REVIEW: Lupus nephritis: An approach to diagnosis and treatment in South Africa

Lupus nephritis (LN) is a significant cause of morbidity and mortality in patients with systemic lupus  erythematosus. Delayed recognition and diagnosis of LN may be a common cause of chronic kidney disease among South Africans. Renal biopsy is the gold standard of diagnosing LN; however, this service is not  available in many centres and the use of urinalysis, urine microscopic examination and other serological tests can be useful in identifying patients with proliferative LN. Proliferative types of LN (class III, class IV and  mixed class V) comprise the larger proportion of patients with this condition. Patients receiving  immunosuppressive therapy need to be monitored closely for side-effects and drug-related toxicities. LN patients with end-stage renal disease (class VI) need to be prepared for renal replacement therapy (dialysis  and renal transplantation). In all patients, treatment should include adjunctive therapies such as renin  angiotensin aldosterone system blockade, bone protection (with calcium supplements and vitamin D), blood  pressure control and chloroquine – all of which help to retard the progression of kidney disease

Assessment of Global Kidney Health Care Status.

Kidney disease is a substantial worldwide clinical and public health problem, but information about available care is limited.To collect information on the current state of readiness, capacity, and competence for the delivery of kidney care across countries and regions of the world.Questionnaire survey administered from May to September 2016 by the International Society of Nephrology (ISN) to 130 ISN-affiliated countries with sampling of key stakeholders (national nephrology society leadership, policy makers, and patient organization representatives) identified by the country and regional nephrology leadership through the ISN.Core areas of country capacity and response for kidney care.Responses were received from 125 of 130 countries (96%), including 289 of 337 individuals (85.8%, with a median of 2 respondents [interquartile range, 1-3]), representing an estimated 93% (6.8 billion) of the world's population of 7.3 billion. There was wide variation in country readiness, capacity, and response in terms of service delivery, financing, workforce, information systems, and leadership and governance. Overall, 119 (95%), 95 (76%), and 94 (75%) countries had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. In contrast, 33 (94%), 16 (45%), and 12 (34%) countries in Africa had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. For chronic kidney disease (CKD) monitoring in primary care, serum creatinine with estimated glomerular filtration rate and proteinuria measurements were reported as always available in only 21 (18%) and 9 (8%) countries, respectively. Hemodialysis, peritoneal dialysis, and transplantation services were funded publicly and free at the point of care delivery in 50 (42%), 48 (51%), and 46 (49%) countries, respectively. The number of nephrologists was variable and was low (<10 per million population) in Africa, the Middle East, South Asia, and Oceania and South East Asia (OSEA) regions. Health information system (renal registry) availability was limited, particularly for acute kidney injury (8 countries [7%]) and nondialysis CKD (9 countries [8%]). International acute kidney injury and CKD guidelines were reportedly accessible in 52 (45%) and 62 (52%) countries, respectively. There was relatively low capacity for clinical studies in developing nations.This survey demonstrated significant interregional and intraregional variability in the current capacity for kidney care across the world, including important gaps in services and workforce. Assuming the responses accurately reflect the status of kidney care in the respondent countries, the findings may be useful to inform efforts to improve the quality of kidney care worldwide

Socioeconomic status and obesity in Abia State, South East Nigeria

Innocent Ijezie Chukwuonye,1 Abali Chuku,2 Ikechi Gareth Okpechi,3 Ugochukwu Uchenna Onyeonoro,4 Okechukwu Ojoemelam Madukwe,5 Godwin Oguejiofor Chukwuebuka Okafor,6 Okechukwu Samuel Ogah5,71Division of Renal Medicine, Department of Internal Medicine, 2Department of Ophthalmology, Federal Medical Centre, Umuahia, Nigeria; 3Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; 4Department of Community Medicine, Federal Medical Centre, 5Ministry of Health, Nnamdi Azikiwe Secretariat, 6Department of Community Medicine, Federal Medical Centre, Umuahia, Nigeria; 7Division of Cardiology, Department of Internal Medicine, University College Hospital, Ibadan, NigeriaBackground and objectives: Obesity is a major risk factor for cardiovascular disease in developed and emerging economies. There is a paucity of data from Nigeria on the association between socioeconomic status and obesity. The aim of this study is to highlight that association in Abia State, South East Nigeria.Material and method: This was a cross-sectional survey in South East Nigeria. Participating subjects were recruited from the three senatorial zones of Abia state. A total of 2,487 adults took part in the study. The subjects were classified based on their monthly income and level of educational attainment (determinants of obesity). Monthly income was classified into three groups: low, middle, and upper income, while educational level was classified into four groups: no formal education, primary, secondary, and tertiary education. Body mass index of subjects was determined and used for defining obesity. Data on blood pressure and other anthropometric measurements were also collected using a questionnaire, modified from the World Health Organization STEPwise Approach to Chronic Disease Risk Factor Surveillance.Results: Overall, the prevalence of obesity in low, middle, and upper income groups was 12.2%, 16%, and 20%, respectively. The overall prevalence of obesity in individuals with no formal education, primary, secondary, and tertiary education was 6.3%, 14.9%, 10.5%, and 17.7%, respectively. Educational status was found to be significantly associated with obesity in women, but not in men, or in the combined group. However, level of income was observed to be significantly associated with obesity in men, women, and in the combined group.Conclusion: Sociodemographic and socioeconomic factors are important determinants of obesity in our study population, and therefore may be indirectly linked to the prevalence and the outcomes of cardiovascular disease in Nigeria.Keywords: obesity, body mass index, BMI, income, education, socioeconomic status, Naira (₦

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

Nicola Wearne,1 Kajiru Kilonzo,2 Emmanuel Effa,3 Bianca Davidson,1 Peter Nourse,4 Udeme Ekrikpo,1,5 Ikechi G Okpechi1 1Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; 2Department of Medicine, Kilimanjaro Christian Medical College, Moshi, Tanzania; 3Department of Medicine, University of Calabar, Calabar, Nigeria; 4Division of Paediatric Nephrology, Red Cross War Memorial Children&rsquo;s Hospital, Cape Town, South Africa; 5Department of Internal Medicine, University of Uyo, Uyo, Nigeria Abstract: Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes. Keywords: dialysis cost, dialysis fluid, peritoneal dialysis, peritonitis, nephrology workforc

Correlates of obesity indices and systemic arterial hypertension in adult Nigerians: a community based study

Background: The aim of the study was to determine the correlation between indices of obesity and systemic arterial hypertension in adult Nigerians.Methods: This cross-sectional descriptive survey and was carried out in Abia state, southeast Nigeria. Two thousand nine hundred and ninety nine (2,999) subjects, aged =18years were selected by a multi-stage sampling technique from six Local Government Areas of Abia state, south east Nigeria. The World Health Organization Stepwise Approach to Surveillance of chronic disease risk factors was used. Body mass index, anthropometric measurements, and other relevant data were collected.Results: Two thousand eight hundred and seven subjects (2,807) gave all the relevant data required. The prevalence of hypertension by three obesity indices, body mass index (BMI), waist circumference (WC), and waist to hip ratio (WHR) was 16.7%, 27.2%, 42.3% respectively. The correlation coefficient (r) of the obesity indices with systolic BP for BMI was 0.141 and 0.110, for WC was 0.182 and 0.198, and for WHR was 0.130 and 0.167, in males and females respectively. The r coefficient of the obesity indices with diastolic BP for BMI was 0.205 and 0.171, for WC was 0.182 and 0.217, and for WHR was 123 and 0.118 in males and females respectively. The odds ratio of obesity indices with BP for BMI was 1.54, and 1.06, for WC was 1.72 and 2.13 and for WHR was 1.48 and 1.47 for males and females respectively. The OR of obesity indices with diastolic BP for BMI was 1.41 and 1.40, for WC was 1.14 and 1.40, and for WHR was 1.28, and 1.20 in males and females respectively.Conclusion: There exit a weak relationship between the indices of obesity and BP.Keywords: Body Mass Index, Waist Circumference, Waist to Hip Ratio, Hypertensio