria remission for 1 year. While some malignancies have been reported in association with NS, its occurrence in association with RMS is quite exceptional. We conclude that RMS may be associated with FSGS and NS. Effective treatment of the RMS was associated with sustained remission of the nephrotic proteinuria.

Lupus nephropathy and cardiopulmonary and hepatic dysfunctions in a child.

Systemic lupus erythematosus (SLE) is a potentially fatal autoimmune multi-systemic rheumatologic disorder. An unusual case is reported of an 11.9-year-old Nigerian girl who was diagnosed after 2.8 years of non-specific symptoms and six episodes of recurrent haemolysis and pancytopaenia warranting blood transfusions. At diagnosis, she had hepatitis, polyarthritis, nephropathy, and cardiopulmonary and bone-marrow dysfunctions. Lymphopaenia, thrombocytopaenia, and direct antiglobulin-test positive haemolytic anaemia were present. Rapid resolution of disease activity followed exchange blood transfusion after an initial poor response to corticosteroid and cyclophosphamide therapy. Any child with recurrent haemolysis and pancytopaenia of unknown aetiology should be investigated for SLE.

Local Versus General Anesthesia in Pediatric Renal Biopsy: Which is Associated With Better Outcome?

Percutaneous renal biopsy (PRB) of the native kidneys of 32 Nigerian children with varied renal diseases were studied to evaluate which of the two anesthetic techniques (local or general) was associated with better outcome. The children were randomly assigned into two anesthetic groups of 16 subjects each. PRB was performed with Franklin-modified Vim-Silverman renal biopsy needle. The outcome indices in this study were, number of biopsy attempts, duration of the biopsy procedure, number of successful biopsies, episodes and duration of macrohematuria, if any, renal biopsy related trauma (RBT) and other associated complications. There were 19 boys and 13 girls. Mean ages were similar in both local (LA) (8.7 +/- 4.14 years) and general anesthesia (GA) (9.9 +/- 3.5 years) groups, P > 0.5. The mean biopsy attempts were 3.1 +/- 1.8 and 1.6 +/- 1.8 in the LA and GA groups respectively (P <0.05). Mean biopsy duration was significantly longer in the LA group (21.6 +/- 6.3 min) than in the GA group (7.6 +/- 5.4 min), P <0.001. Number of successful biopsies were similar in both groups; 12/16 in LA group and 15/16 in the GA group, P = 0.1446. The overall success rate was 84.4%. Mean episodes and duration of macrohematuria were similar in the two groups (P>0.5). It is concluded that in the anxious, fretful and uncooperative children, GA should be the anesthetic technique of choice for kidney biopsy given the fewer biopsy attempts as well as shorter biopsy duration associated with it.

Renal failure in Nigerian children: factors limiting access to dialysis.

A 5-year clinical and laboratory study of Nigerian children with renal failure (RF) was performed to determine the factors that limited their access to dialysis treatment and what could be done to improve access. There were 48 boys and 33 girls (aged 20 days to 15 years). Of 81 RF patients, 55 were eligible for dialysis; 33 indicated ability to afford dialysis, but only 6 were dialyzed, thus giving a dialysis access rate of 10.90% (6/55). Ability to bear dialysis cost/dialysis accessibility ratio was 5.5:1 (33/6). Factors that limited access to dialysis treatment in our patients included financial restrictions from parents (33%), no parental consent for dialysis (6%), lack or failure of dialysis equipment (45%), shortage of dialysis personnel (6%), reluctance of renal staff to dialyze (6%), and late presentation in hospital (4%). More deaths were recorded among undialyzed than dialyzed patients ( P<0.01); similarly, undialyzed patients had more deaths compared with RF patients who required no dialysis ( P<0.025). Since most of our patients could not be dialyzed owing to a range of factors, preventive nephrology is advocated to reduce the morbidity and mortality from RF due to preventable diseases.