Kidney disease among children in sub-Saharan Africa: systematic review

Abstract

The global burden of kidney disease is increasing, and several etiologies first begin in childhood. Risk factors for pediatric kidney disease are common in Africa, but data regarding its prevalence are lacking. We completed a systematic review of community-based studies describing the prevalence of proteinuria, hematuria, abnormal imaging, or kidney dysfunction among children in sub-Saharan Africa. Medline and Embase were searched. Five hundred twenty-three references were reviewed. Thirty-two references from 9 countries in sub-Saharan Africa were included in the qualitative synthesis. The degree of kidney damage and abnormal imaging varied widely: proteinuria 32.5% (2.2%-56.0%); hematuria 31.1% (0.6%-67.0%); hydronephrosis 11.3% (0.0%-38.0%), hydroureter 7.5% (0.0%-26.4%), major kidney abnormalities 0.1% (0.0%-0.8%). Serum creatinine was reported in four studies with insufficient detail to identify the prevalence renal dysfunction. A majority of the studies were performed in Schistosoma haematobium endemic areas. A lower prevalence of kidney disease was observed in the few studies from non-endemic areas. Published data on pediatric kidney disease in sub-Saharan Africa is highly variable and dependent on S. haematobium prevalence. More community-based studies are needed to describe the burden of pediatric kidney disease, particularly in regions where S. haematobium infection is non-endemic.

Proteinuric kidney disease in children at Queen Elizabeth Central Hospital, Malawi

“…However, studies done in Africa, Asia, Middle East and South American developing countries all show similar findings [5–7] where in contrast to high income settings, glomerular disease is the predominant cause of paediatric kidney disease.. There is a high prevalence of infectious diseases in developing countries which is a risk factor for glomerular kidney disease [6–9]. …”

“…We measured kidney size using length in centimetres and plotted the result against the participant’s age. Kidney size was classified as large (> + 2 SD), small (< − 2 SD) and normal (-2SD to +2SD) for age [9]. …”

“…The pattern of kidney disease varies in different geographical locations depending on ethnic backgrounds and environmental factors [9]. However, the pattern of kidney disease in children has not been widely studied in Sub Saharan Africa, particularly Malawi and neighbouring countries [10].…”

The state of renal replacement therapy for children in South Africa: Data from the first report of the re‐established National Renal Registry

“…The incidence of chronic kidney disease (CKD) in Sub Saharan Africa is thought to be higher than is known. 16 The need for RRT therefore is probably greater than is appreciated. This is because several risk factors for CKD in children are more common in Sub Saharan Africa, such as intrauterine injury, malnutrition, schistosomiasis, post-infectious glomerulonephritis and HIV-associated nephropathy.…”

Inequalities in access to pediatric ESRD care: a global health challenge

“…Yet, its prevalence is higher in individuals from low-and middle-income countries [4], and among disadvantaged populations in high-income countries, including children. Besides genetic background, this is partially driven by infectious diseases, low birth weight and early malnutrition, poor sanitation, pollutants, and traditional medications [22,23]. Another major contributor to the burden of CKD is acute kidney injury (AKI).…”