The role of infectious agents in the aetiology and pathogenesis of childhood nephrotic syndrome in Africa

The role of infections in the emergence of non-communicable diseases (NCDs): Compelling needs for novel strategies in the developing world

The emergence of non-communicable diseases (NCDs) follows multiple aetiological pathways requiring recognition for effective control and prevention. Infections are proving to be conventional, emerging and re-emerging aetiological factors for many NCDs. This review explores the possible mechanisms by which infections induce NCDs citing examples of studies in Africa and elsewhere where NCDs and infections are proposed or confirmed to be causally linked and also discusses the implications and challenges of these observations for science and medicine. The need to re-evaluate and expand early community and individual preventive and control strategies that will lead to reduction and even elimination of NCDs especially in Africa and other developing countries where infections are prevalent is highlighted.

Childhood renal disorders in Nigeria

The common childhood renal disorders in Nigeria are post-infectious acute glomerulonephritis (PIAGN), nephrotic syndrome, hypertension, congenital anomalies and urinary tract infection. Children with PIAGN often present with hypertension, circulatory overload and hypoalbuminaemia. Nephrotic syndrome is characterized by a paucity of minimal change and a poor prognosis. Posterior urethral valves and hydronephrosis are the most frequent congenital anomalies. Children with congenital anomalies present late with advanced disease. The commonest malignancy is nephroblastoma, but Burkitt's lymphoma of the kidney also occurs. Both acute and chronic renal failure present depressing and distressing clinical problems, with an aggressive course and a high morbidity and mortality. Poor socio-economy has adverse effects on the presentation, management and follow-up of Nigerian children with renal disorders.

Clinicopathological features of childhood nephrotic syndrome in Saudi Arabia

The clinicopathological features are described in 119 Arab children in Saudi Arabia with the nephrotic syndrome. The clinical and laboratory data are similar to those described in other parts of the world. However, mesangial proliferative glomerulonephritis (MesPGN) was found in 21 of 66 biopsies (31.8%), giving a frequency of 17.6% of all children with the nephrotic syndrome. Minimal-change nephrotic syndrome (MCNS) was diagnosed in 17 biopsies (25.8%) and in 58 patients (48.7%). Onset of the nephrotic syndrome was at less than 1 year of age in 17 patients (14.3%). Seven children had 11 episodes of peritonitis. Seven children had positive hepatitis B surface antigen (HBsAg) in their serum: renal biopsy carried out on four of them showed membranous glomerulonephritis (MGN) in three, and four of the seven patients developed end-stage renal disease (ESRD). There were nine deaths, all in patients with end-stage renal disease: six of the deaths occurred in infants. The pattern of childhood nephrotic syndrome in Saudi Arabia is different from the pattern in tropical countries.

Hepatitis B surface antigen associated nephrotic syndrome

Hepatitis B virus (HBV) has been reported in association with the nephrotic syndrome from different parts of the world, but its role as a cause of the pathological findings of nephrotic syndrome is still controversial. We report seven nephrotic children with positive hepatitis B markers in which members of their families were also positive for the markers but without clinical, renal or hepatic involvement. Four showed haematuria at onset and three developed hypertension later in the course of the disease. Only two were responsive to steroid therapy. Renal biopsy was performed in four, of whom three showed membranous nephropathy and the other showed mesangioproliferative glomerulonephritis. Four patients developed end-stage renal disease. We conclude that in our environment HBV, when detected in children with nephrotic syndrome, should not be considered as a chance finding, but may have a definite role in its pathogenesis. Moreover, the prognosis of HBV-associated nephrotic syndrome appears poor.