Spectrum of kidney diseases in Africa: malaria, schistosomiasis, sickle cell disease, and toxins

Abstract

Kidney diseases have assumed epidemic proportions in both developed and developing countries, particularly chronic kidney disease (CKD). While treatment modalities are available and accessible in developed economies with improvement in outcomes, survival, and quality of life, they are either unavailable or inaccessible in nations with emerging economies, particularly in sub-Saharan Africa (SSA), with an attendant worsening outcome and survival for CKD patients. The epidemiology of CKD in SSA has revealed that it preferentially affects adults in their economically productive years, usually below the age of 50 years, with consequent drain on the economy. This derives mainly from the major etiologies in the region, which are infection-induced chronic glomerulonephritis and hypertension, compounded by poverty as well as societal and health underdevelopment, poor resource allocation to health, and underdeveloped health infrastructures. This has made preventive nephrology a major goal in the sub-region, although those who have already developed CKD must be managed up to tertiary levels. In this review, we assessed the contributions of parasitic diseases (i.e., malaria and schistosomiasis), sickle cell disease and nephrotoxins with the aim of espousing their contributions to the burden of kidney disease, and proposing management options with the goal of ultimately reducing the burden of kidney disease in these disadvantaged populations.

The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study

“…Candidate risk factors which merit study include environmental exposures such as heavy metals [53,54], endemic infections causing glomerulonephritis, and acquired or congenital anatomic abnormalities. These risk factors may interact with genetic risk factors enriched in sub-Saharan Africa-such as the APOL1 renal risk variants and sickle cell trait [55,56], or other yet to be identified genetic susceptibility loci. Furthermore, these risk factors distribution may differ by geography, which can explain the geographic variation in CKD prevalence observed in this study.…”

How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study

“…We will examine the role of traditional cardiovascular risk factors including diabetes mellitus, obesity and lipid profiles along with conventional and ambulatory blood pressure monitoring. In addition we will measure the impact of infections which may be of great importance in this region where infectious diseases are common and may play a major role in disease causation alongside genetic factors [43][44][45][46][47][48][49].…”

Nephrotic syndrome in adults: symptoms and management

“…Malaria-associated AKI can be classified as AKI from acute tubular necrosis (ATN), acute malarial-associated GN (reversible), or chronic and progressive GN (irreversible). 463 Immune system activation between the malaria antigen and host red blood cells can lead to immune-complex complement-mediated GN, acute interstitial nephritis, or acute GN. 464 (Figure IGN5) Figure IGN5.…”

“…These patients will present with NS (transient mild proteinuria, microscopic hematuria, and occasionally low complement levels), and histopathology revealing MPGN and mesangioproliferative GN. 463 Chronic infection with P. malariae (and to a lesser extent P. vivax, P. ovale) has been associated with irreversible and progressive GN. In the past, this has been known as tropical nephritis or "quartan malarial nephropathy" (QMN).…”