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African Journal of Nephrology
Number of Followers: 2

This is an Open Access Journal

Open Access journal
ISSN (Print) 2306-8205 - ISSN (Online) 2518-4601
Published by Stellenbosch University

[12 journals]

Editorial note: Welcome to the year 2024 and Volume 27 - Time for assisted
kidney protection'
- Authors: Alain G Assounga
  Pages: 1 - 1
  Abstract: On behalf of the African Journal of Nephrology (AJN) editorial board, I wish all our contributors and readers a happy and prosperous new year. Welcome to 2024 and volume 27 of the Journal. The year 2023 was a pivotal one, in which the COVID-19 pandemic and its consequences receded. Some of the lessons learnt will continue to characterise our lives. We started the year with a very successful African Nephrology and Transplantation Summit in Cairo, a hybrid (in-person and virtual) congress. Continuing our progress, the AJN published four interesting reviews and 11 original articles, including one original in French. We thank all the contributors for selecting AJN to publish their valuable research findings. In 2019, we achieved becoming indexed in the Directory of Open Access Journals (DOAJ). This year, we are planning to apply for indexing by Scopus. The Journal will have to move to a professional hosting platform to sustain our progress. As this comes with additional costs, the editorial committee has decided that each publication will be charged a modest article processing fee of US$100. I invite all our future contributors to continue to support the Journal by submitting their best work. In particular, we wish to publish the best research on clinical nephrology in Africa. Special consideration will be given to manuscripts on tropical nephrology as the AJN wants to establish this as a niche topic. World Kidney Day 2024 will be celebrated on Thursday, 8 March. This year, the theme is “Kidney health for all – advancing equitable access to care and optimal medication practice”. As a young nephrology trainee, I was fascinated by home-based dialysis treatment for kidney failure. I still remember the 75-year-old patient who was successfully trained in two weeks to use a haemodialysis machine at home. There is much potential for home haemodialysis and this should be actively promoted. Of course, peritoneal dialysis is a well-established home-based therapy, which is already practised worldwide. The current data show that approximately 14–16% of the African population has chronic kidney disease (CKD) [1]. Africa, therefore, needs to manage at least one hundred million people with the condition. This is an impossibility using the current healthcare models. As most patients with early CKD stages are symptom-free, is it not time to screen everyone and train individuals to treat themselves' This may require that reno-protective medications be dispensed without a prescription by the pharmacist. CKD clinics might then be run in novel settings like sports clubs or gyms. The responsibility for protecting the kidney must be placed at an individual level, with clinics providing education and support. I propose the term “assisted kidney protection centre” to describe these clinics. We would accommodate the entire spectrum of clients, from individuals who need no assistance to those who require maximum assistance. Useful educational materials tailored to the public can be found in an earlier publication [2]. Making the knowledge, tools and support available to preserve kidney function through assisted kidney protection will contribute to advancing equitable access while providing individualised kidney care.
  PubDate: 2024-02-14
  DOI: 10.21804/27-1-6359
  Issue No: Vol. 27, No. 1 (2024)
Acknowledgement to reviewers 2023
- Authors: M Razeen Davids
  Pages: 2 - 2
  Abstract: The editors of AJN wish to thank the colleagues who generously gave of their time and expertise to review manuscripts for us during 2023. We greatly appreciate their contribution to the quality of the work that we publish.
  PubDate: 2024-02-28
  Issue No: Vol. 27, No. 1 (2024)
Know thy donor: a qualitative study investigating the experiences of
living kidney donors at Tygerberg Hospital, Cape Town, South Africa
- Authors: Julian C Hellig, Chantelle J Scott, Andre van der Merwe
  Pages: 3 - 8
  Abstract: This study aimed to understand the experiences of living renal donors at Tygerberg Hospital, a tertiary referral hospital in Cape Town, South Africa. A qualitative, descriptive phenomenological study design was used. Semistructured interviews were conducted with 12 kidney donors and transcribed verbatim. Thematic analysis was used, and the main themes that illustrated the donors’ motivation to provide their organs were: 1) to save a life, 2) interpersonal relationships and family acceptance, 3) selfless unsung heroes, 4) life after donation – it goes on, and 5) no regrets. Our findings highlight the positive overall experience of donors.
  PubDate: 2024-02-28
  DOI: 10.21804/27-1-5943
  Issue No: Vol. 27, No. 1 (2024)
Kidney disease and its risk factors among Nigerians: Report of the World
Kidney Day 2022 National Screening Programme
- Authors: Yemi R Raji, Ogochukwu Okoye, Udeme Ekrikpo, Oluseyi Adejumo, Yauba Mohammed Saad, Ugochi Onu, Zumnan M Gimba, Shamsuddeen Yusuf, Adie Awafung Emmanuel, Ajibike Shanu, Abdulrasheed Mujtaba, Aliyu Abdu, Fatiu A Arogundade, Ifeoma Ulasi, Adanze Asinobi, NAN WKD Working Group
  Pages: 9 - 20
  Abstract: Background The burden of Chronic Kidney Disease (CKD) is more enormous in low and middle-income regions of the world compared to high-income regions. The knowledge of the national prevalence is crucial to drive and support evidence-based advocacy for policies that will alleviate the burden of CKD. Using the vehicle of the World Kidney Day (WKD) we set out to determine the prevalence of CKD and its risk factors in a nationally representative sample. Methods This was a cross-sectional study of Nigerians from all six geopolitical zones of the country, involving 36 public and private medical facilities, which served as screening centres for the communities they serve, during the WKD 2022 activities. Awareness campaigns, health education and screening for CKD and its risk factors were undertaken. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula, while freshly voided urine was obtained for dipstick urinalysis. An eGFR <60mls/min/1.73m2 was considered to indicate kidney dysfunction. A random effects model was used to obtain the pooled prevalence of kidney dysfunction after transformation of the individual proportions using the Freeman-Tukey transformation. Results A total of 4313 participants were screened. The mean age was 43.07±13.35 years, while the overall female proportion was 60.35%. The pooled prevalence of kidney dysfunction was 13.7% (95%CI 11.1 – 16.5%), while 46.7%, 7.42%, 24.07 and 19.75% of the participants had hypertension, DM, obesity, and proteinuria, respectively. Conclusion There is a high prevalence of kidney dysfunction among adult Nigerians, and hypertension, DM, and obesity were the leading risk factors for CKD identified in the population.
  PubDate: 2024-05-09
  DOI: 10.21804/27-1-5740
  Issue No: Vol. 27, No. 1 (2024)
Isolated persistent left-sided superior vena cava in a patient with
end-stage kidney disease
- Authors: Poobalan Naidoo, Nischal Ramkisson, Kalpesh Giresh Mody, Rory Forseth Leisegang, Yeshkir Naidoo, Sudesh Premchund Hariparshad, Alain Guy Honore Assounga
  Pages: 21 - 23
  Abstract: An adult male of Asian origin with end-stage kidney disease secondary to diabetic nephropathy, was found to have a persistent left-sided superior vena cava (PLSVC) that drained into the coronary sinus, without an associated right-sided SVC, following the placement of a haemodialysis catheter. A persistent left-sided SVC arises from the failure of obliteration of the embryological left anterior cardinal vein. It is a rare finding and is usually asymptomatic. Given that nephrologists manage patients who may require vascular access, knowledge of the possibility of vascular anomalies may assist in preventing vascular injuries. Guidewires and dilators should be handled with utmost care to prevent vascular injury and the risk of cardiac rupture. Routine imaging should be performed to evaluate the position and course of central venous catheters after insertion so that vascular anomalies such as PLSVC can be identified timeously.
  PubDate: 2024-04-05
  DOI: 10.21804/27-1-6238
  Issue No: Vol. 27, No. 1 (2024)
Platypnoea–orthodeoxia syndrome in a patient on haemodialysis: a case
report and scoping review
- Authors: Akosua Asomaning, Sumanth Karamchand, Mogamat-Yazied Chothia
  Pages: 24 - 33
  Abstract: Introduction: Platypnoea–orthodeoxia syndrome (POS) is a rare condition caused most frequently by an intracardiac right-to-left shunt. Diagnosis requires a high index of suspicion. We report a case of a young man on chronic haemodialysis who developed POS because of superior vena cava obstruction. We also conducted a scoping review of the literature on POS in adult patients. Methods: We followed the PRISMA–ScR guidelines. Studies were eligible for inclusion if they reported on patients with POS in hospitalised adults. We included case reports and case series from 1 January 1949 to 31 May 2023, sought from PubMed (Medline), Web of Science Core Collection, and the Cumulative Index of Nursing and Allied Health Literature. Results: A 29-year-old man undergoing long-term haemodialysis experienced respiratory distress during his dialysis sessions, particularly when seated upright. His oxygen saturation improved to 100% when supine but dropped to 80% when he stood up. Blocking the arteriovenous fistula (AVF) while standing raised his oxygen saturation to 93%. Left heart catheterisation revealed extensive systemic venous collaterals draining into the left atrium via pulmonary veins. A diagnosis of POS from systemic venovenous collateral vessels due to superior vena cava obstruction was made. Because of the patient’s comorbidities and the AVF being his last viable vascular access, no further interventions were pursued. Three hundred and thirty-seven articles (662 patients) were identified in the search of the literature. Six of the patients were on kidney replacement therapy (KRT). The median age was 70 years (IQR 58–79 years). Overall, the most common cause (80%) of POS was an intracardiac right-to-left shunt and patent foramen ovale (PFO) was the most common (74%) primary cause. Hepatopulmonary syndrome (HPS) was the most common extracardiac cause (38%) of POS. Of the six patients on KRT, five had intracardiac causes of POS and one had an extracardiac cause. Most patients (67%) with PFO had percutaneous closure of the shunt. Four of the five patients on KRT with intracardiac shunt had percutaneous or open surgical closure whereas one was managed conservatively. Most of the patients were discharged and had a low mortality rate of only 5%. Conclusions: This case report and literature review describes the causes, treatment, and outcome of POS. Since this is a rare condition, a high index of suspicion is needed for diagnosis. There is a limited number of documented cases in individuals receiving KRT. Although intracardiac shunts were still the most prevalent cause of POS in patients on KRT, SVC obstruction is another aetiology that should be considered. Overall, the prognosis for individuals with POS as reported in the literature was excellent, with a low mortality rate.
  PubDate: 2024-05-10
  DOI: 10.21804/27-1-6223
  Issue No: Vol. 27, No. 1 (2024)
Mind the gap in kidney care: translating what we know into what we do
- Authors: Valerie A Luyckx, Katherine R Tuttle, Dina Abdellatif, Ricardo Correa-Rotter, Winston WS Fung, Agnès Haris , Li-Li Hsiao, Makram Khalife, Latha A Kumaraswami, Fiona Loud, Vasundhara Raghavan , Stefanos Roumeliotis, Marianella Sierra, Ifeoma Ulasi , Bill Wang, Siu-Fai Lui, Vassilios Liakopoulos, Alessandro Balducci
  Pages: 34 - 45
  Abstract: Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression–kidney failure or death–it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
  PubDate: 2024-04-30
  DOI: 10.21804/27-1-6455
  Issue No: Vol. 27, No. 1 (2024)
The burden, predictors and outcomes of acute kidney injury in children
admitted to the paediatric intensive care unit at the University Teaching
Hospitals’- Children’s Hospital in Lusaka, Zambia
- Authors: Ilunga Chambah, Jessy Zgambo, Somwe Wa-Somwe, Chisambo Mwaba
  Pages: 46 - 52
  Abstract: Background: Acute kidney injury (AKI) is common in critically ill patients and generates poor outcomes as a consequence. There is scant evidence on AKI encountered in paediatric intensive care units (PICU) in low-income countries such as Zambia. We have conducted a prospective study to investigate the burden, predictors, and consequences of AKI in children admitted to a tertiary hospital PICU in Lusaka. Methods: A total of 134 participants, aged 29 days to 18 years and meeting the eligibility criteria, were investigated. Diagnosis of AKI was based on the Kidney Disease Improving Global Outcome (KDIGO) 2012 criteria. A predesigned form was used to collect baseline demographic and clinical data as well as patient outcomes. Data were stored and analysed using SPSS version 25. Results: The median age of the study population was 3.75 years (IQR 5,12), in whom AKI was present in 34%. Children under the age of one year had the highest prevalence of AKI (42%; P = 0.001) and sepsis was the cause in 31% of all AKI patients. Hypernatremia (AOR = 1.115; CI = 1.050–1.185; P = <0.001) and fluid overload (AOR = 6.207; CI = 1.020–37.591; P = <0.047) were predictors of AKI, which was associated with the need for vasopressor support (AOR = 10.015; CI = 1.038–51.763; P = <0.006) and 49% mortality (OR = 2.47; P = <0.008). Children with hospital-acquired AKI (HA-AKI) stayed longer in the hospital (43%) than those with community-acquired AKI (CA-AKI; 2.65% P = 0.001), and required prolonged ventilator support. Conclusion: In this setting, AKI affects a third of PICU patients with infants, sepsis, fluid overload and hypernatremia being associated with a higher risk of developing AKI. This condition was linked to increased need for vasopressors and a high mortality.
  PubDate: 2024-06-20
  DOI: 10.21804/27-1-5944
  Issue No: Vol. 27, No. 1 (2024)

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