Kidney diseases in Africa: aetiological considerations, peculiarities and burden

Abstract

Aim: To review available literature on the burden of kidney diseases in Africa from the perspective of acute kidney injury and chronic kidney disease. It also aims to provide information on the status of renal replacement therapy activities, and the emerging roles of the double burden of communicable and non communicable diseases interfacing with the kidney in a continent with distinct environmental, socio-cultural, infrastructural and economical peculiarities.

Methods: A literature search was conducted on the aetiopathogenesis, management options of peculiar diseases causing both acute kidney injury and chronic kidney diseases and renal replacement therapies in Africa. The literature review used the electronic database; Medline, Pubmed and theAfrican Journal on line (AJOL). Information related to the topic over a 30-year period (1979-2009) was retrieved and reviewed. Search terms used were; acute renal failure in Africa, acute kidney injury in Africa, chronic renal failure/chronic kidney disease in Africa, heamodialysis, peritoneal dialysis and transplantation in Africa.

Result: Nephrotoxins and infections are prevalent causes of acute kidney injury (AKI) in the continent. Chronic glomerulonephritis, hypertension and lately diabetes mellitus are still major peculiar aetiological factors of chronic kidney disease (CKD). A variety of renal syndromes which can be acute or chronic is associated with the Human immunodiefficency virus infection and its magnitude and consequences portend a grim reality in a continent that is least prepared to respond appropriately. Renal replacement therapy therapy is limited to less than five percent of those that need it especially in the sub-Saharan Africa.

Conclusion: There is a huge burden of AKI and CKD in Africa from the perspective of their peculiar aetiological considerations. The status of renal replacement therapy activities is poor except in North and South Africa. The major challenges of kidney diseases in Africa include the high prevalence, delayed presentation, cost of treatment, general lack of preventive measures, lack of epidemiological studies and general lack of functional renal registries. There is thus a need for a strong advocacy for support for renal care in Africa.