Editorial Note: Welcome to Volume 21 and the year 2018

African Journal of Nephrology (AJN) has completed a full year of operation as a web-based journal. After addressing a few teething problems, the journal is now running smoothly. I wish to thank reviewers, readers and the members of the editorial board for having participated in this endeavour.On behalf of the editorial board, I wish to thank all colleagues who have chosen to submit their valuable work to our journal. A special welcome and thanks to contributors who have submitted their manuscript in French, with an English abstract. They ensure that AJN remains a representative vehicle for nephrology research output in Africa.Volume 20, for the year 2017, has now given way to Volume 21, which will include publications throughout the year 2018. As a tribute, I wish to summarize few highlights of Volume 20. The story of the African Association of Nephrology (AFRAN) by Prof Rashad Barsoum, the founding president of AFRAN, is a very good record of the development of nephrology in Africa. The review of renal physiology in patients with potassium disorders by Prof Mitch Halperin and the review of focal and segmental glomerulosclerosis by Prof John Feehally are excellent updates of the two topics. Original articles and case reports from contributors from various African regions are testament to the active production of nephrology knowledge in Africa.Finally, congress proceedings of the AFRAN Congress in March 2017 in Yaoundé (Cameroon) and of the Southern African Transplantation Society Congress in September 2017 in Durban (South Africa) are excellent records of high quality nephrology meetings in Africa.As we are continuing to digitize and preserve our past, I wish to invite everyone to read our archive of publications. I urge everyone who may have copies of old AJN issues or manuscripts that are missing in the archive, to forward them to us to ensure that we make all our past papers available online.In the beginning, AJN started as a newsletter, published by the late Prof Salma Suleiman of Sudan. To complete the AJN archive, we hope to include the past newsletters as a tribute to the late Prof Suleiman. We urge anyone having any copies of the newsletter to forward it to AJN.As in Volume 20 in 2017, Volume 21 will consist of a single issue and include all publications for 2018. They will be added throughout the year as they are accepted for publication. We should expect exciting reviews by experts as in our previous volumes as well as special articles. For our legacy project that was started by Prof Rashad Barsoum, first AFRAN President, we will request the subsequent AFRAN presidents to each submit a review of the period of their tenure. As in the past, we expect to publish original articles as well as interesting case reports, and we encourage regional and national societies to submit the abstracts from their conference proceedings for publication.Finally, I wish to take this opportunity to express my best wishes for the year 2018 to all contributors, reviewers and readers.Alain G AssoungaEditor-in-Chie

Editorial note: welcome to Volume 23 and the year 2020

The Editorial Board of African Journal of Nephrology (AJN) and I wish all readers, contributors and reviewers a very happy and successful year 2020. The year 2019 was a very productive year for AJN and the African Association of Nephrology (AFRAN). The 2019 AFRAN congress, held from 25 to 29 September 2019 in Mombasa (Kenya), was a very successful one, with the participation of hundreds of delegates from all regions of Africa. The congress was held in partnership with the Kenya Renal Association and the African Paediatric Nephrology Association (AFPNA). The main congress was preceded by several successful courses. Prof Antony Were from Kenya was elected President of AFRAN. The next AFRAN congress will be held next year in Côte d’Ivoire. In 2019, we published excellent reviews covering global disparities in kidney disease and its treatment as well as the use of data from renal registries in randomised controlled trials. We therefore encourage our readers to participate in the collection of data for registries as well as to make use of registry data for research. The AJN 2019 volume also published excellent original articles that showcased the strength of clinical nephrology research in various regions of Africa. The year 2020 is expected to witness several national and regional nephrology meetings. I urge all convenors to use AJN to publicize their meetings, as well as publish their proceedings. The World Congress of Nephrology will take place in Abu Dhabi from 26 to 29 March 2020. This year, World Kidney Day is scheduled for Thursday, 12 March 2020. The theme is “Kidney Health for Everyone Everywhere – from Prevention to Detection and Equitable Access to Care”. I am confident that, in 2020, AJN will continue the trends set in the previous year, by publishing outstanding in-depth review articles as well as interesting original research articles. Finally, I am pleased to announce that this year, the South African Renal Society Congress will take place in Durban at the International Convention Centre, from 25-29 November 2020. The theme of the congress is “Big Data and Access to Quality Renal Care”. As President of the Local Organising Committee, I invite everyone to SARS Congress 2020. WOZA – DURBAN! Alain G AssoungaEditor-in-Chie

Editorial note: welcome to Volume 22 and the year 2019

On behalf of the Editorial Board of the African Journal of Nephrology (AJN), I wish all readers, contributors and reviewers a happy and successful 2019. We have successfully completed our third year as an online Journal.  We sincerely thank everyone who contributed to this achievement.  With your support, we will achieve more milestones.I wish to take this opportunity to remind all our readers and contributors that AJN is the official journal of the African Association of Nephrology (AFRAN).During 2019, AFRAN, in partnership with the Kenya Renal Association, will convene its biennial congress in Mombasa, Kenya, from 25–29 September. Let us give Professor Were, AFRAN President-Elect, and the Kenya Renal Association all the support they need.  Through our participation, we will ensure that the AFRAN congress is a great success.This year, the nephrology calendar is fully loaded. Besides various local and regional congresses, including the AFRAN Congress, at the global level the World Congress of Nephrology will be held in Melbourne, Australia, from 12–15 April 2019. World Kidney Day is also fast approaching. It will be celebrated as usual, on the second Thursday of March, 14 March 2019. The theme this year is “Kidney Health for Everyone Everywhere”.In Volume 21 in 2018, AJN published excellent original articles from various regions of Africa, including East, West and Southern Africa. The proceedings of the 2018 South African Renal Congress are also part of AJN Volume 21. Of note, also in Volume 21, the publication of the 2016 South Africa Renal Registry Annual Report gives a picture of renal replacement therapy in an African country.In 2019, in Volume 22, AJN expects to continue to publish excellent original articles as well as review articles to display research outputs from our contributors. We invite researchers to continue to submit their best work, and nephrology societies to submit the proceedings of their local and regional congresses.Once again, Happy 2019 and we look forward to seeing you in Melbourne in April and Mombasa in September!KARIBUNI SANA AFRAN Congress in Kenya!Alain G AssoungaEditor-in-Chie

Editorial note: Welcome to the year 2023 and Volume 26 - Are we ready for the next disaster?

On behalf of the Editors and the Editorial Board of the African Journal of Nephrology (AJN), I wish all authors, reviewers and readers a blessed and prosperous New Year! I wish to express my sincere gratitude to Prof Fergus Caskey, for his great contribution to AJN as Associate Editor. He left the Journal last year. We wish him great success in his new and future endeavours. I am proud of the AJN publications for Volume 25, published last year. Indeed, AJN is progressing very well to establish itself as the journal of choice for publishing African nephrology research. In 2022, we published three excellent reviews covering hyperuricaemia in chronic kidney disease, the measurement of GFR in Africa and a road map for kidney care in Africa. Eighteen original articles from diverse African countries were also published last year. We were pleased to publish the 2020 annual report for the South African Renal Registry, and we call on other African countries to submit their registry reports for publication. The international community has decreed that this year’s World Kidney Day theme is: “Kidney health for all, preparing for the unexpected, supporting the vulnerable.” This theme is pertinent and should assist with the progress toward the “Health for all” goal. In nephrology, the unexpected can be very expensive. From the management of hypovolaemia to dialysis in acute kidney injury, how ready are we? At an individual level, a family level, societal level, regional level, country and continental level and finally, at a global level, we need to prepare to deal with disasters. Countries often rely on NGOs such as Médecins Sans Frontières, Gift of the Givers and others to do the work. We should commend these NGOs for their assistance. In Africa, government institutions need to improve their capacity for disaster management. The nephrology community in Africa, through AFRAN, could play a significant role together with other regional organisations. This role will require a commitment like the one we proposed in a book we published ten years ago, “Kidney disease in an African setting” [1]. The closest community to the disease must take the lead, as time is of the essence. I am encouraged by the level of cooperation in AFRAN during the COVID-19 pandemic, which produced guidelines for managing COVID-19 in Africa [2]. We should emulate that effort as a legacy of the COVID-19 experience and use the AFRAN committee structures to put together projects that bring positive progress to kidney care in Africa. I propose that this initiative be named the Antony Were COVID Legacy initiative, inspired by and in honour of our AFRAN President, who started the revival of AFRAN during the COVID-19 pandemic but could not live to witness the end of it. On a lighter note, we all remember our collective dedication during the long Sunday evening AFRAN meetings chaired by Dr Were. Let us commit ourselves to his memory and in memory of all our colleagues who lost their lives to COVID-19. Alain G AssoungaEditor-in-Chie

Editorial note: Welcome to the year 2022 and Volume 25

The Editorial Board and Editors of the African Journal of Nephrology wish all authors, reviewers and readers a very happy and blessed New Year. Like the last two years, we start this year in a wave of the COVID-19 pandemic. Hopefully, the future waves will be less and less severe and deadly. Given the significant protection against severe forms of disease provided by COVID vaccines, we urge everyone to get vaccinated. We are proud to announce that the African Journal of Nephrology is 25 years old this year. From its humble beginnings in 1997 when the founding editor-in-chief, the late Prof Maher Ramzy of Egypt, published the first i ssue, the Journal has persevered for 25 years and is now an established online publication and a member of the Directory of Open Access Journals. In 2021, the African nephrology calendar included the African Association of Nephrology (AFRAN) congress in Abidjan, Côte D’Ivoire, in December 2021. The pre-congress workshops included a workshop on research methodology organized with the collaboration of the ERA-EDTA Registry and the African Journal of Nephrology. The congress was successful despite the challenges of the pandemic, showcasing research from the continent. The proceedings will be published in volume 25 of the Journal. To commemorate our 25th year, we will continue with the African nephrology legacy project to document the history of nephrology in Africa. This volume will feature the history of nephrology in South Africa. The first publication of the African nephrology legacy project covered the history of AFRAN [1] and was published in 2017, authored by Prof Rashad Barsoum, the first AFRAN president. This year also marks the 10th anniversary of my tenure as Editor-in-Chief of the Journal. I am proud and honoured to have led the Journal for a decade. I wish to thank everyone who made it possible, including authors, reviewers and especially the editorial team including Deputy Editor Prof Razeen Davids, Associate Editors Prof Fergus Caskey, Prof Sarala Naicker and Prof Faiçal Jarraya, and Editorial Fellows Drs Yazied Chothia, Elliot Tannor and Vincent Boima. My thanks also goes to the secretarial team including Yolisa Mncundza, Jane John, Lethisha Harilall and the Turners Secretariat, the production team including Reach Publishers, Graham Baker and Ilze de Kock, Stellenbosch University for hosting the Journal, and the University of KwaZulu-Natal for supporting my efforts to lead the Journal and contribute to the  promotion of African scholarship. Finally, in 2022, the South African Renal Congress will be held in Durban from 26–29 May and I invite you all to join us. Once again, Happy 25th Anniversary to the African Journal of Nephrology! Alain G AssoungaEditor-in-Chie

Kidney transplant recipients possess less depressing plasma than healthy controls in KwaZulu-Natal (South Africa) – a paradoxical observation

Background: The reduced activation of lymphocytes of patients on immunosuppressive drugs is well documented. Human plasma has been reported previously to play a role in lymphocyte proliferation. Several factors, including alpha globulin and lipoproteins, have been proposed as modulators of lymphocyte proliferation. Aim: To measure the ATP response of peripheral blood mononuclear cells (PBMCs) from kidney transplant patients and healthy controls following phytohaemagglutinin (PHA) stimulation and to compare the effect of plasma of transplant recipients and of healthy controls on lymphocyte activation. Methods: Peripheral blood mononuclear cells from the blood of healthy controls and kidney transplant patients on regimens based respectively on cyclosporine, sirolimus and tacrolimus, were separated by density gradient centrifugation. Cells were counted and incubated overnight with and without PHA. The luciferin–luciferase enzyme reaction, which induces bioluminescence, and the Turner Biosystem luminometer were used to measure intracellular ATP levels in relative light units, which were converted to ng/mL using an ATP standard curve. A chi-squared test using the Instat 3 program (Graphpad®) was used to compare results. Results: PHA stimulation of PBMC from healthy individuals produced a 47% increase in ATP production. This increase was reduced to 31% when transplant patient plasma was added (P < 0.05). However, when plasma from healthy controls was added instead, paradoxically, the ATP production decreased further to 14%. A similar difference between patient and control plasma was recorded using PBMCs from transplant patients. The reduction in ATP production was the greatest in PBMCs from transplant patients on the tacrolimus-based regimen (P = 0.0388). Receiver operator characteristic (ROC) for ATP level revealed an area under the curve of 0.986. The cut-off value of ATP level between kidney transplant and control using the Youden index was 595 ng/mL, with a sensitivity of 93.3% and specificity of 99.9% Conclusion: Plasma isolated from patients on immunosuppressive drugs suppressed the response of lymphocytes to PHA stimulation. Paradoxically, plasma from healthy controls suppressed T cell activation even more severely. If confirmed in a more extensive study, this observation may be used to influence the choice of replacement fluid in the practice of plasma exchange in transplantation. Keywords: plasma, peripheral blood mononuclear cells, T cell &nbsp

Editorial note: Welcome to the year 2021 and Volume 24

On behalf of the editors and the editorial board of African Journal of Nephrology (AJN), I wish all our readers, authors and reviewers a very happy New Year. This year could not have come soon enough after we all experienced a turbulent 2020 which was marked by the global COVID-19 pandemic, the worst in recent memory. I request that we all take a minute to reflect on and honour those colleagues and family members who passed away in 2020. In particular, I wish to mention Dr Anthony Were, who was the current AFRAN president, Prof Mohamed Abdullah, the second AFRAN President, and Prof Jacob Plange-Rule, from Ghana. We will forever be grateful for their contributions to nephrology in Africa. Of the 2020 publications, I wish to highlight the guidelines for treatment of COVID-19 in Africa. This important document was the product of a fruitful continent-wide collaboration and outlines an approach to the management of COVID-19 in patients with kidney disease in Africa. We are very pleased to announce that the South African Department of Higher Education and Training has now included Directory of Open Access Journals (DOAJ)-listed journals among those which qualify for research subsidies for South African authors. AJN achieved inclusion into DOAJ in 2019. Running the Journal is a collective effort. I wish to acknowledge all who contributed in years past, including our founding editor, the late Prof Maher Ramzy, and I wish to thank our current editorial team, Deputy Editor Prof Razeen Davids, Associate Editors Prof Faiçal Jarraya, Dr Fergus Caskey and Prof Sarala Naicker, and all our authors, reviewers and readers. Finally, as we start the New Year in the middle of the second wave of the COVID-19 pandemic, I wish a successful and safe New Year to all. Alain G AssoungaEditor-in-Chie

Regulatory T cell frequency in peripheral blood of women with advanced cervical Cancer including women living with HIV

Abstract Background Persistent high-risk Human papillomavirus (HR-HPV) infections are the main cause of cervical cancer. Cumulative evidence implicates regulatory T cells (Tregs) as a critical factor in the failure to eliminate HPV-induced cancers leading to their persistence and progression to cancer. Also, the WHO recognised cervical cancer as 100% attributable to persistent HR-HPV infection. The province of KwaZulu-Natal (KZN) in South Africa has a high prevalence of cervical cancer and HIV infection. Materials and methods We evaluated Treg frequency in dual infection of HR HPV and HIV coinfection using phenotypic markers, CD4, CD25 and intracellular Foxp3, in the peripheral blood of 51 cervical cancer and 46 non-cervical cancer participants and evaluated the effect of HIV on regulatory T cell proportion. Peripheral blood mononuclear cells were surface stained with a cocktail fluorescent labelled CD4 and CD25 and subsequently with APC anti-human FoxP3 (eBioscience). Flow cytometry was performed with FACS analysis. Statistical analysis of results was done using Instat 3 program (GraphpadR). Tregs results were expressed as median ± interquartile range (IQR). Associations of cervical cancer with demographic, clinical and laboratory variables were evaluated by univariate and multivariate logistic regression analysis using SPSS version 27 (IBM). Results Tregs frequency was significantly higher in individuals with cervical cancer (11.00 ± 19.79%) compared to controls (1.71 ± 8.91%) (p < 0.0001). HIV infection was associated with an increase in Tregs frequency. In controls a significant difference in Tregs frequency was noted between women living with HIV (6.00 ± 10.57%, n = 9) and those without HIV (1.30 ± 6.10%, n = 37), p = 0.0023. In multivariate logistic regression, Tregs frequency was significantly associated with cervical cancer after controlling for age, smoking, weight loss, presence of STI, HIV and HPV genotype. Discussion/Conclusion Higher Tregs frequency was significantly associated with cervical cancer highlighting the immunosuppressive role of Tregs in cervical cancer. Treg frequency was more strongly associated with cervical cancer than HIV infection. We provide baseline data for monitoring Treg frequencies in response to new preventive and therapeutic strategies in the management of cervical cancer