Screening for kidney disease in children on World Kidney Day in Lagos State, Nigeria

Background: Across the world, World Kidney Day (WKD) is marked yearly to increase awareness of kidney diseases. In 2016, its focus was on children for the first time. We report on a WKD screening initiative for kidney disease that was conducted in two public schools in Lagos State, Nigeria.Methods: Participants were recruited after guardians provided signed consent and older children gave assent. Baseline data were obtained which included family history of chronic diseases like sickle cell disease, hypertension, diabetes, renal disease, and the use of herbal medications. Anthropometric parameters such as height, weight and body mass index (BMI) were recorded. Investigations included urinalysis, measurement of serum creatinine and estimation of glomerular filtration rate (eGFR) using the Schwartz formula.Results: A total of 405 children were screened; there were 190 (46.9%) males and 215 females. The children were aged 2 to 17 years with a mean age of 9.1 ± 3.0 years. Over 80% of the children had normal nutritional status. Severe thinness was seen in 22 (6.8%) whereas overweight was present in 10 (3.1%). Only 1 was obese. eGFR was above 90 mL/min/1.73 m2 in 232 (94.3%) of the participants. Hypertension was present in 47 (14.4%), with the highest rate among those 0–8 years old. Proteinuria was detected in 118 (29.2%); none of the children had haematuria. Systolic hypertension, a family history of smoking and the use of herbal medications were associated with proteinuria.Conclusions: The study has highlighted a high rate of proteinuria, associated with the use of herbal medications, hypertension and a family history of smoking. Screening for renal disease in children with appropriate follow-up and timely intervention to avoid progression to end-stage renal disease is imperative

Rationale and Design of the Diet, CKD, and Apolipoprotein L1 Study in Low-Income and Middle-Income Countries

IntroductionDiet, chronic kidney disease (CKD), and Apolipoprotein L1 (APOL1) (DCA) Study is examining the role of dietary factors in CKD progression and APOL1 nephropathy. We describe enrollment and retention efforts and highlight facilitators and barriers to enrollment and operational challenges, as well as accommodations made in the study protocol.MethodsThe DCA study is enrolling participants in 7 centers in West Africa. Participants who consented were invited to complete dietary recalls and 24-hour urine collections in year 1. We conducted focus groups and semistructured interviews among study personnel to identify facilitators and barriers to enrollment as well as retention and operational challenges in the execution of the study protocol. We analyzed emerging themes using content analyses.ResultsA total of 712 participants were enrolled in 18 months with 1256 24-hour urine and 1260 dietary recalls. Barriers to enrollment were the following: (i) a lack of understanding of research, (ii) the burden of research visits, and (iii) incorporating cultural and traditional nuances when designing research protocols. Factors facilitating enrollment were the following: (i) designing convenient research visits, (ii) building rapport and increased communication between the research team and participants, and (iii) cultural sensitivity - adapting research protocols for the populations involved. Offering home visits, providing free dietary counseling, reducing the volume of study blood collection, and reducing the frequency of visits were some changes made in the study protocol that increased participant satisfaction.ConclusionAdopting a participant-centered approach with accommodations in the protocol for cultural adaptability and incorporating participant feedback is vital for carrying out research in low-income and middle-income regions