JournalTOCs

Journal of Illicit Economies and Development
Number of Followers: 1

This is an Open Access Journal

Open Access journal
ISSN (Online) 2516-7227
Published by LSE Press

[1 journal]

Editorial note: Welcome to the year 2023 and Volume 26 - Are we ready for
the next disaster'
- Authors: Alain G Assounga
  Pages: 1 - 1
  Abstract: On behalf of the Editors and the Editorial Board of the African Journal of Nephrology (AJN), I wish all authors, reviewers and readers a blessed and prosperous New Year! I wish to express my sincere gratitude to Prof Fergus Caskey, for his great contribution to AJN as Associate Editor. He left the Journal last year. We wish him great success in his new and future endeavours. I am proud of the AJN publications for Volume 25, published last year. Indeed, AJN is progressing very well to establish itself as the journal of choice for publishing African nephrology research. In 2022, we published three excellent reviews covering hyperuricaemia in chronic kidney disease, the measurement of GFR in Africa and a road map for kidney care in Africa. Eighteen original articles from diverse African countries were also published last year. We were pleased to publish the 2020 annual report for the South African Renal Registry, and we call on other African countries to submit their registry reports for publication. The international community has decreed that this year’s World Kidney Day theme is: “Kidney health for all, preparing for the unexpected, supporting the vulnerable.” This theme is pertinent and should assist with the progress toward the “Health for all” goal. In nephrology, the unexpected can be very expensive. From the management of hypovolaemia to dialysis in acute kidney injury, how ready are we' At an individual level, a family level, societal level, regional level, country and continental level and finally, at a global level, we need to prepare to deal with disasters. Countries often rely on NGOs such as Médecins Sans Frontières, Gift of the Givers and others to do the work. We should commend these NGOs for their assistance. In Africa, government institutions need to improve their capacity for disaster management. The nephrology community in Africa, through AFRAN, could play a significant role together with other regional organisations. This role will require a commitment like the one we proposed in a book we published ten years ago, “Kidney disease in an African setting” [1]. The closest community to the disease must take the lead, as time is of the essence. I am encouraged by the level of cooperation in AFRAN during the COVID-19 pandemic, which produced guidelines for managing COVID-19 in Africa [2]. We should emulate that effort as a legacy of the COVID-19 experience and use the AFRAN committee structures to put together projects that bring positive progress to kidney care in Africa. I propose that this initiative be named the Antony Were COVID Legacy initiative, inspired by and in honour of our AFRAN President, who started the revival of AFRAN during the COVID-19 pandemic but could not live to witness the end of it. On a lighter note, we all remember our collective dedication during the long Sunday evening AFRAN meetings chaired by Dr Were. Let us commit ourselves to his memory and in memory of all our colleagues who lost their lives to COVID-19. Alain G Assounga
  Editor-in-Chief
  PubDate: 2023-01-24
  Issue No: Vol. 26, No. 1 (2023)
Acknowledgement to reviewers 2022
- 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 2022. We greatly appreciate their contribution to the quality of the work that we publish.
  PubDate: 2023-01-24
  Issue No: Vol. 26, No. 1 (2023)
Vascular access in Senegalese patients starting chronic haemodialysis
- Authors: Moustapha Faye, Ismail Raqui, Maria Faye, Bacary Ba, Ahmed Tall Lemrabott, Sidy Mohamed Seck, Abdou Niang, Elhadji Fary Ka
  Pages: 3 - 8
  Abstract: Introduction: It is recommended that patients should start chronic haemodialysis using an arteriovenous fistula (AVF). We aimed to determine the proportion of Senegalese patients who used an AVF at the start of haemodialysis and examined the factors associated with its use. Methods: We conducted a cross-sectional study from 1 June 2021 to 2 October 2021 among patients on chronic haemodialysis in 10 centres in the Dakar and Thiès regions. Clinical and laboratory data were collected from medical records and also via patient interviews. Results: The patients (n = 543) had a median age of 50 years [interquartile range (IQR) 40–62 years] and 50.6% were male. The socio-economic level was low in two-thirds of cases. The median duration of haemodialysis was 40 (IQR 17–76) months. Hypertension was noted in 92% and diabetes in 13%. Hypertensive kidney disease was the cause of kidney failure in 33%. Only 47 patients (9%) had started dialysis using an arteriovenous fistula. Factors associated with its use at haemodialysis initiation were socio-economic level (OR 0.48; 95% confidence interval (CI) 0.25–0.94 for low socio-economic level) and duration of pre-dialysis follow-up by a nephrologist for >4 months (OR 7.82; 95% CI 3.05–26.50). In 65% of prevalent patients, the vascular access used was an AVF, a tunnelled central venous catheter in 28%, an arteriovenous graft in 2% and a temporary central venous catheter in 4.4%. Conclusions: The proportion of Senegalese patients with an AVF at the start of haemodialysis was low. AVF use was associated with socio-economic level and pre-dialysis follow-up by a nephrologist for >4 months.
  PubDate: 2023-01-24
  DOI: 10.21804/26-1-5381
  Issue No: Vol. 26, No. 1 (2023)
Patterns of biopsy-proven kidney disease amongst South African adults from
1995 to 2017
- Authors: Ahmed Mushtak Esmail, William D Bates, Mazhar Hussein Amirali, Thabiet Jardine, Mogamat Razeen Davids
  Pages: 9 - 16
  Abstract: Introduction: Little data is available on biopsy-proven kidney disease in African countries. In this study, we have described the patterns of biopsy-proven kidney disease amongst South African adults encountered over a 23-year period and report whether these have changed over time. Methods: This retrospective study included all adults who underwent a native kidney biopsy at Tygerberg Hospital in Cape Town from January 1995 to December 2017. Only the first biopsy for each patient was included in the analysis. From patient records, we extracted demographic and clinical information and details of the kidney biopsies, including the indications and the final histopathological diagnosis. Results: During the study period, 2227 first native kidney biopsies were performed. The median age of the patients was 38.0 years (interquartile range 30.0–48.1 years), and 53.3% were female. The most common indication for biopsy was nephrotic syndrome (38.6%). Glomerulonephritis (GN) was the most common pattern of kidney disease, with similar numbers of cases of primary and secondary glomerular disease. Among the primary glomerular diseases, mesangiocapillary GN (34.5%) was the most common, followed by focal segmental glomerulosclerosis (22.3%) and membranous nephropathy (15.8%). Among the secondary glomerular diseases, lupus nephritis was the most common (39.1%), followed by human immunodeficiency virus-associated nephropathy (HIVAN, 22.1%), and diabetic nephropathy (14.4%). IgA nephropathy was uncommon, accounting for only 2.0% of all glomerular disease, as was hypertensive kidney disease, which was diagnosed in only 1.3% of all our biopsies. Conclusions: Over the last two decades, mesangiocapillary GN was the most common primary glomerular disease and lupus nephritis the most common secondary glomerular disease. There was a steady increase in the number of patients with HIVAN. Hypertensive nephropathy was an uncommon histological diagnosis, and IgA nephropathy remains rare.
  PubDate: 2023-02-01
  DOI: 10.21804/26-1-5376
  Issue No: Vol. 26, No. 1 (2023)
Investigating toxic aluminium levels in haemodialysis patients after
“Day Zero” drought in Cape Town, South Africa
- Authors: Bianca Southon, Jody A Rusch, Helena W Vreede, Bianca Davidson, Daniel Mweli, Nicola Wearne, Malini Chetty, Erika SW Jones
  Pages: 17 - 23
  Abstract: Introduction: Aluminium is the most abundant metallic element in the earth’s crust and can be consumed through water, medications, and by using metallic cooking utensils. Aluminium levels become a concern when they are above biological exposure limits and can present with multiple clinical complications. When patients have chronic kidney disease and are on haemodialysis, impaired aluminium excretion can lead to its accumulation. Significantly elevated serum aluminium levels were noted in patients with chronic kidney disease (stage 5) on haemodialysis at Groote Schuur Hospital, Cape Town, South Africa. This coincided with one of the worst water crises ever experienced in this metropolitan area, with extreme water restrictions being imposed and alternative water sources being accessed.
  Method: A multidisciplinary task force performed a systematic evaluation of aluminium concentrations throughout the dialysis water system. Additionally, a thorough investigation was performed to assess the quality of the laboratory results.
  Results: Possible areas of contamination and potential sources of exposure were excluded. The laboratory results were verified, and potential sources of error were excluded. The investigation verified that aluminium was truly elevated in the serum of patients, and concluded that dialysis was not the cause. Subsequently, patients’ results have declined to baseline, making it possible that there was increased environmental exposure during the drought.
  Conclusion: This report serves as a reminder to clinicians of acceptable serum aluminium levels in people on dialysis, and in the water system. Furthermore, it highlights the importance of a multidisciplinary collaborative team approach for the investigation of unexpected results or changes in trends.
  PubDate: 2023-01-31
  DOI: 10.21804/26-1-5423
  Issue No: Vol. 26, No. 1 (2023)
Saliva urea nitrogen dipsticks to predict acute kidney injury in Malawian
trauma patients
- Authors: Erica Bjornstad, William Muronya, Zachary H Smith, Manly Kamija, Rhys Evans, Amy K Mottl, Yvonne M Golightly, Keisha Gibson, Anthony Charles, Emily W Gower
  Pages: 24 - 29
  Abstract: Background: Many low-resource settings have limited access to serum creatinine tests necessary for kidney disease identification. Among Malawian patients who are hospitalized after trauma, we evaluated the use of point-of-care saliva urea nitrogen (SUN) dipsticks to predict acute kidney injury (AKI). Methods: In a nested prospective cohort study, we enrolled hospitalized acute trauma patients aged ≥6 months to evaluate AKI (defined by KDIGO criteria) and the test characteristics of SUN to predict AKI. Results: Among 335 participants (approximately three-quarters able to expectorate and 34% aged ≤18 years), 12.5% (n = 42) developed AKI. At a SUN threshold of ≥40 mg/dL, a positive dipstick test was specific (99.3%) but insensitive (14.3%) in predicting AKI, with a positive predictive value of 75% and negative predictive value of 89%. At this threshold, 2.4% of participants were dipstick-positive (SUN+), and 75% of those had AKI. Reducing the SUN threshold to ≥30 mg/dL increased participants who were SUN+ to 5.0% (n = 16) but also increased the false positive rate and missed 79% (n = 33) of AKI cases. Stratified results showed better performance among adults than children and similar results when comparing participants who could and could not expectorate. There was moderate correlation between categorized BUN values and SUN (r = 0.53) but less agreement (weighted kappa 0.27; 95% CI 0.17–0.37). Conclusions: SUN dipstick testing has good specificity and negative predictive value for ruling out AKI, but poor sensitivity. We found similar results among those who could or could not expectorate a saliva sample.
  PubDate: 2023-01-26
  DOI: 10.21804/26-1-5462
  Issue No: Vol. 26, No. 1 (2023)
From Alpha to Omicron: anatomy of the SARS-CoV-2 pandemic in an outpatient
haemodialysis unit in Johannesburg, South Africa
- Authors: Ranbir Maharaj, Chandni Dayal, Zaheera Cassimjee, Sheetal Chiba, Adekunle O Ajayi, Malcolm Davies
  Pages: 30 - 37
  Abstract: Background Recipients of kidney replacement therapy are more susceptible to severe disease and mortality from SARS-CoV-2 infection. We evaluated disease kinetics and clinical outcomes across four COVID-19 outbreak waves in the haemodialysis unit of a tertiary-level hospital in South Africa. Methods Data from 70 patients was analysed. Temporal trends in SARS-CoV-2 infection as diagnosed by nasopharyngeal RT-PCR swab were described as were severity of resultant COVID-19 disease, survival outcomes, and recurrent infections. The effect of patient-related demographic and comorbidity factors, and that of probable SARS-CoV-2 variant on disease severity and recurrence, were additionally assessed. Results Three-quarters of patients in this unit ultimately developed SARS-CoV-2 infection. The majority of infections were asymptomatic or of mild clinical presentation. The Alpha variant (first) wave and the Delta variant (third) wave accounted for the majority of infections. COVID-19 disease was more frequently severe in the Delta variant wave and all mortalities in this cohort occurred in this wave. Male sex and comorbid diabetes were associated with more severe disease. Duration of swab positivity was longer following clinically severe infection and in cases of infection with the Beta variant. Prior episodes of SARS-CoV-2 infection reduced clinical severity at subsequent re-infection and shortened duration of swab positivity. Conclusion The present study is the first description of the COVID-19 pandemic in an African haemodialysis unit. Significant temporal differences in infection rates, disease severity, and survival outcomes were demonstrated over the course of the pandemic in this vulnerable population. Evolving SARS-CoV-2 virulence and immunity potentially account for these differences.
  PubDate: 2023-01-27
  DOI: 10.21804/26-1-5395
  Issue No: Vol. 26, No. 1 (2023)
Acute kidney injury and in-hospital mortality among patients with COVID-19
in Ghana – a single centre study
- Authors: Elliot Koranteng Tannor, Emmanuel Ofori, Kojo Awotwi Hutton-Mensah, Martin Akutek, Felicia Akua Afriyie, Obed Ofori Nyarko, Yasmine Hardy, Samuel Amoabeng Kontoh, Priscilla Abrafi Opare-Addo, Divine Amenuke
  Pages: 38 - 46
  Abstract: Introduction: Acute kidney injury (AKI) occurs in patients with coronavirus disease 2019 (COVID-19) and is associated with high mortality, but this has not yet been described in Ghana. We therefore record here the proportion of COVID-19 patients with AKI, and determined the corresponding mortality, in a tertiary-level hospital in Ghana. Methods: We conducted a retrospective study of all patients admitted to the Komfo Anokye Teaching Hospital, with a diagnosis of COVID-19 proven by reverse transcriptase polymerase chain reaction (RT-PCR), from March 2020 to February 2021. Demographics, clinical findings and laboratory investigations were recorded and summary statistics used to describe the data. Predictors of mortality were established by multiple logistic regression. Results: The study involved 250 patients, of whom 129 (52%) were males, with a mean age of 56.3 ± 17.4 years. AKI occurred in 123 (49%). The most common causes of AKI were pre-renal AKI and ischaemic ATN – 65 (73%) and 37 (30%) cases, respectively. Haemodialysis was required in 6 (5%) cases. The in-hospital mortality of all the COVID-19 patients was 71 (31%). The predictors of in-patient mortality in multivariate analysis were hyperglycaemia (OR = 18.48 [95%CI (2.0 –165.2], P = 0.009), severe COVID-19 (OR = 31.3 [95% CI 1.53–635.5], P = 0.025), elevated white blood cell count (OR = 1.32 [95% CI 1.09–1.59], P = 0.004), lymphopenia (OR = 0.16. [95% CI 0.03–3.26], P = 0.027) and not AKI (OR = 0.79 [95% CI 0.45–1.34], P = 0.380). Stage 3 (severe) AKI, however, occurred in 39 (32%) cases and was significantly associated with mortality [OR = 2.41 (95% CI 1.05–5.49, P = 0.036)] as compared to those with mild–moderate AKI in a sub-analysis. Conclusions: AKI is common in hospitalized patients with COVID-19. Stage 3 AKI was associated with increased in-hospital mortality. Predictors of mortality were severe COVID-19 disease, lymphopenia and hyperglycaemia.
  PubDate: 2023-02-01
  DOI: 10.21804/26-1-4908
  Issue No: Vol. 26, No. 1 (2023)
In memoriam: Rashad Sami Barsoum
- Authors: Saraladevi Naicker, Mohamed Hany Hafez, John H Dirks
  Pages: 47 - 49
  Abstract: Rashad Sami Barsoum, a pioneer in nephrology in Egypt and Africa, and former secretary general of the International Society of Nephrology and inaugural past president of the African Association of Nephrology, died on 25 October 2022, at the age of 81.
  PubDate: 2023-01-30
  DOI: 10.21804/26-1-5733
  Issue No: Vol. 26, No. 1 (2023)
Disordered minerals and disease of soft tissue and bones in chronic kidney
disease
- Authors: Charles R Swanepoel
  Pages: 62 - 69
  Abstract: This article briefly reviews the mineral and bone disorder (MBD) found in patients with chronic kidney disease (CKD) and should provide a useful summary for trainees in nephrology and internal medicine. The storage of minerals is one of the principal roles of our bones, which are alive and are constantly being remodelled under the influence of vitamin D and parathyroid hormone (PTH), aided and abetted by calcium and phosphates. This occurs in a controlled fashion in healthy individuals. In patients with CKD, this control is lost and either an exaggerated, ineffectual remodelling takes place, resulting in the removal (in the case of high-turnover bone disease) or inadequate (in low-turnover bone disease) deposition of minerals. Vascular (and other soft tissue) calcification accompanies MBD, with phosphate and calcium playing major roles in the pathogenesis of the condition. The development of MBD is insidious and evident by changes in blood PTH, calcium and phosphate levels seen as early as stage 3 CKD. Vascular calcification may also be observed at this early stage. Various reports have demonstrated associations between these abnormal blood levels and morbidity and mortality; however, randomised controlled studies are lacking that show definite proof of cause and effect. In resource-limited countries, the control of PTH is restricted to the use of basic, inexpensive medicines, and patients with CKD can have inadequate means to afford blood tests. The use of vitamin D must be balanced between the use of natural vitamin D (a relatively cheap option) and active vitamin D. The cost of intravenous vitamin D analogues can be prohibitive. The more expensive phosphate binders (mostly non-calcium containing) too are unaffordable for most African patients. The surgical expertise to perform parathyroidectomies is limited to only certain major centres throughout the continent.
  PubDate: 2023-03-06
  DOI: 10.21804/26-1-5668
  Issue No: Vol. 26, No. 1 (2023)