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The pattern of renal disease and its basic principles of management are essentially the same in the tropics as in the temperate environment. Glomerulonephritis and pyelonephritis with concomitant hypertension account for most cases of renal failure. Malaria is now well recognised as a cause of the nephrotic syndrome. Economic and manpower factors dictate a conservative approach to therapy. Maintenance haemodialysis and renal transplantation are not realistic in the present context, having regard to the order of priorities in health care delivery.

Hypertension in Africa represents a challenge and an opportunity. As the two epidemics of infection and malnutrition are increasingly brought under control, increasing morbidity and mortality from hypertension have been documented and offer a challenge for prevention. Heterogeneity within and between African populations offers opportunities for detecting clues to the etiology and pathogenesis of hypertension. For example, populations in urban areas have already shown a greater prevalence of obesity, hypertension, and hypertensive heart and kidney disease than those in rural areas. The generally better lipid profiles in African blacks compared with whites is associated not only with low rates of coronary heart disease, but also with low prevalences of hypertensive retinopathy, despite substantial prevalences of hypertension in African blacks. Areas of Africa with a natural abundance of salt, such as Gambia and Senegal, tend to have indigenes with less tendency to retain a salt load than those from areas that are traditionally salt poor.

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