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   2021| October-December  | Volume 21 | Issue 4  
    Online since October 27, 2021

 
 
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SYSTEMATIC REVIEW
The burden of diabetic kidney disease in Nigeria − systematic review and meta-analysis
Taoreed A Azeez, Oluwafemi Efuntoye, Busayo I Abiola, Segun P Adeyemo, Boluwatife A Adewale
October-December 2021, 21(4):194-202
DOI:10.4103/jesnt.jesnt_16_21  
Background Diabetic kidney disease (DKD) is a microvascular complication of diabetes mellitus. Considering that the burden of diabetes mellitus is rising in Nigeria, there is a need to ascertain the burden of one of its most common complications. The objective of the meta-analysis was to determine the pooled prevalence of DKD in Nigeria and identify its risk factors. Patients and methods The study is a meta-analysis and it followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Google scholar, PubMed, AJOL, SCOPUS, medRxiv, and the gray literature were systematically searched using appropriate key terms. Statistical analysis was done with MetaXL. The inverse-variance heterogeneity model was used for the meta-analysis and heterogeneity was determined using the I2 statistic and the Cochran’s Q test. Publication bias was checked with the Doi plot and LFK index. Results Nineteen studies met the eligibility criteria. The total sample size was 56 571. The pooled prevalence of DKD in Nigeria was 28% (95% confidence interval 3–58). The Cochran’s Q was 747 (P<0.001), while the I2 statistic was 97.6%. The Doi plot was drawn and the LFK index was 6.22. The most common risk factors for DKD were suboptimal glycemic control, hypertension, obesity, duration of diabetes, male sex, and advancing age. Conclusion The prevalence of DKD in Nigeria is high and greater attention should be focused on managing the risk factors so as to alleviate the burden of the disease.
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ORIGINAL ARTICLES
Comparison between high-dose, low-dose cyclophosphamide and mycophenolate mofetil in treatment of proliferative lupus nephritis (an Egyptian multicenter retrospective study)
Rasha A. Abdel Noor, Mervat Eissa, Hanaa I Okda, Hend H Abdelnabi, Sahar A Ahmed, Eman F Mohammed, Noha Abdel Salam, Enas S Zahran
October-December 2021, 21(4):174-183
DOI:10.4103/jesnt.jesnt_13_21  
Background Proliferative lupus nephritis (LN) is an aggressive pathological lesion of LN. Corticosteroids, cyclophosphamide (CYC) pulse therapy either by high dose; National Institute of Health (NIH) CYC or low dose; European cyclophosphamide regimen (EURO-CYC), and mycophenolate mofetil (MMF) are the best valid lines for treatment, but the choice between them is still challenging. The objective of this study was to compare the efficacy of both CYC regimens and MMF in the treatment of proliferative LN patients. Patients and methods We retrospectively collected the data of 225 biopsy-proven proliferative LN patients (adults and juveniles) from five tertiary centers. Forty four of patients received low-dose regimen, 124 received high-dose regimen, and 57 received MMF. All demographic data, laboratory tests, activity markers, and systemic lupus disease-activity index were recorded and compared at initial presentation and at 3, 6, 12, and 24 months of follow-up. Results After 6 months of treatment, 61.2% of NIH-CYC group reached complete response, while the rate was 40.9% of EURO-CYC group and 52.7% for MMF group, and the results were in favor for the NIH group over EURO group, while there was no difference between NIH and MMF groups, but at the end of 12th, 18th, and 24th months of follow-up, the outcomes of the three groups were comparable in efficacy and safety. Conclusion For induction treatment of proliferative LN, high-dose CYC shows a better and rapid complete response after the sixth month of treatment in adults and juvenile LN patients, but after the first year of therapy, the three regimens have comparable efficacy and safety.
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EDITORIAL
Living well with kidney disease by patient and care-partner empowerment: kidney health for everyone everywhere
Kamyar Kalantar-Zadeh, Philip Kam-Tao Li, Ekamol Tantisattamo, Latha Kumaraswami, Vassilios Liakopoulos, Siu-Fai Lui, Ifeoma Ulasi, Sharon Andreoli, Alessandro Balducci, Sophie Dupuis, Tess Harris, Anne Hradsky, Richard Knight, Sajay Kumar, Maggie Ng, Alice Poidevin, Gamal Saadi, Allison Tong
October-December 2021, 21(4):149-155
DOI:10.4103/jesnt.jesnt_9_21  
Living with chronic kidney disease is associated with hardships for patients and their care-partners. Empowering patients and their care-partners, including family members or friends involved in their care, may help minimize the burden and consequences of chronic kidney disease-related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including an emphasis on patients being in control. The World Kidney Day Joint Steering Committee has declared 2021 the year of ‘Living Well with Kidney Disease’ in an effort to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labeling claims for medicines and devices. Funding agencies could establish targeted calls for research studies that address the priorities of patients. Patients with kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the overall wellness program for patients with kidney disease, the need for prevention should be reiterated. Early detection with a prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programs, should be promoted. World Kidney Day 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals, and policy makers, applicable to both developed and developing countries.
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ORIGINAL ARTICLES
Role of microRNA as a marker in detection of diabetic nephropathy in type-2 diabetic Egyptian patients
Said S.A Khamis, Yassin S Yassin, Ahmed R Tawfeek, Heba El Sayed Kasem, Sally M Ibrahim, Elsayed Ghonamy
October-December 2021, 21(4):167-173
DOI:10.4103/jesnt.jesnt_17_21  
Background Diabetic kidney disease (DKD) represents the major cause of chronic kidney disease. New biomarkers for early diagnosis of DKD are of interest. Our objective is to elucidate the significance of microRNA-192 (miRNA-192) and neutrophil gelatinase-associated lipocalin (NGAL) as early predictors of diabetic nephropathy in comparison with albuminuria in type-2 diabetic patients. Patients and methods A number of 45 persons in three groups, group 1: 15 healthy persons with no diabetes mellitus (DM). Group 2: 15 patients diagnosed with type-2 diabetes mellitus (T2DM) without albuminuria. Group 3: 15 patients diagnosed with T2DM with albuminuria. Estimation of serum miRNA, NGAL, urine albumin/creatinine ratio, serum creatinine, urea, fasting blood glucose, 2-h postprandial blood glucose, and glycated hemoglobin. Results The study showed that the serum miRNA-192 and NGAL levels were significantly higher in patients diagnosed with T2DM with albuminuria in comparison with patients diagnosed with T2DM without albuminuria. There was a significant positive correlation between miRNA-192 and NGAL and urine albumin/creatinine ratio. Conclusion Serum NGAL and miRNA-192 may serve as tools to follow up the development and progression of DKD.
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Nutritional-status assessment using body-composition monitor device in a cohort of end-stage renal disease on maintenance hemodialysis
Rasha I. Abd Elrazek Gawish, Nourhan Abd Elrahman, Montasser M Zeid
October-December 2021, 21(4):184-193
DOI:10.4103/jesnt.jesnt_18_21  
Background Uremic malnutrition is strongly associated with increased risk of death and hospitalization events in this patient population. Many studies have focused on the association between nutritional status and clinical outcome, supporting for the hypothesis that malnutrition may cause or contribute to mortality. The aim of the present work was to study the nutritional status in patients receiving sessions of maintenance hemodialysis by using the body composition monitor device. Patients and methods In total, 50 end-stage renal-disease patients on maintenance hemodialysis were enrolled in the study. Assessment of nutritional status using body composition monitor was done for all the patients included in the study. The BCM device takes three steps to display the final output parameters: overhydration, adipose-tissue mass (ATM), and lean-tissue mass (LTM). All output parameters have been validated against the gold-standard reference methods in various studies involving more than 500 patients and healthy controls. Results The studied group was divided according to subjective global assessment questionnaire score into three groups: 26 (52%) patients were well nourished, 14 (28%) patients were mildly/moderately malnourished, and 10 (20%) patients were severely malnourished. The body composition monitor showed a decrease in the parameters related to the LTM, while an increase in the parameters related to the ATM. There were statistically significant negative correlations between both parameters. Conclusion Body composition monitor is a noninvasive, bedside, easy, and convenient method of assessment of the body composition by assessing the LTM and ATM that gives a better idea regarding the nutritional status of the patients.
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CMV viraemia in kidney transplantation; Risk factors and outcomes in the era of prophylaxis
Alshymaa R Eltahan, Iman I Sarhan, Amal S.A.F Hafez, Mamdouh M Mahdi, Ahmed Halawa
October-December 2021, 21(4):156-166
DOI:10.4103/jesnt.jesnt_21_21  
Background Cytomegalovirus (CMV) is among the most prevalent opportunistic pathogens sequencing solid-organ transplantation. Viral immunomodulatory effect can result in the deleterious indirect impacts of CMV over the patient and the graft. The aim of this work was to study the risk factors and the outcomes of CMV viremia in kidney-transplantation recipients. Patients and methods Via a retrospective cohort analysis, we tracked 320 kidney-transplantation recipients’ archives who had their kidney grafts from the beginning of January 2008 to the end of December 2013. The data of 307 recipients were recorded. The study groups were tracked for 10 years post kidney transplantation for the cumulative incidence of CMV viremia, possible risk factors, and incidence of significant post-transplant clinical events. Results One-hundred twenty-seven recipients were CMV-positive, with the first year’s cumulative incidence 36.3% post kidney transplantation. The recipient’s age, pretransplant hypertension, and CMV serostatus mismatch were independent CMV viremia risk factors. CMV was not an independent predictor for the decreased patient survival in this study, but was associated with a significantly reduced graft function as assessed by estimated glomerular-filtration rate. Conclusion Screening, prophylaxis, and prompt treatment have negated the negative outcomes of CMV viremia on patient and graft survival.
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