1
|
Xavier AM, Kumar AS. Acute kidney injury in the tropics. Trop Doct 2024; 54:98-107. [PMID: 38247316 DOI: 10.1177/00494755231222956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Acute kidney injury in the Tropics is strikingly different from that in developed countries in terms of aetiology and presentation. Moreover, there are radical differences between the developed world and the economically poorer regions within the tropics. Infections are the number one cause leading to significant mortality. This article reviews the most common causes of acute kidney injury in the Tropics and describes its management briefly.
Collapse
Affiliation(s)
- Asha Maria Xavier
- Assistant Professor, Department of Internal Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Ag Sravan Kumar
- Assistant Professor, Department of Orthopaedics, Shri Sathya Sai Medical College and Research Institute, Chengalpet, Tamil Nadu, India
| |
Collapse
|
2
|
Anders HJ, Kitching AR, Leung N, Romagnani P. Glomerulonephritis: immunopathogenesis and immunotherapy. Nat Rev Immunol 2023; 23:453-471. [PMID: 36635359 PMCID: PMC9838307 DOI: 10.1038/s41577-022-00816-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 01/14/2023]
Abstract
'Glomerulonephritis' (GN) is a term used to describe a group of heterogeneous immune-mediated disorders characterized by inflammation of the filtration units of the kidney (the glomeruli). These disorders are currently classified largely on the basis of histopathological lesion patterns, but these patterns do not align well with their diverse pathological mechanisms and hence do not inform optimal therapy. Instead, we propose grouping GN disorders into five categories according to their immunopathogenesis: infection-related GN, autoimmune GN, alloimmune GN, autoinflammatory GN and monoclonal gammopathy-related GN. This categorization can inform the appropriate treatment; for example, infection control for infection-related GN, suppression of adaptive immunity for autoimmune GN and alloimmune GN, inhibition of single cytokines or complement factors for autoinflammatory GN arising from inborn errors in innate immunity, and plasma cell clone-directed or B cell clone-directed therapy for monoclonal gammopathies. Here we present the immunopathogenesis of GN and immunotherapies in use and in development and discuss how an immunopathogenesis-based GN classification can focus research, and improve patient management and teaching.
Collapse
Affiliation(s)
- Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.
| | - A Richard Kitching
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
- Department of Nephrology, Monash Health, Clayton, VIC, Australia
- Department of Paediatric Nephrology, Monash Health, Clayton, VIC, Australia
| | - Nelson Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Paola Romagnani
- Department of Experimental and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| |
Collapse
|
3
|
Butt N, Ahmed E. Falciparum malaria associated acute kidney injury with polyneuropathy and intra-arterial thrombosis (stroke). Eur J Med Res 2022; 27:2. [PMID: 34991710 PMCID: PMC8734130 DOI: 10.1186/s40001-021-00627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is still major problem in developing countries, such as Pakistan. Besides fever, body ache and vomiting it can present with acute kidney injury, proteinuria, hematuria and cerebral manifestations which are more common with falciparum malaria. Neurological manifestations are rare presentation of malaria and should be consider in patients who are admitting with features of neuropathy and stroke. CASE PRESENTATION We describe an unusual case of falciparum malaria, complicated by acute kidney injury who developed Polyneuropathy and intra-arterial thrombosis in middle cerebral artery territory. Our patient recovered his renal functions during admission and recovered his power and sensation in his limbs as well after 1 month. CONCLUSION Malaria cause neurological manifestations including axonal and sensory neuropathy, cerebral venous and arterial thrombosis, PMNS, cerebellar signs and symptoms, psychosis, etc. With prompt diagnosis and early treatment they can be cure and regain their motor and sensory functions to normal level.
Collapse
Affiliation(s)
- Nausheen Butt
- Sindh Institute of Urology and Transplant, Karachi, Sindh, Pakistan.
| | - Ejaz Ahmed
- Sindh Institute of Urology and Transplant, Karachi, Sindh, Pakistan
| |
Collapse
|
4
|
Amoura A, Moktefi A, Halfon M, Karras A, Rafat C, Gibier JB, Gleeson PJ, Servais A, Argy N, Maillé P, Belenfant X, Gueutin V, Delpierre A, Tricot L, El Karoui K, Jourde-Chiche N, Houze S, Sahali D, Audard V. Malaria, Collapsing Glomerulopathy, and Focal and Segmental Glomerulosclerosis. Clin J Am Soc Nephrol 2020; 15:964-972. [PMID: 32444394 PMCID: PMC7341769 DOI: 10.2215/cjn.00590120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Malaria, a potentially life-threatening disease, is the most prevalent endemic infectious disease worldwide. In the modern era, the spectrum of glomerular involvement observed in patients after malarial infections remains poorly described. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We therefore performed a retrospective multicenter study to assess the clinical, biologic, pathologic, and therapeutic characteristics of patients with glomerular disease demonstrated by kidney biopsy in France within 3 months of an acute malaria episode. RESULTS We identified 23 patients (12 men), all but 1 of African ancestry and including 10 patients with concomitant HIV infection. All of the imported cases were in French citizens living in France who had recently traveled back to France from an endemic area and developed malaria after their return to France. Eleven patients had to be admitted to an intensive care unit at presentation. Plasmodium falciparum was detected in 22 patients, and Plasmodium malariae was detected in 1 patient. Kidney biopsy was performed after the successful treatment of malaria, a mean of 24 days after initial presentation. At this time, all patients displayed AKI, requiring KRT in 12 patients. Nephrotic syndrome was diagnosed in 17 patients. Pathologic findings included FSGS in 21 patients and minimal change nephrotic syndrome in 2 patients. Among patients with FSGS, 18 had collapsing glomerulopathy (including 9 patients with HIV-associated nephropathy). In four patients, immunohistochemistry with an antibody targeting P. falciparum histidine-rich protein-2 demonstrated the presence of the malaria antigen in tubular cells but not in podocytes or parietal epithelial cells. An analysis of the apoL1 risk genotype showed that high-risk variants were present in all seven patients tested. After a mean follow-up of 23 months, eight patients required KRT (kidney transplantation in two patients), and mean eGFR for the other patients was 51 ml/min per 1.73 m2. CONCLUSIONS In patients of African ancestry, imported Plasmodium infection may be a new causal factor for secondary FSGS, particularly for collapsing glomerulopathy variants in an APOL1 high-risk variant background.
Collapse
Affiliation(s)
- Ariane Amoura
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France.,Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
| | - Anissa Moktefi
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France.,Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Département de Pathologie, Créteil, France
| | - Matthieu Halfon
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Service de Néphrologie, Paris, France
| | - Alexandre Karras
- Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Néphrologie, Paris, France.,Faculté de Médecine Paris-Descartes, Université de Paris, Paris, France
| | - Cédric Rafat
- Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France
| | - Jean-Baptiste Gibier
- University of Lille, Centre Hospitalier Universitaire de Lille, Institut de Pathologie, Centre de Biologie Pathologie, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1172, Lille, France
| | - Patrick J Gleeson
- Institut National de la Santé et de la Recherche Médicale U1149, Immunoreceptors and Renal Immunopathology Laboratory, Université Diderot, Paris, France.,Royal College of Physicians of Ireland, Division of Nephrology, Dublin, Republic of Ireland
| | - Aude Servais
- Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Paris, France
| | - Nicolas Argy
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Laboratoire de Parasitologie-Mycologie Médicale, Centre National de Référence du Paludisme, Paris, France.,Institut pour la Recherche et le Développement, Université de Paris, Faculté de Pharmacie, Mère et enfant en milieu tropical Unité Mixte de Recherche 261, Paris, France
| | - Pascale Maillé
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Département de Pathologie, Créteil, France
| | - Xavier Belenfant
- Groupe Hospitalier Grand Paris Nord Est, Hôpital André Grégoire, Service de Néphrologie-Dialyse, Montreuil, France
| | - Victor Gueutin
- Association pour l'Utilisation du Rein Artificiel, Service de Néphrologie-Dialyse, Association pour l'Utilisation du Rein Artificiel Paris Plaisance, Paris, France
| | - Alexia Delpierre
- Hôpital Duchenne, Service de Néphrologie et Médecine Interne, Boulogne sur Mer, France
| | - Leila Tricot
- Hôpital Foch, Service de Néphrologie, Transplantation Rénale et Dialyse, Suresnes, France
| | - Khalil El Karoui
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France.,Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
| | - Noémie Jourde-Chiche
- Aix Marseille University, Institut National de la Santé et de la Recherche Médicale, Institut national de recherche pour l'agriculture, l'alimentation et l'environnement, Centre de recherche en CardioVasculaire et Nutrition, Assistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - Sandrine Houze
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Laboratoire de Parasitologie-Mycologie Médicale, Centre National de Référence du Paludisme, Paris, France.,Institut pour la Recherche et le Développement, Université de Paris, Faculté de Pharmacie, Mère et enfant en milieu tropical Unité Mixte de Recherche 261, Paris, France
| | - Dil Sahali
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France.,Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
| | - Vincent Audard
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Créteil, France .,Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France
| |
Collapse
|
5
|
Wu J, Li P, Chen Y, Yang XH, Lei MY, Zhao L. Hypereosinophilia, mastectomy, and nephrotic syndrome in a male patient: A case report. World J Clin Cases 2019; 7:3145-3152. [PMID: 31624767 PMCID: PMC6795739 DOI: 10.12998/wjcc.v7.i19.3145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/03/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hypereosinophilia (HE) is a heterogeneous disease of unknown etiology in which tissue and organ injury is inflicted by excess numbers of circulating or infiltrating eosinophils. Herein, we describe a patient with rare organ damage due to HE and review the pertinent literature.
CASE SUMMARY A 43 year-old Chinese man with a 13-year history of eosinophilia and shortness of breath for 7 d presented to our hospital. During the course of his illness, the patient variably presented with gastrointestinal symptoms, eczema, vitiligo, mastitis, joint symptoms, nephrotic syndrome, and interstitial pneumonia. The chronic mastitis proved burdensome, necessitating bilateral mastectomy. HE was diagnosed by repeat bone marrow biopsy, and a kidney biopsy showed focal segmental glomerulosclerosis. Intermittent steroidal therapy is typically initiated to relieve such symptoms, although relapse and organ involvement often ensue once treatment is withdrawn. We administered methylprednisolone sodium succinate (40 mg/d) intravenously for 3 d, followed by oral tablets at the same dose. Subsequent computed tomography (CT) of the chest CT showed relative improvement of the interstitial pneumonia. The patient is currently on a continuous regimen of oral steroid, and his condition is stable.
CONCLUSION HE is heterogeneous condition. This is the first reported case of bilateral mastectomy in a male patient with longstanding HE.
Collapse
Affiliation(s)
- Jian Wu
- Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Peng Li
- Department of Respiratory Medicine, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yu Chen
- Department of Respiratory Medicine, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiang-Hong Yang
- Department of Pathology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Meng-Yun Lei
- Department of Endocriology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Li Zhao
- Department of Respiratory Medicine, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| |
Collapse
|
6
|
Husain NE, Ahmed MH, Almobarak AO, Noor SK, Elmadhoun WM, Awadalla H, Woodward CL, Mital D. HIV-Associated Nephropathy in Africa: Pathology, Clinical Presentation and Strategy for Prevention. J Clin Med Res 2018; 10:1-8. [PMID: 29238427 PMCID: PMC5722038 DOI: 10.14740/jocmr3235w] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/06/2017] [Indexed: 01/28/2023] Open
Abstract
The human immunodeficiency virus (HIV) infection can lead to progressive decline in renal function known as HIV-associated nephropathy (HIVAN). Importantly, individuals of African ancestry are more at risk of developing HIVAN than their European descent counterparts. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "HIVAN" and "pathology and clinical presentation", in addition to "prevalence and risk factors for HIVAN", with special emphasis on African countries for any articles published between 1990 and 2017. HIVAN is characterized by progressive acute renal failure, proteinuria and enlarged kidneys. A renal biopsy is necessary to establish definitive diagnosis. Risk factors are male gender, low CD4 counts, high viral load and long use of combined antiretroviral medication (cART). There is a wide geographical variation in the prevalence of HIVAN as it ranges from 4.7% to 38% worldwide and little published literature is available about its prevalence in African nations. Microalbuminuria is a common finding in African populations and is significantly associated with severity of HIV disease progression and CD4 count less than 350 cells/µL. Other clinical presentations in African populations include acute kidney injury (AKI), nephrotic syndrome and chronic kidney disease. The main HIV-associated renal pathological lesions were focal segmental glomerulosclerosis, mainly the collapsing form, acute interstitial nephritis (AIN), and immune complex-mediated glomerulonephritis (ICGN). HIV infection-induced transcriptional program in renal tubular epithelial cells as well as genetic factors is incriminated in the pathogenesis of HIVAN. This narrative review discusses the prevalence, presentation, pathogenesis and the management of HIVAN in Africa. In low resource setting countries in Africa, dealing with HIV complications like HIVAN may add more of a burden on the health system (particularly renal units) than HIV medication itself. Therefore, the obvious recommendation is early use of cART in order to decrease risk factors that lead to HIVAN.
Collapse
Affiliation(s)
- Nazik Elmalaika Husain
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Ahmed O. Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Sufian K. Noor
- Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Wadie M. Elmadhoun
- Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Clare L. Woodward
- Department of HIV and Blood Borne Viruses, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Dushyant Mital
- Department of HIV and Blood Borne Viruses, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| |
Collapse
|
7
|
Silva GBD, Pinto JR, Barros EJG, Farias GMN, Daher EDF. Kidney involvement in malaria: an update. Rev Inst Med Trop Sao Paulo 2017; 59:e53. [PMID: 28793022 PMCID: PMC5626226 DOI: 10.1590/s1678-9946201759053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/22/2017] [Indexed: 11/30/2022] Open
Abstract
Malaria is an infectious disease of great importance for Public Health, as it is the
most prevalent endemic disease in the world, affecting millions of people living in
tropical areas of the globe. Kidney involvement is relatively frequent in infections
by P. falciparum and P. malariae, but has also been
described in the infection by P. vivax. Kidney complications in
malaria mainly occur due to hemodynamic dysfunction and immune response. Liver
complications leading to hepatomegaly, jaundice and hepatic dysfunction can also
contribute to the occurrence of acute kidney injury. Histologic studies in malaria
also evidence glomerulonephritis, acute tubular necrosis and acute interstitial
nephritis. It is also possible to find chronic kidney disease associated with
malaria, mainly in those patients suffering from repeated episodes of infection.
Plasmodium antigens have already been detected in the glomeruli, suggesting a direct
effect of the parasite in the kidney, which can trigger an inflammatory process
leading to different types of glomerulonephritis. Clinical manifestations of kidney
involvement in malaria include proteinuria, microalbuminuria and urinary casts,
reported in 20 to 50% of cases. Nephrotic syndrome has also been described in the
infection by P. falciparum, but it is rare. This paper highlights
the main aspects of kidney involvement in malaria and important findings of the most
recent research addressing this issue.
Collapse
Affiliation(s)
- Geraldo Bezerra da Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil
| | - José Reginaldo Pinto
- Universidade de Fortaleza, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil
| | - Elvino José Guardão Barros
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Rio Grande do Sul, Brazil
| | - Geysa Maria Nogueira Farias
- Universidade de Fortaleza, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil
| | | |
Collapse
|
8
|
Abstract
Glomerular diseases are common and important. They can arise from systemic inflammatory or metabolic diseases that affect the kidney. Alternately, they are caused primarily by local glomerular abnormalities, including genetic diseases. Both intrinsic glomerular cells and leukocytes are critical to the healthy glomerulus and to glomerular dysregulation in disease. Mesangial cells, endothelial cells, podocytes, and parietal epithelial cells within the glomerulus all play unique and specialized roles. Although a specific disease often primarily affects a particular cell type, the close proximity, and interdependent functions and interactions between cells mean that even diseases affecting one cell type usually indirectly influence others. In addition to those cells intrinsic to the glomerulus, leukocytes patrol the glomerulus in health and mediate injury in disease. Distinct leukocyte types and subsets are present, with some being involved in different ways in an individual glomerular disease. Cells of the innate and adaptive immune systems are important, directing systemic immune and inflammatory responses, locally mediating injury, and potentially dampening inflammation and facilitating repair. The advent of new genetic and molecular techniques, and new disease models means that we better understand both the basic biology of the glomerulus and the pathogenesis of glomerular disease. This understanding should lead to better diagnostic techniques, biomarkers, and predictors of prognosis, disease severity, and relapse. With this knowledge comes the promise of better therapies in the future, directed toward halting pathways of injury and fibrosis, or interrupting the underlying pathophysiology of the individual diseases that lead to significant and progressive glomerular disease.
Collapse
Affiliation(s)
- A. Richard Kitching
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Department of Nephrology, and
- Department of Pediatric Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
| | - Holly L. Hutton
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Department of Nephrology, and
| |
Collapse
|
9
|
Okpechi I, Swanepoel C, Duffield M, Mahala B, Wearne N, Alagbe S, Barday Z, Arendse C, Rayner B. Patterns of renal disease in Cape Town South Africa: a 10-year review of a single-centre renal biopsy database. Nephrol Dial Transplant 2010; 26:1853-61. [PMID: 20980357 DOI: 10.1093/ndt/gfq655] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The patterns of glomerular diseases have been widely reported from different regional and national biopsy registries worldwide. However, there are scant studies on the epidemiology of biopsy-proven renal disease, particularly glomerular diseases in sub-Saharan Africa. METHODS We retrospectively analysed the reports of 1284 native renal biopsies, reviewed by the same pathologist and performed at the Groote Schuur Hospital in Cape Town from 1 January 2000 to 31 December 2009. RESULTS The mean age of all the patients biopsied was 36.8 ± 14.0 years with 61.8% of the patients being under 40 years of age. There was a preponderance of females (54.8%). There were more coloured patients (53.7%) than blacks (42.2%) or whites (3.9%). The frequencies of clinical indications for a renal biopsy were nephrotic range proteinuria (52.5%), acute renal failure (21.3%), asymptomatic urinary abnormalities (13.6%), chronic renal failure (6.4%), acute nephritic syndrome (5.8%) and haematuria (0.3%). The frequencies of the primary glomerulonephritis (GN) include mesangiocapillary GN (20.4%), mesangial proliferative GN (19.2%), membranous GN (18.5%), crescentic and necrotizing GN (11.4%), focal and segmental glomerulosclerosis (10.5%), post-infectious GN (8.2%), minimal change disease (6.0%) and IgA nephropathy (5.8%). Lupus nephritis was the most frequent secondary glomerular disease (39.0%) and was also the most frequent cause of the nephrotic range proteinuria (17.2%). HIV-associated nephropathy increased from 6.6% in 2000 to 25.7% in 2009 (P < 0.0001). CONCLUSION Our data are an important contribution to the epidemiology of renal disease in Africa. We hope that this will form the basis for developing a renal biopsy registry in South Africa and across the continent.
Collapse
Affiliation(s)
- Ikechi Okpechi
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Observatory, 7925, Cape Town, South Africa.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
The contrasting characteristics of acute kidney injury in developed and developing countries. ACTA ACUST UNITED AC 2008; 4:138-53. [DOI: 10.1038/ncpneph0722] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 10/31/2007] [Indexed: 01/07/2023]
|