Clinical Outcomes of a Dedicated Kidney Adolescent and Young Adult Clinic (KAYAC) in South Africa.

Aim: Adolescents and young adults (AYAs) are increasingly utilising kidney health care services. However, there is no data on the impact of kidney transition clinics, as well as the AYA spectrum of kidney diseases, in South Africa (SA). This study evaluates kidney outcomes and patient survival amongst AYA patients attending a dedicated kidney AYA clinic (KAYAC).

Malaria associated pathogenesis of chronic kidney disease (MAP-CKD): a prospective study of children hospitalized with severe malaria.

Background: Severe malaria (SM) remains a leading cause of child mortality and an important global contributor to acute kidney injury (AKI), which can progress to chronic kidney disease (CKD) in some survivors. Notably, 80% of AKI deaths occur in low- and middle-income countries (LMIC). Despite this burden, the mechanisms and recovery trajectory of SM associated AKI remain poorly understood.

Dialytic sodium removal in children with acute kidney injury treated with peritoneal dialysis.

Background: Dialytic sodium removal (DSR) is an important parameter of peritoneal dialysis (PD) adequacy. The aim of this study was to report the DSR of children with acute kidney injury (AKI) on a standard acute PD prescription and to compare it to that of children on continuous flow peritoneal dialysis (CFPD).

Methods: A secondary analysis of prospectively collected data was performed from a published randomized controlled crossover trial comparing children on conventional PD and CFPD.

The global health burden of pediatric chronic kidney disease: An analysis of the Global Burden of Disease database from 1990 to 2021.

Background: Chronic kidney disease (CKD) poses a significant global health challenge; however, its burden on pediatric populations remains underexplored. This study assesses the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of pediatric CKD attributable to type 1 diabetes mellitus, type 2 diabetes mellitus, hypertension, glomerulonephritis, and congenital anomalies of the kidney and urinary tract from 1990 to 2021.

Methods: Data were extracted from the Global Burden of Disease (GBD) 2021 database.

Educational Gaps and Suggestions for Change for Pediatric Transplant Fellowship Training Based on Fellow Survey Responses.

Background: Advancements in organ transplant technology are pushing global transplant capabilities to new heights. However, challenges persist in pediatric surgical and medical transplant fellowship training, primarily due to a limited number of adequate training programs and gaps in education. Addressing these gaps is essential for improving patient outcomes and advancing the field of pediatric transplantation.

Pediatric kidney replacement therapies in low-to-middle income countries: a review and white paper.

Acute kidney injury (AKI) disproportionately impacts children in low- and middle-income countries (LMICs), where up to 85% of AKI cases occur. As for pediatric chronic kidney disease (CKD), the true burden in LMICs remains unclear, as many cases go undiagnosed early, and other children succumb without adequate treatment. Unfortunately, these disparities result from limited access to kidney replacement therapy (KRT), kidney laboratory and imaging resources, healthcare provider shortages, and financial barriers.

Toxoplasmosis Prophylaxis Practices: A Survey of International Pediatric Solid Organ Transplantation Centers.

Background: Toxoplasma gondii can cause opportunistic infections leading to life-threatening disseminated disease after organ transplantation. However, there is a paucity of pediatric-specific data to guide recommendations for the prevention of toxoplasmosis after solid organ transplantation.

Methods: To assess current practices, international pediatric transplant providers were surveyed.

Clinical, immune and genetic risk factors of malaria-associated acute kidney injury in Zambian children: A study protocol.

Background: Acute kidney injury (AKI) affects nearly half of children with severe malaria and increases the risk of adverse outcomes such as death and poor cognitive function. The pathogenesis and predictors of malaria-associated acute kidney injury (MAKI) are not fully described. This study aims to determine the clinical, immune, and genetic correlates of risk to AKI in Zambian children admitted with malaria.

The role of sex and gender in acute kidney injury-consensus statements from the 33rd Acute Disease Quality Initiative.

Sex differences exist in acute kidney injury (AKI), and the role that sex and gender play along the AKI care continuum remains unclear. The 33rd Acute Disease Quality Initiative meeting evaluated available data on the role of sex and gender in AKI and identified knowledge gaps. Data from experimental models, pathophysiology, epidemiology, clinical care, gender, social determinants of health, education, and advocacy were reviewed.

Innovation of a Neonatal Peritoneal Dialysis Catheter to Expand Dialysis Capabilities for Critically Ill Neonates in Low-Resource Settings.

Introduction: The lack of peritoneal dialysis (PD) catheters designed explicitly for neonates creates significant challenges in the provision of neonatal PD. High resource settings can circumvent this limitation by resorting to alternative extracorporeal dialysis methods. However, in low-resource settings, PD remains the preferred dialysis modality, and the use of off-label catheters for PD results in complications such as omental wrapping and occlusion.

IPNA clinical practice recommendations on care of pediatric patients with pre-existing kidney disease during seasonal outbreak of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic, instigated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has profoundly impacted healthcare infrastructures around the globe. While children are usually asymptomatic or have mild symptoms, children with pre-existing kidney conditions require specialized attention. This pivotal report, championed by the International Pediatric Nephrology Association (IPNA), delivers precise and actionable recommendations tailored for pediatric patients with kidney ailments in this pandemic landscape.

First ABO-Incompatible Pediatric Kidney Transplant in South Africa-A Case Report.

Background: Blood group incompatibility previously represented an obstacle to living related donor (LRD) options; desensitization modalities have expanded LRD options. ABO-incompatible kidney transplants have been successful in adults and pediatric liver transplants, but to date not yet in pediatric kidney transplants in South Africa.

Case Report: Patient X is a 5 year old male with end-stage kidney failure due to Posterior Urethral Valves, requiring peritoneal dialysis pre-transplant.

Pediatric to Adult Transition in Solid Organ Transplant Recipients: A Systematic Review of Existing Transition Programs.

Background: Pediatric organ transplantation is the primary treatment for end-organ failure. Improving medication adherence and healthcare compliance can decrease healthcare burdens, graft rejection, morbidity, and mortality. Adolescents commonly struggle with non-adherence, necessitating a smooth transition to adult care.

Discontinuation of maintenance peritoneal dialysis in children-A 10-year review from a single center in a low resource setting.

Introduction: In South Africa, only children considered eligible for transplantation are offered dialysis as bridge to kidney transplantation. Maintenance peritoneal dialysis (PD) is preferred and has several advantages over hemodialysis (HD). While awaiting transplantation, PD may be discontinued due to permanent transfer to HD or death while on PD, of which the occurrence and burden is not known in our setting.

Dialysis for paediatric acute kidney injury in Cape Town, South Africa.

Background: Dialysis is lifesaving for acute kidney injury (AKI), but access is poor in less resourced settings. A "peritoneal dialysis (PD) first" policy for paediatric AKI is more feasible than haemodialysis in low-resource settings.

Methods: Retrospective review of modalities and outcomes of children dialysed acutely at Red Cross War Memorial Children's Hospital between 1998 and 2020.

Evaluation of the implementation of a "Pediatric Feasibility Assessment for Transplantation" tool in children and adolescents at Red Cross War Memorial Children's Hospital, Cape Town, South Africa.

Background: Kidney transplantation remains the treatment of choice for children with kidney failure (KF). In South Africa, kidney replacement therapy (KRT) is restricted to children eligible for transplantation. This study reports on the implementation of the Paediatric Feasibility Assessment for Transplantation (pFAT) tool, a psychosocial risk score developed in South Africa to support transparent transplant eligibility assessment in a low-resource setting.

Point-of-Care Ultrasound (POCUS) Training Curriculum for Pediatric Nephrology: PCRRT-ICONIC Group Recommendations.

Key Points: Despite a high need and interest in point-of-care ultrasound (POCUS) in trainees and faculty of Pediatric Nephrology, the majority are not receiving POCUS training. There is a need to establish a structured pediatric nephrology POCUS program for clinicians and fellows. This study suggests a blueprint of POCUS curriculum which can serve as a foundation for POCUS education in pediatric nephrology centers worldwide.

Health-related quality of life for pediatric patients with end-stage kidney disease: A systematic review and meta-analysis of the Pediatric Quality of Life Inventory (PedsQL).

Introduction: Health-related quality of life (HRQoL) studies demonstrate the impact of end-stage renal disease (ESRD) on the physical and psychosocial development of children. While several instruments are used to measure HRQoL, few have standardized domains specific to pediatric ESRD. This review examines current evidence on self and proxy-reported HRQoL among pediatric patients with ESRD, based on the Pediatric Quality of Life Inventory (PedsQL) questionnaires.

Kidney adolescent and young adult clinic: A transition model in Africa.

Adolescents and Young Adults (AYAs) with chronic kidney disease (CKD) have challenges unique to this developmental period, with increased rates of high-risk behavior and non-adherence to therapy which may impact the progression of kidney disease and their requirement for kidney replacement therapy (KRT). Successful transition of AYA patients are particularly important in low- and middle-income countries (LMICs) where KRT is limited, rationed or not available. Kidney AYA transition clinics have the potential to improve clinical outcomes but there is a paucity of data on the clinical translational impact of these clinics in Africa.

Development of PD in lower-income countries: a rational solution for the management of AKI and ESKD.

It is estimated that >50% of patients with end-stage kidney disease (ESKD) in low-resource countries are unable to access dialysis. When hemodialysis is available, it often has high out-of-pocket expenditure and is seldom delivered to the standard recommended by international guidelines. Hemodialysis is a high-cost intervention with significant negative effects on environmental sustainability, especially in resource-poor countries (the ones most likely to be affected by resultant climate change).

A 6-year review of acute post-streptococcal glomerulonephritis at a public children's hospital in Cape Town, South Africa.

Background: Acute post-streptococcal glomerulonephritis (APSGN) is the most common cause of acute nephritis in children globally and, in some cases, may be associated with progressive kidney injury and failure, cumulating in the need for long-term dialysis and/or kidney transplantation.

Methods: Our retrospective study describes the occurrence of APSGN among children (< 14 years) admitted to a tertiary children's hospital in Cape Town, South Africa, from January 2015 to December 2020.

Results: Of 161 children who presented with acute nephritis (haematuria, oedema, oliguria, and hypertension), 100 met the inclusion criteria.