In Zimbabwe, the population of patients with chronic kidney disease is rising, putting a strain on the nation’s few dialysis treatment centers, whether government or private. The government covers the whole expense of delivering dialysis in the government facilities, increasing the financial burden. Patients from both public and private dialysis units opting for kidney transplantation (KT) are referred abroad at high foreign currency costs. The goal of this study focused on reviewing the economic advantage of KT in relation to renal dialysis as a means of establishing a KT program in Zimbabwe. Economic advantage studies on KT versus renal dialysis were obtained using various digital resources. The search strategy was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations. Economic assessment tools such as the Markov model, cost–utility analysis, cost-effective analysis were utilized to substantiate the relevance of KT in improving survival of end-stage renal disease patients at a lower expenditure. In studies where cost-effectiveness between KT and dialysis was compared, it was shown that KT is a cheaper solution with a higher quality of life than dialysis. It was also shown in most of the studies that among the dialysis modalities, hemodialysis (HD) was more expensive than peritoneal dialysis (PD). In one of the studies, the cost values were Euro 36 000 for HD, Euro 26 000 for PD, and Euro 11 000 for KT. The quality-adjusted life years per patient were 0.46 for HD, 0.49 for PD, and 0.61 for KT. As far as cost-effectiveness and raising the health status, wellness level, good living, and survival, KT is rated highly and a better modality than dialysis. It is a more appropriate renal treatment for introduction in Zimbabwe to save on the scarce foreign currency. The barriers to the commencement of KT were identified, and the solutions were enumerated.

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Background Childhood steroid-sensitive idiopathic nephrotic syndrome (SSINS) is plagued with relapses that contribute to its morbidity and the cost of treatment. Patients and methods This is a retrospective review of relapses among children with SSINS at the University of Abuja Teaching Hospital from January 2016 to July 2020. Triggers related to relapse incidents were noted. χ² test was deployed for predictors (factors at the first clinical presentations that associate with subsequent relapses) of relapses. Predictors with P values of less than 0.05 were considered significant, and 95% confidence intervals (CI) and odd ratio (OR) were described. Results A total of 60 patients with SSINS, comprising 52 (86.7%) males, aged 23 months to 18 years, with a mean age of 7.04±4.16 years, were studied. A total of 38 (63.3%) participants had 126 relapses, including infrequent relapses in 30 (78.9%) and frequent relapses in eight (21.1%). The commonest triggers were acute upper respiratory tract infections (68, 53.9%) and urinary tract infections in 25 (19.8%) relapses. In four (3.2%) relapses, no trigger was identified. The time-to-first relapse ranged 14–365 days, with a median time of 60 days. The significant predictors were hypertension (OR=3.4, 95% CI; 1.04–11.09, P=0.038), urinary tract infections (OR=9.9, 95% CI; 1.16–80.71, P=0.014), malaria fever (OR=8.0, 95% CI; 2.45–26.38, P<0.001), microhematuria (OR=4.9, 95% CI; 11.58–15.16, P=0.004), elevated serum creatinine (OR=12.3, 95% CI; 1.48–101.20, P=0.005), and hypercholesterolemia (OR=4.1, 95% CI; 1.35–12.63, P=0.011). Conclusion Although the pathogenesis of relapses remains unknown, it is prudent to consider relapse-specific preventive strategies against triggers and predictors of relapses in our setting.

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Background Patients with chronic kidney disease and end-stage kidney disease have reduced physical performance and impaired quality of life. The aim of this work is to study the effect of intradialytic aerobic training using a pedal on physical performance and quality of life among hemodialysis (HD) patients. Patients and methods This experimental study was conducted on 30 adult patients with end-stage kidney disease on maintenance HD for more than 3 months. Mentally or physically unfit patients, patients with overt ischemic heart disease or cardiac decompensation, severe anemic patients (hemoglobin≤8 g/dl), patients with advanced chronic kidney disease-mineral and bone disorder, patients with advanced lower limbs joints disease, and those with amputation of the lower limb were excluded. Patients were divided into two groups; each group consisted of 15 patients. Group A performed intradialytic aerobic exercise for 30 min three times/week for 8 weeks. Group B was a control group. Results There was significant improvement in the distance walked in 6-min walk test in the exercise group (P=0.04). Moreover, there was significant improvement in the main scales of kidney disease quality-of-life short form, version 1.3, Arabic version (Kidney Disease Component Summary, Physical Composite Scale, and Mental Composite Scale) (P<0.001, P=0.018, and P=0.037, respectively). Conclusion Exercise has a beneficial effect on the physical performance and quality of life in HD patients.

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Background Hepcidin is a polypeptide secreted from the liver. It regulates iron metabolism by blocking further iron absorption when iron stores are high. Hepcidin levels are usually higher than the normal range in hemodialysis (HD) patients. Hepatitis C virus (HCV) infection leads to lowering of hepcidin levels, leading to more iron overload. The objectives were to determine whether there is a correlation between iron stores and hepcidin levels in HD patients after HCV treatment and to assess the level of hepcidin in those patients who were treated from HCV compared with those who have chronic HCV infection. Patients and methods In total, 60 patients on regular HD were recruited and 30 healthy controls . Group I: 30 patients who have been successfully treated from HCV by directly acting antiretroviral drugs with a persistently negative PCR for at least 3 months, group II: 30 patients with chronic HCV infection, and 30 healthy controls form group III. Serum hepcidin levels, iron profile, and complete blood count were compared in all groups. Results Hepcidin levels were significantly higher in the HCV-treated group versus the HCV-infected group (mean 226.77±144.13 and 87.77±40.77 ng/dl), respectively, significantly higher transferrin-binding capacity (TIBC), and mean levels 410.5±74.65 and 310.93±122.57 μg/dl . Ferritin levels were higher in the HCV-infected group (355.13±196, 899.5±1522 ng/dl) than in HCV-treated. There was a significant correlation between hepcidin and serum iron, TIBC, and transferrin saturation in the HCV-treated group. On regression analysis, only TIBC and transferrin saturation correlated significantly. Conclusions Post HCV treatment with directly acting antiretroviral drugs, hepcidin levels are higher than during HCV-infection state and correlate significantly to higher TIBC . Further studies are needed to establish the effect of iron supplementation on hepcidin level in this subgroup of patients.

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Background There is a dearth of reports on the relationship between bone metabolism and renal function in Nigeria. This study determined the association between bone-turnover markers and renal functional status in healthy Nigerian adults. Patients and methods This exploratory observational study consisted of 80 apparently healthy participants aged 22–50 years without known risk factors for renal impairment. Fasting samples were analyzed for biochemical bone-turnover markers, including serum osteocalcin, total alkaline phosphatase, 24-h urine-calcium excretion, parathyroid hormone (PTH), and 25-hydroxyvitamin D [25(OH)D]; and calcium, phosphate, and creatinine. The estimated glomerular-filtration rate (GFR) was calculated using the Cockcroft–Gault formula. Bone mineral density (BMD) was measured by Dual-energy X-ray Absorptiometry scan (DXA scan). Statistical analysis was carried out and P level less than 0.05 was regarded as significant. Results The mean age of study participants was 32.1±5.8 years with a mean GFR of 98.15±9.02 ml/min, mean serum 25(OH)D 51.53±15.45 mmol/l, and mean BMD/Z score 0.54±0.07)/0.20±1.02. None of the participants had osteoporosis or vitamin-D deficiency. There is a significant correlation between bone marker − osteocalcin and BMD, and PTH with BMD and GFR (P<0.05). Also, a nonsignificant trend was observed between calcium excretion, 25(OH)D, and estimated GFR (P=0.07, P=0.08). Conclusion PTH may be an early marker of bone loss in renal dysfunction.

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Background Although there is progressive loss of renal mass and function as age progresses, still newer kidney diseases occur. Kidney diseases in the elderly are different compared with younger population. This is because of more commoner occurrence of secondary kidney diseases than primary kidney diseases compared with younger. There is a paucity of Indian literature regarding kidney biopsy in the elderly. The reasons could be fear of increased risk of complications in the elderly, or attributing all kidney diseases to common comorbidities like diabetes mellitus, hypertension, malignancy, intake of potential nephrotoxic medications, and not subjecting them to kidney biopsy. Thus, performing kidney biopsies and analyzing the biopsy findings is not only important for diagnosis of potentially curable kidney diseases, but also guides the therapy. Patients and methods It was a retrospective observational study conducted to assess the clinical profile and histopathological spectrum in elderly patients who underwent kidney biopsies. Results The most common indication of kidney biopsy was nephrotic syndrome. The commonest histological finding was membranous nephropathy. Compared with the elderly group, the frequency of lupus nephritis, focal segmental glomerulosclerosis, minimal change disease, IgA nephropathy, and acute tubular necrosis was significantly more in younger age. Conclusions The most common indication for kidney biopsy in the elderly was nephrotic syndrome. Membranous nephropathy was the commonest histologic finding. The results obtained in this study could add to previous studies to give valuable information of kidney diseases in the elderly. Kidney biopsy is useful in diagnosing many treatable kidney diseases in the elderly and prevents unwanted exposure to empirical immunosuppression.

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