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Recent reports from small studies in West Africa suggest that Black children may have high rate of steroid sensitivity nephrotic syndrome (SSNS) contrary to long held knowledge. Herein, we determined the proportion of children with idiopathic nephrotic syndrome (INS) who achieved complete remission with steroid therapy and identified factors associated with complete remission. We reviewed the medical records of 241 children with INS in two centres in Lagos from 2010 to 2019. We extracted demographic data, clinical features, laboratory values at the time of diagnosis, and receipt and response to steroids and other immunosuppressants. The median (interquartile range) age at diagnosis of INS was 5.1 (3.0-8.7) years and boys were 60.2% of the study population. Children with SSNS made up 85.9% (n = 207) of the study cohort. Among those aged 0-5 years, 92.6%were SSNS compared with 69.2% in those aged 11-17 years at the time of diagnosis. In addition, the proportion of children with SSNS increased from 73.8% between year 2010 and 2012 to 88.4% afterwards. Also, children with SSNS had lower serum creatinine (0.44 vs 0.70; p<0.001) and higher estimated glomerular filtration rate (101 vs 74.3 ml/min/1.73 m.sup.2 ; p = 0.008) at the time of diagnosis than those with steroid resistant nephrotic syndrome (SRNS). Among Black children in Lagos, the proportion with SSNS is comparable to proportions described in children of Asian and European descent. Furthermore, children with SSNS had lower serum creatinine and higher glomerular filtration rate than those with SRNS.

Background: Childhood nephrotic syndrome (NS) follows a chronic course in most children. However, little is known about the psychosocial burden of NS on the caregivers despite evidence that caregiver burden or impairment in their well-being may alter the outcome of chronic childhood illnesses. Objectives: To determine the frequency and predictors of significant caregiver burden and psychological distress among caregivers of children with NS. Design: A cross-sectional study. Setting: Two pediatric nephrology clinics in Lagos, Nigeria. Patients: We included primary caregivers of children with idiopathic NS for at least 6 months. Measurements: The primary outcomes were psychological distress and significant caregiver burden among caregivers. Methods: We interviewed caregivers using the 12-item General Health Questionnaire (GHQ-12) and the 6-item Zarit Burden Interview (ZBI-6). The GHQ-12 scores ≥ 3 and ZBI-6 scores ≥ 6 indicated psychological distress and significant caregiver burden, respectively. Results: The caregivers were mostly mothers (77.9%) and married (92.4%), whereas the children (n = 172) were mainly male (65.1%). Most of the children (n = 152; 88.4%) had steroid-sensitive NS including 24 (14%) children with frequent relapses or steroid dependence and 20 (11.6%) with steroid-resistant NS. Of the 172 caregivers, 53 (30.8%) and 30 (17.4%) reported psychological distress and significant burden, respectively. Caregivers of children in relapse had adjusted an odds ratio (aOR) with 95% confidence interval (CI) of 2.45 (1.05-5.67) and 3.30 (1.22-8.92) of psychological distress and significant caregiver burden, respectively. Furthermore, caregivers of male children and those who needed help paying for health care had an aOR of 4.61 (1.34-15.68) and 3.06 (1.06-8.87) of significant caregiver burden, respectively. Limitations: The study was limited by its cross-sectional design and the use of generic rather than disease-specific instruments. Conclusion: One in every 6 caregivers of children with idiopathic NS reported significant caregiver burden, and it was associated with psychological distress. Our findings underscore the need for psychosocial support for caregivers of children with NS, especially those with identifiable vulnerability.

Insufficient data to guide the authorities responsible for resource allocation and a focus on communicable diseases increase the challenges of care of children with kidney disease in resource-constrained settings like ours. This study was performed with the aim to describe the current spectrum of pediatric nephrology disease in a tertiary hospital in Sub-Saharan Africa and highlight the challenges encountered in their care. A 4-year retrospective review of pediatric renal admissions was carried out and the overall prevalence, disease-specific prevalence and mortality rates were determined. Results were compared with nationwide data. Kidney diseases accounted for 8.9 % of pediatric admissions with a prevalence of 22.3 admissions per 1000 child-admissions per year. Nephrotic syndrome, acute kidney injury and nephroblastoma accounted for almost 70 % of admissions. The overall mortality was 14.4 % with acute kidney injury accounting for 36 % of this. Chronic kidney disease was also associated with poor outcome. The spectrum of disease nationwide is similar with a wide variation in disease-specific prevalence between geographic regions. The prevalence of genetic and hereditary conditions was low. The prevalence of pediatric renal disease in our environment is on the increase and associated with significant morbidity and mortality. Late presentation and high treatment costs were limitations to care. Preventive nephrology, training of pediatric nephrologists and strengthening of health insurance schemes are advocated.

Steroid-resistant nephrotic syndrome (SRNS) is the most severe form of childhood nephrotic syndrome with an increased risk of progression to chronic kidney disease stage 5. Research endeavors to date have identified more than 80 genes that are associated with SRNS. Most of these genes regulate the structure and function of the podocyte, the visceral epithelial cells of the glomerulus. Although individuals of African ancestry have the highest prevalence of SRNS, especially those from Sub-Saharan Africa (SSA), with rates as high as 30–40% of all cases of nephrotic syndrome, studies focusing on the characterization and understanding of the genetic basis of SRNS in the region are negligible compared with Europe and North America. Therefore, it remains unclear if some of the variants in SRNS genes that are deemed pathogenic for SRNS are truly disease causing, and if the leading causes of monogenic nephrotic syndrome in other populations are the same for children in SSA with SRNS. Other implications of this lack of genetic data for SRNS in the region include the exclusion of children from the region from clinical trials aimed at identifying potential novel therapeutic agents for this severe form of nephrotic syndrome. This review underlines a need for concerted efforts to advance the genetic basis of SRNS in children in SSA. Such endeavors will complement global efforts at understanding the genetic basis of nephrotic syndrome.

Introduction: Reference values of oxygen saturation (SpO2) to guide care of low birth weight neonates have been obtained mainly from Caucasians. Data from African newborns are lacking. To determine the pre- and post-ductal SpO2values of low birth weight neonates within the first 72 h of life, compare SpO2values of moderate-late preterm and term low birth weight neonates and determine how mode of delivery affected SpO2in the first 24 h of life. Methodology: An observational descriptive study was carried out on apparently healthy low birth weight newborns weighing 1500 to ≤2499 g. Pre and post ductal SpO2values were recorded at the following hours of life: 10-24 h, >24-48 h and >48-72 h using a NONIN® pulse oximeter. Results: The ranges of pre- and post-ductal SpO2in the study were similar for both preterm and term neonates in the study (89%-100%). The mean (standard deviation [SD]) pre-ductal SpO2was 95.9% (2.3) and the mean (SD) post-ductal SpO2was 95.9% (2.1). There was a significant increase in pre-ductal SpO2from 10 to 24 h through >48-72 h of life (P = 0.027). The mode of delivery did not affect SpO2values within 10-24 h of life. Conclusion: The present study documented daily single pre- and post-ductal SpO2 values for preterm and term low birth weight neonates weighing 1500 g to <2500 g during the first 72 h of life. The overall range and mean pre- and post-ductal SpO2 were similar for both categories of stable low birth weight neonates in the study. There was no significant difference between SpO2ranges for late preterm compared to term low birth weight neonates. The results obtained could serve as guide in assessing SpO2of low birth weight neonates weighing between 1500 and 2499 g in the first 72 h of life.

Background Sickle cell anaemia (SCA) is associated with growth failure. However, recent reports indicate high rates of overweight or obesity among children with SCA in developed countries. It is unclear whether overweight or obesity is also common in children with SCA in developing countries. The objectives of the study were to determine the prevalence of overweight or obesity, wasting and stunting and identify predictors of wasting and stunting among children with SCA in Nigeria. Method Children with SCA attending a public-funded tertiary hospital clinic were studied. Weight, height, haemoglobin, haemoglobin fractions and white cell count were measured. Anthropometric values were converted to z scores and referenced to the WHO Child Growth Standards and WHO Reference 2007. The proportions with wasting, stunting and overweight or obesity were determined. Regression analysis was used to identify the predictors of wasting and stunting. Results Two hundred and thirty-three children [mean (±SD) age of 9.0 (±4.0) years, 60.9 % males] participated in the study. Wasting, stunting and overweight or obesity rates were 22.7 %, 11.6 % and 1.7 %, respectively. Boys and children from low socioeconomic class were 3.25 (1.45-7.29) and 2.42 (1.14-5.18) times more likely to be wasted respectively, while both wasting and stunting were more common with increasing age [adjusted OR of 1.33 (1.18-1.51) and 1.15 (1.01-1.32) respectively]. Sickle cell-related complications and intake of oral penicillin and hydroxyurea were not associated with wasting and stunting. Conclusion Overweight or obesity is uncommon while wasting and stunting are still prevalent in children with SCA in Lagos. The strongest predictors of wasting and stunting were older age, male gender and low socioeconomic status.

Background Limited data is available on kidney function in HIV-infected children in sub-Saharan Africa. In addition, malnutrition in these children further reduces the utility of diagnostic methods such as creatinine-based estimates of glomerular filtration rate. We determined the serum cystatin C level and estimated glomerular filtration rate of 60 antiretroviral-naïve, HIV-infected children and 60 apparently healthy age and sex matched children. Methods Serum cystatin C level was measured using enzyme-linked immunosorbent assay technique, while glomerular filtration rate was estimated using Filler's serum cystatin C formula. Student t test, Mann Whitney U test, Pearson chi square and Fisher's exact test were used, where appropriate, to test difference between groups. Results Compared to the controls, the HIV-infected group had significantly higher median (interquartile range) serum cystatin C levels {0.77 (0.29) mg/l versus 0.66 (0.20) mg/l; p = 0.025} and a higher proportion of children with serum cystatin C level >1 mg/l {10 (16.7%) versus one (1.7%); p = 0.004}. The HIV-infected children had a mean (± SD) eGFR of 96.8 (± 36.1) ml/min/1.73 m 2 compared with 110.5 (± 27.8) ml/min/1.73 m 2 in the controls (p = 0.021). After controlling for age, sex and body mass index, only the study group (HIV infected versus control) remained a significant predictor of serum cystatin C level (β = -0.216, p = 0.021). The proportion of HIV-infected children with eGFR <60 ml/min/1.73 m 2 was eight (13.3%) versus none (0%) in the control group (p = 0.006). However, the serum cystatin C level, eGFR and proportions of children with serum cystatin C level >1 mg/l and eGFR <60 ml/min/1.73 m 2 were not significantly different between the HIV-infected children with advanced disease and those with milder disease. Conclusions HIV-infected children in Nigeria have higher serum cystatin C level and lower eGFR compared to age and sex matched controls.

The modest decline in child mortality in Africa raises the question whether the pattern of diseases associated with acute kidney injury (AKI) in children in Nigeria has changed. A database of children, aged between one month and 16 years, with AKI (using modified pediatric RIFLE criteria) was reviewed. The cause of AKI was defined as the major underlying disease. The clinical and laboratory features of children with AKI who survived were compared to those who died. Of the 4 015 children admitted into Lagos University Teaching Hospital between July 2010 and July 2012, 70 episodes of AKI were recorded equalling 17.4 cases per 1000 children. The median age of the children with AKI was 4.8 (range 0.1-14.4) years and 68.6% were males. Acute kidney injury was present in 58 (82.9%) children at admission with 70% in 'failure' category. Primary kidney disease (38.6%), sepsis (25.7%) and malaria (11.4%) were the commonest causes. The primary kidney diseases were acute glomerulonephritis (11) and nephrotic syndrome (8). Nineteen (28.4%) children with AKI died. Need for dialysis [odds ratio: 10.04 (2.94-34.33)], white cell >15 000/mm(3) [odds ratio: 5.72 (1.65-19.89)] and platelet <100 000/mm(3) [odds ratio: 9.56 (2.63-34.77)] were associated with death. Acute kidney injury is common in children admitted to hospitals. The common causes remain primary kidney diseases, sepsis and malaria but the contribution of sepsis is rising while malaria and gastroenteritis are declining. Acute kidney injury-related mortality remains high.

ObjectivesThe use of Highly Active Anti-Retroviral Therapy (HAART) as a treatment modality has led to an increase in the survival of people living with Human immunodeficiency virus (HIV) infection with accompanying overall increase in the frequency of some non-communicable diseases; particularly kidney diseases owing to drug toxicity, co-morbid chronic medical conditions and co-infection with other chronic viral illnesses.1 2 HIV infection is a known risk factor for kidney disease and Makurdi, Nigeria has a huge burden of the infection.3 This study determined the prevalence and risk factors of glomerular and proximal tubular dysfunction among children living with HIV attending tertiary health institutions in Makurdi, Nigeria.MethodsThis was a cross-sectional analytical study involving children aged 18 months to 17 years distributed into 91 children living with HIV and 91 age and sex-matched uninfected children for comparison. Relevant information was obtained from administered questionnaire and clinical records of these children. Blood samples for serum creatinine and urine samples for β2-microglobulin, albumin and creatinine were collected from each study participant. Data was analysed using SPSS version 23.0 and level of significance was taken as <0.05.ResultsThe prevalence of albuminuria was 65.9% (n = 60) among children living with HIV and 64.8% (n = 59) among comparison group (p = 0.876). The prevalence of reduced GFR was 5.5% (n = 5) among children living with HIV and 1.1% (n = 1) among the comparison group (p = 0.211).Table 1 shows overall prevalence of glomerular dysfunction was 4.4% (n = 4) among children living with HIV compared with 0% (n = 0) among comparison group (p = 0.115).Abstract 6425 Table 1Figure 1 shows prevalence of proximal tubular dysfunction was 93.4% (n = 85) among children living with HIV compared with 73.6% (n = 67) among comparison group (p = 0.001)Abstract 6425 Figure 1Prevalence of proximal tubular dysfunction among study participantsThe use of HAART for less than 60 months was identified as a risk factor for albuminuria [OR 2.69 (CI 1.040–6.958) p = 0.041]. Risk factors associated with reduced GFR were older age group [OR 0.670 (CI 0.513–0.876) p = 0.003], use of HAART for <60 months [OR 0.958 (CI 0.920 – 0.998), p = 0.038], and use of Tenofovir-based HAART regimen [OR 0.111 (CI 0–0.847) p = 0.032]. HIV infection was the only factor associated with proximal tubular dysfunction [OR 5.075 (CI 1.962 – 13.124) p = 0.001].ConclusionGlomerular and proximal tubular dysfunction are common among children living with HIV attending tertiary health institutions in Makurdi.ReferencesPhair J, Palella F. Renal disease in HIV infected individuals. Curr Opin HIV AIDS. 2011;6(4):285–28.Smith C, Sabin CA, Lundgren JD, Thiebaut R, Weber R, Law M, et al. Factors associated with specific causes of death amongst HIV-positive individuals in the D:A:D Study. AIDS. 2010;24(10):1537–1548.National Agency for the Control of HIV/AIDS (NACA). Nigeria Prevalence Rate. Available at: https://naca.gov.ng/nigeria-prevalence-rate/

Congenital malaria is an important cause of morbidity and mortality in newborns. Signs and symptoms of congenital malaria are non-specific and could be confused with Neonatal sepsis. There has been a recent decline in malaria burden worldwide attributed to a new strategy recommended by the WHO including the use of intermittent preventive treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPT-SP) during pregnancy, long lasting insecticide treated nets, malaria case management with Artemisinin-based combination therapy etc. This study sets out to determine the effect of these changes on the prevalence of congenital malaria in two centres in Lagos, Nigeria. Using a cross-sectional observational descriptive design, a total of 291 mother and newborn pairs were enrolled from an urban area and a semi-rural area in Lagos between April and October 2014. About three-fifths of the total study population was derived from the urban centre. A pre-designed questionnaire was used to extract basic physical and demographic information such as the use of IPT-SP during pregnancy. Malaria microscopy was carried out on the maternal blood samples, and the corresponding newborns’ heel prick and cord blood samples while the placenta tissues were examined for malaria pigments. Malaria parasitaemia, cord blood and congenital malaria were 0.34%, 0% and 0% respectively while that of placental malaria pigmentation was 18.9%. Placental malaria incidence was less in mothers who received IPT-SP in pregnancy ( p  = 0.016). Placental malaria incidence was higher in mothers ≤ 24 years ( p  = 0.044) and the less educated women had a higher prevalence of placental malaria ( p  = 0.001). The incidence of placental malaria was higher in the semi-rural area (92.7% vs. 7.3%, p  ≤ 0.0001). Newborns of mothers with placental malaria had lower birth weight (2881.8 vs. 3100.7 g, p  = 0.020) and smaller head circumference (34.3 vs. 35.1 cm, p  = 0.006). This study demonstrated a significant decline in the prevalence of congenital malaria reflecting the recently reported decline in the burden of malaria in the general population in Africa. Use of IPT-SP during pregnancy, urban area residence and higher educational status appear to have been protective against malaria. A regular surveillance is however necessary considering the dynamics involved in malaria drug resistance.