African Journal of Paediatric Nephrology

Acute kidney injury in neonates admitted to a tertiary institution in North Central Nigeria

O. Avong — 2025-02-07

Background:Acute kidney injury (AKI) may be defined as a sudden decline in kidney function or an inability of the kidney to maintain fluid and electrolyte homeostasis.AKI impacts significantly neonatal outcomes due to the functional immaturity of the kidneys. Both creatinine and cystatin C are endogenous markers used to determine estimated glomerular filtration rate, which is a measure of renal function

Aims: This study was carried out to determine the incidence of AKI(Acute kidney injury) in neonates admitted and the ability of creatinine and cystatin C to predict AKI.

Methodology: A prospective study was conducted involving one hundred and seventy-three neonates admitted at the (Special care baby unit) SCBU of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria over a period of five months between July and November 2020. The renal function of the babies was evaluated. The blood samples were taken on admission for serum cystatin C and serum creatinine and at 48 hours for serum creatinine. Cystatin C was analyzed by Goldsite protein analyzer which uses the nephelometry principle. Creatinine was analyzed by the Jaffe method.

Results: Fourteen (8.6%) of the neonates had AKI according to the neonatal KDIGO (kidney disease improving global outcomes) criteria. Using the Receiver operative curve, the cystatin C level at admission had a higher predictive ability to diagnose AKI, the AUC for cystatin C was 0.682 compared to 0.281 for creatinine.

Conclusion: Cystatin C is moderately predictive of AKI in neonates and is a better predictor of AKI, than creatinine among neonates.

Spectrum of renal abnormalities in children with sickle cell anaemia

NJ Iduoriyekemwen — 2025-02-07

Background: In Nigeria, the spectrum of renal abnormalities in children with sickle cell anaemia has not been extensively studied.

Objective: To determine the prevalence of various renal abnormalities (haematuria, hemoglobinuria, hyposthenuria, albuminuria glomerular filtration abnormalities and chronic kidney diseases) and their association with anaemia in children with sickle cell anaemia

Methods: A cross-sectional study of 146 children with sickle cell anaemia in steady state, aged 1- < 19 years, attending the Paediatric Haematology Outpatient Clinic at the University of Benin Teaching Hospital, Benin City, Nigeria. The method involved using interviewer-administered proforma, physical examination and determination of various renal parameters using urinalysis, urine microscopy, osmometer, urinometer, urine albumin creatinine ratio, and serum creatinine.

Results: The prevalence of the various renal abnormalities were, haematuria 10(6.8%), hemoglobinuria 9(6.2%), hyposthenuria 121(82.9%), microalbuminuria 51(34.9%), macroalbuminuria 6(4.1%), glomerular hyperfiltration 27(18.5%), glomerular hypofiltration 45(30.8%) and chronic kidney diseases 11(7.5%) The factors independently associated with anaemia were haemoglobinuria [odd ratio =8.3, 95% confidence interval of 1.970 -35.25(p = 0.009)], hyposthenuria [odd ratio= 0.1, 95% confidence interval of 0.047 -0.430 (p = 0.001)], haematuria [odd ratio 9.1 (95% confidence interval of 1.193 – 70.04 (p=0.06)] and albuminuria [odd ratio 2.9 (95% confidence interval of 1.006 – 8.611 p=0.06)].

Conclusion: In children with sickle cell anaemia, hyposthenuria is the most prevalent renal abnormality, followed by albuminuria and glomerular filtration abnormalities.

Renal biopsy in children presenting with renal disorders in a tertiary health facility in Nigeria

O T Adedoyin — 2025-02-07

Background: The practice of carrying out renal biopsies in children continues to evolve across the nation. However, the success rate has varied depending on the skills (trainee vs paediatric nephrologist), and the biopsy device among others. Thus, we aim to determine the success rate of renal biopsy in children presenting with renal disorders in University of Ilorin Teaching Hospital(UITH).

Materials and Methods: An audit of all renal biopsies done from January 2010 to December 2023 in children seen at UITH Nigeria was carried out. The audit covered the number of renal biopsies done, number of glomeruli harvested in each biopsy, the range and mean glomeruli obtained, indication for the biopsy, equipment used, and problems encountered. A biopsy was considered successful if a renal tissue specimen obtained at laboratory analysis was ≥ 5 glomeruli.

Results: A total of 66 children were biopsied comprising of 35 males and 31 females. The age range of the subjects was 2-18years with mean (SD) of 7.8±3.8 years. The range of glomeruli obtained was 1-56 with a mean of 12.7±11.3. There was no yield of renal tissue containing glomerulus in 15(22.7%) children while the remaining 51(77.3%) children had at least one glomerulus on histology. Based on the presence of ≥5 glomeruli, the procedure was successful in 42(63.6%) children.

Conclusion: A success rate of 63.6% over thirteen years was recorded in our study. However, 77.3% of our patients had at least one glomerulus on the histology.

Systemic lupus erythematosus in an adolescent Nigerian girl presenting as nephrotic syndrome.

Patrick A. Ekpebe — 2025-02-07

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect various organ systems, including the kidneys. Lupus nephritis (LN) is a major complication of SLE and can significantly impact the patient's prognosis.

Case report: We present the case of a 17-year-old girl diagnosed with LN class III+V. She presented with generalized body swelling, fatigue and reduced appetite. Laboratory investigations revealed proteinuria 3+, hematuria 2+, elevated antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA) antibodies, and decreased complement levels, consistent with a diagnosis of SLE. A kidney biopsy confirmed the diagnosis of LN class III+V. She responded to high dose methyl prednisolone, hydroxychloroquine and treatment, with a significant reduction in proteinuria and improvement in renal function. The patient is currently being closely monitored for any disease flare-ups or adverse effects of the medications.

Discussion: This case highlights the importance of early recognition and appropriate management of LN in adolescent patients with features of NS. The combination of corticosteroids and MMF has shown promising results in the treatment of this complex condition. Ongoing monitoring and a multidisciplinary approach are essential for the successful management of LN in this patient population.

Management of childhood steroid resistant nephrotic syndrome by paediatric nephrologists in Nigeria.

DC Briggs — 2025-02-07

Background: Steroid resistant nephrotic syndrome (SRNS) is a significant cause of morbidity and mortality in children. Management entails a prolonged course with varying investigations and immuno suppressants depending on practice of the Paediatric Nephrologists and affordability by the patients despite existing International guidelines.

Aim: To describe the management practices of Childhood SRNS among paediatric nephrologists / paediatricians in centres offering paediatric renal services in Nigeria.

Method:A cross-sectional online survey was conducted from 5^th December 2022 to 5^th January 2023 among paediatricians/paediatric nephrologists in 35 facilities that manage children with nephrotic syndrome in Nigeria using Google online questionnaire. The management including pattern of steroid and steroid-sparing medications usage in the management of SRNS was 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. The working definition of SRNS among respondents differed, with half (50%) defining SRNS as lack of remission after 8 weeks of prednisolone / prednisone at 2mg/kg/day or 60mg/m²/day and about one-third (28.1.%) and the remaining, one-fifth (21.9%) defining SRNS as lack of remission after 6 weeks of prednisolone/prednisone at 2mg/kg/day or 60mg/m²/day and lack of remission after 4 weeks of prednisolone/prednisone at 2mg/kg/day or 60mg/m²/day respectively. Majority (40.6%) rarely performed kidney biopsy following diagnosis of SRNS, 34.4% did most times while 9.4% did always. The top three choices of steroid sparing medications for SRNS were cyclophosphamide (37.5%), Cyclosporine A (28.1%) and Mycophenolate mofetil(28.1%) respectively. There were marked variations in the choice and duration of administration of steroid sparing medications, combination with low dose prednisolone, as well as the use of adjunct medications in SRNS.

Conclusion: We identified that some aspects of management of SRNS were not in keeping with international guidelines. Wide variations exist for the choice and duration of steroid-sparing medications, its' combination with low dose prednisolone and use of other adjunct medications, strengthening the need for a national guideline and continuous training among paediatricians and nephrologists.