African Journal of Paediatric Nephrology

Challenges Encountered in the Care of Adolescents with Kidney Disease

R.M. Akuse — 2024-01-19

Background: As adolescents (persons aged 10-19 years) have the potential to affect national development, managing their health is important. Chronic kidney disease (CKD) is a major cause of mortality worldwide and adolescents with CKD have a higher mortality than their healthy peers. Sub-Saharan Africa (SSA) has the fastest growing adolescent population in the world, but few studies describe challenges healthcare workers in SSA face, caring for adolescents with kidney disease. Such knowledge could improve patient care and prevent adolescents developing CKD.

Case-series: Report of four adolescents with kidney disease (nephrotic syndrome, HIV Associated Nephropathy, pelviureteric junction obstruction), seen in a tertiary hospital in Nigeria, selected because their management was particularly challenging. Poor adherence to prescribed therapy and depression were major challenges. Others were managing poor perception of illness, school problems and risky behaviour (handling chemicals with bare hands). Inability to enforce adherence and financial constraints led to parental frustration. Two patients improved with counselling and support. Two died – one from severe respiratory disease, one from kidney failure.

Conclusion: Adolescents should be routinely screened for adherence, depression, and risky behaviours. Attention should be paid to socioeconomic issues of parents. Research is needed to identify other challenges especially those peculiar to SSA.

Hypertension artérielle chez l'enfant : étude rétrospective sur 58 patients en milieu hospitalier au Sénégal

Amadou Sow — 2024-01-19

Introduction: La prévalence de l'hypertension artérielle (HTA) chez l'enfant a significativement augmenté ces dernières décennies. Les études font apparaître qu'elle est de plus en plus présente dans les pays en voie de développement, notamment en Afrique.

Objectifs: Etudier les aspects épidémiologiques, cliniques, thérapeutiques et évolutifs de l'hypertension artérielle en milieu hospitalier chez l'enfant et l'adolescent.

Méthodologie: Il s'agissait d'une étude rétrospective descriptive multicentrique sur une période de 3 ans (2019-2021), portée sur 58 patients qui furent hospitalisés pour HTA dans les centres de référence pédiatriques : l'hôpital d'enfant Albert Royer, le service de pédiatrie de l'hôpital Aristide Le Dantec et le service de pédiatrie du centre hospitalier Abass Ndao.

Résultats : La prévalence hospitalière de l'HTA était de 0,3%. L'âge moyen au moment du diagnostic était de 11,4±3,5 ans avec un sex-ratio M/F de 1,9. Le signe physique le plus fréquent était les œdèmes de type rénal (77,6%). Parmi les 54 cas d'HTA réno-vasculaires, 26 (48,1%) étaient constitués par les glomérulonéphrites aiguës (GNA) dont 65,4% (n=17/26) d'origine infectieuse streptococcique. L'association thérapeutique la plus retrouvée était le furosémide associé à un inhibiteur calcique (44,9%). La durée moyenne d'hospitalisation était de 15±23,9 jours. La survenue de complications concernait 20 patients (34,5%) dont la plus fréquente était l'œdème aigu du poumon (30%). L'évolution était favorable chez 65,51 % (38/58) des patients.

Conclusion : Nos résultats montrent la prédominance des causes Renovasculaires dans l'HTA de l'enfant notamment les glomérulonéphrites infectieuses d'où l'intérêt de la prévention et le traitement des infections streptococciques cutanées et des angines streptococciques.

Introduction: The prevalence of hypertension in children has increased significantly in recent decades. Studies show that it is increasingly present in developing countries, particularly in Africa.

Objectives: To study the epidemiological, clinical, therapeutic aspects and outcome of arterial hypertension in hospitalized children and adolescents.

Methodology: This was a multicentre descriptive retrospective study over a 3-year period (2019-2021), involving 58 patients with arterial hypertension who were hospitalised in pediatric reference centres: the Albert Royer children's hospital, the paediatrics department of the Aristide Le Dantec hospital and the paediatrics department of the Abass Ndao hospital.

Results: Hospital prevalence of arterial hypertension was 0.3%. The mean age at diagnosis was 11.4±3.5 years, with an M/F sex ratio of 1.9. The most frequent physical sign was renal oedema (77.6%). Among the 54 cases of renal hypertension, 26 (48.1%) were caused by acute glomerulonephritis (AGN), of which 65.4% (n=17/26) were of streptococcal infectious origin. The most common therapeutic combination was furosemide combined with a calcium channel blocker (44.9%). The average duration of hospital stay was 15±23.9 days. Complications occurred in 20 patients (34.5%), the most frequent of which was acute pulmonary oedema (30%). The outcome was favourable in 65.51% (38/58) of patients.

Conclusion: Our results show the predominance of Renovascular causes in children's hypertension including infectious glomerulonephritis, hence the interest of prevention and treatment of streptococcal skin and throat infections.

Management practices of Childhood Steroid Sensitive Nephrotic Syndrome among Paediatric Nephrologists/Paediatricians in Nigeria

D.C. Briggs — 2024-01-19

Aim: To describe the management practices for childhood nephrotic syndrome among paediatric nephrologists / paediatricians in centres offering paediatric renal services in Nigeria.

Method: A cross-sectional online survey was conducted between 5th December 2022 to 5th January 2023 among paediatricians / paediatric nephrologists in 35 facilities that manage children with nephrotic syndrome. The steroid-prescribing patterns for steroid-sensitive nephrotic syndrome (SSNS), steroid-sparing medications usage and in relapses were assessed.

Result: Out of respondents surveyed, 32 (91.4%) completed the online survey and they were from the six geopolitical zones in Nigeria. Two-fifths (40.6%) practised paediatrics/paediatric nephrology for ≥ 10 years and a half (50%) practised in federal teaching hospitals. For new-onset nephrotic syndrome, 84.4% of respondents would prescribe prednisolone at 60mg/m2/day, with an initial daily prednisolone duration of 4, 6, and 8 weeks in 15.6%, 37.5% and 28.1% respondents respectively and total prednisolone duration of 8, 12, and 16 weeks in 29.1%, 37.5% and 15.6% respectively. There were marked variations in the use of adjunct medications as well as the duration of steroid-sparing medications and prednisolone dosage and treatment duration in those with frequent and infrequent relapses (FRNS), steroid-dependent nephrotic syndrome (SDNS).

Conclusion: The management of new-onset steroid-sensitive nephrotic syndrome was considerably in-keeping with international guidelines. However, wide variations exist for the choice of steroid-sparing medications and treatment of relapses and SDNS, strengthening need for a national guideline and continuous training among paediatricians and nephrologists.

Xanthogranulomatous Pyelonephritis In A 7-year-old Nigerian Girl

Aliu Rasaki — 2024-01-19

Background: Xanthogranulomatous pyelonephritis (XGP) is a rare, recurrent and chronic infection of the kidney that can lead to irreversible damage of the entire renal parenchyma necessitating chronic renal replacement therapy if not diagnosed and treated early. Abdominal ultrasound and CT are both sensitive diagnostic tools.

Case report: We report a rare case of localised XGP in a 7-year-old Nigerian girl detected with ultrasound and open biopsy. She presented with recurrent high fever, recurrent left loin pain and recurrent dysuria of 1 year. The patient failed conservative management and eventually had partial nephrectomy. She is currently clinically stable with normal renal function test.

Discussion: Xanthogranulomatous pyelonephritis, a unilateral disease, usually presents with flank and abdominal pain, fever, abdominal mass, malaise, growth retardation, and has a laboratory features of urinary tract infections caused by necrotizing organisms.

Effect of Frequent Crises on the Glomerular Filtration Rate of Children with Sickle Cell Anaemia in South- South Nigeria

E.A. Joboy-Okei — 2024-01-19

Background: Sickle cell anaemia (SCA) is a major childhood problem worldwide that presents with varied clinical manifestations including renal impairments often manifesting with decreased glomerular filtration rate (GFR).

Materials and Methods: This study which was carried out at the University of Port Harcourt Teaching Hospital involved children with SCA in steady state and age and gender matched non SCA children who were being treated for minor ailments. It involved the use of questionnaire-based study and estimation of GFR of the children in both groups.

Results: A total of 140 children aged between 1 to 17 years were studied. Thirty-five (50.0%) subjects had three or more crises in the preceeding year while 29 (41.4%) had two or less crises in the preceeding year. Six (8.6%) have never had any crisis before this study. The mean estimated GFR for the subjects was 104.26mls/min/1.73m² while that of controls was 105.94mls/min/1.73m². Twenty-three (32.9%) of the subjects had decreased eGFR (< 90mls/min/1.73m²) compared to eight (11.4%) of the control.

Conclusion; Frequent crises in children with SCA could have long term impact on GFR. Therefore children with SCA should have regular follow up treatment in order to reduce the frequency of crises.