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Background. Africa has the highest rate of HIV infection, and HIV-associated nephropathy (HIVAN) is one of the most frequent kidney diseases observed in children. HIVAN in children usually presents as a form of nephrotic syndrome, predominantly focal segmental glomerulosclerosis (FSGS) on histopathology, that often leads to chronic kidney failure. Objective. This study determined the urinary concentrations of ß-2-microglobulin (ß2M) and cystatin C proteins in children with HIVAN and primary FSGS. Methods. The study group comprised 34 children; 14 with HIVAN and 20 with primary FSGS. The control groups were 20 HIV-positive and 20 HIV-negative children with no kidney disease. Urine samples collected from these 74 children were stored at -80°C. Bio-Plex technology was used to analyse the urinary protein concentration of cystatin C and ß2M. Results. A significant increase in urinary ß2M levels was observed in the HIVAN group compared with the HIV-negative group (p=0.0240). No other statistically significant differences in urinary ß2M concentrations were noted across the study groups. Urinary cystatin C levels were significantly increased in primary FSGS children compared with both HIV-negative (p=0.0041) and HIV-positive controls (p=0.0256). Urinary cystatin C displayed a significant increase in the primary FSGS compared with the HIVAN group (p=0.0150). No significant differences in urinary cystatin C levels were noted in the HIVAN group compared with the HIV-negative and HIV-positive control groups. Conclusion. Urinary cystatin C has promising prognostic value to predict primary FSGS from HIVAN. [ABSTRACT FROM AUTHOR]

Glomerulonephritis (GN) is a predominant cause of kidney failure in Africa. The prevalence of primary GNs varies widely across Africa depending on the relative proportion of secondary GNs and genetic predispositions. We assessed the overall and subregional prevalence of primary GN and its histologic subtypes in Africa. We searched PubMed, EMBASE and African Journals Online for studies of biopsyproven primary GNs across all age groups in Africa published between 2010 and 2022. Data for primary GNs [minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), mesangioproliferative GN (MesPGN), membranoproliferative GN (MPGN), post-infectious GN (PIGN), IgA Nephropathy (IgAN), and crescentic GN (CresGN)] were extracted. Pooled prevalence was determined using the random effects model. Seventeen eligible articles (n = 6,494 individuals) from 8 African countries met the inclusion criteria. The overall pooled prevalence of FSGS, MCD, MN, MPGN, MesPGN, PIGN, IgAN and CresGN was 26.10%, 22.40%, 8.40%, 6.40%, 6.40%, 2.60%, 2.60%, 1.40%, respectively. Only 4 studies (23.5%) used light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM) for diagnosis. There were significant differences in the distribution of histologic subtypes in the paediatric compared to the adult population and across geographic sub-regions, with West Africa having a higher prevalence of FSGS. Overall, the dominance of FSGS across most regions and age groups has implications for disease diagnosis and ongoing care. Research efforts to understand the impact of this trend on kidney disease outcomes and efforts to improve kidney biopsy practice as a means of early disease detection are needed in Africa. [ABSTRACT FROM AUTHOR]

Nephrotic syndrome is a common childhood glomerular disease that is associated with massive proteinuria and edema. Children with nephrotic syndrome are at risk of chronic kidney disease, disease-related complications, and treatment-related complications. Patients with frequently relapsing disease or steroid toxicity may require newer immunosuppressive medications. However, access to these medications is limited in many African countries owing to prohibitive cost, the need for frequent therapeutic drug monitoring, and a lack of appropriate facilities. This narrative review examines the epidemiology of childhood nephrotic syndrome in Africa, including trends in treatment and patient outcomes. In most of North Africa, as well as among White and Indian populations in South Africa, the epidemiology and treatment of childhood nephrotic syndrome closely resembles that of European and North American populations. Historically, secondary causes of nephrotic syndrome (eg, quartan malaria nephropathy and hepatitis B–associated nephropathy) were predominant among Blacks in Africa. Over time, the proportion of secondary cases has decreased, along with rates of steroid resistance. However, focal segmental glomerulosclerosis increasingly has been reported among patients with steroid resistance. There is a need for consensus guidelines for the management of childhood nephrotic syndrome in Africa. Furthermore, establishing an African nephrotic syndrome registry could facilitate monitoring of disease and treatment trends, and provide opportunities for advocacy and research to improve patient outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]