Chronic kidney disease (CKD) is increasing in prevalence and is associated with increased morbidity and mortality, especially in low- and lower middle-income countries (LLMICs). Risk factors for CKD ...are numerous and may start in utero through to adulthood. Low socioeconomic status increases the risk of CKD and contributes to late presentation and suboptimal management especially in LLMICs. This leads to progression to kidney failure with associated increased mortality when kidney replacement therapy is required. Poor socioeconomic status may be the most important contributor to disease progression to kidney failure, especially in LLMICs, and may complicate other risk factors such as acute kidney injury, genetic risk, sickle cell disease, cardiovascular risk, and infections such as HIV. In this review, we explore the impact of low socioeconomic status on the increase in incidence and prevalence of CKD in LLMICs from in utero to adulthood, as well as mechanisms leading to increased burden, faster progression, and significant morbidity and mortality from CKD, especially in the absence of affordable, accessible, and optimum kidney replacement therapy.
Glomerular diseases account for a significant proportion of chronic kidney disease in low-income and middle-income countries (LMICs). The epidemiology of glomerulonephritis is characterized ...inadequately in LMICs, largely owing to unavailable nephropathology services or uncertainty of the safety of the kidney biopsy procedure. In contrast to high-income countries where IgA nephropathy is the dominant primary glomerular disease, focal segmental glomerulosclerosis is common in large populations across Latin America, Africa, Middle East, and South East Asia, while IgA nephropathy is common in Chinese populations. Despite having a high prevalence of known genetic and viral risk factors that trigger focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis also is common in adults and children in some African countries. Treatment of glomerular diseases in adults and children in LMICs largely is dependent on corticosteroids in combination with other immunosuppressive therapy, which often is cyclophosphamide because of its ready availability and low cost of treatment, despite significant adverse effects. Partial and/or complete remission status reported from studies of glomerular disease subtypes vary across LMIC regions, with high rates of kidney failure, mortality, and disease, and treatment complications often reported. Improving the availability of nephropathology services and ensuring availability of specific therapies are key measures to improving glomerular disease outcomes in LMICs.
Introduction: The prevalence of chronic kidney disease (CKD) in Africa is generally higher than global averages. Moreover, the management of patients with CKD suffers huge disparities compared to the ...rest of the world. We reviewed the literature on the major challenges in the management of kidney disease in Africa and suggest ways to bridge the gap for better kidney care on the African continent. Results and recommendations: The prevalence of CKD in Africa is 15.8%. Kidney failure is associated with increased morbidity and mortality as a result of limited infrastructure and out-of-pocket payment for renal replacement therapy in most parts of the continent. The increasing prevalence of CKD results from epidemiological transition with increasing non-communicable diseases (NCDs) and established communicable diseases. Furthermore, Africa has unique risk factors and causes of kidney disease such as sickle cell disease, APOL1 risk alleles, and chronic infections such HIV, and hepatitis B and C. Challenges facing kidney care in Africa include poverty, weak health systems, inadequate primary health care, misplaced priorities by political leaders, a relatively low nephrology workforce, poor identification of acute kidney injury (AKI), low transplantation rates as well as a lack of sustainable prevention policies and renal registries. To bridge the gap to better kidney care, there should be more community engagement, advocacy for increased government support into kidney care, comprehensive renal registries, training of a greater nephrology workforce, task shifting of nephrology services to non-nephrologists, expanded access to renal replacement therapy and promotion of organ donation. Conclusion: Africa needs greater investment in kidney health. Keywords: chronic kidney disease, Africa, sub-saharan Africa, Kidney failure, kidney health
