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Currently, few high-quality studies evaluating the epidemiology of KLB in South Africa have been published. The aim of this study is to investigate economic means of predicting kidney function in CKD by investigating the relationship between estimated glomerular filtration rate (eGFR) and renal morphology evaluated by ultrasound (US). The dual effect of IE and LCMD tended to significantly shorter RL and lower eGFR than in the presence of one or no US abnormality (p <0.001).
GFR determination and US are inexpensive ways to assess renal function, especially in resource-limited settings. IE and RL are surrogate markers of renal function, with an increased echogenic pattern being most predictive of renal dysfunction in chronic kidney disease, especially in HIV. Defining key diagnostic tools for chronic kidney disease in the African population will enable early identification of patients at risk and initiation of therapy.
This study aims to review renal function (eGFR) and renal morphology on US of patients diagnosed with CKD at Inkosi Albert Luthuli Central Hospital (IALCH) to determine if an association exists between these two variables.
Literature review and motivation
RL is the distance between the lower and upper poles of the kidney and is measured in a longitudinal axis view. Cortical thickness is measured from the base of the medullary pyramid to the edge of the kidney. It was also found that there was no significant difference in RL or cortical thickness in different age categories despite age-related declines in glomerular filtration rate.
Renal length and anteroposterior diameter on US as well as the serum creatinine were determined. Specific sonographic features of the various risk factors involved in the pathogenesis of CKD have been described. In a cross-sectional study of 302 patients, hypertension, diabetes and HIV were found to be the most common causes of CKD at primary/regional health care facilities in KZN [ 21 ].
HIV-associated nephropathy (HIVAN) is characterized on US by a variable RL, spheroid, an LCMD, IE and decrease in renal sinus fat. Further correlations on which etiology best matches the change in renal function with a specific morphological parameter on sonography can be determined and compared with other etiologies.
Methods Research question
Objectives
Study Design
Site details
Study enrolment
Inclusion criteria
Exclusion criteria
Data source, collection and analysis
Data collected
Definitions
Statistical analysis
Ethical Consideration
Discussion of results
Parallel to these disorders is the deterioration of kidney function at rates that depend on underlying genetic and environmental factors.12,13 The end product is the incorrect handling of metabolites, electrolytes and urea which is accompanied by a significant cardiovascular risk. These approaches include increasing public awareness, early initiation of therapy at primary levels of care and rapid referral to specialist centers in the face of established CKD.16 Despite these active measures taken to circumvent these problems, Africa continues to lag behind the most Northern areas. Fortunately, the assessment of the eGFR and renal morphology via US are minimally invasive and cost-effective diagnostic methods to evaluate CKD.
If it results abnormally and/or is accompanied by other clinical disorders, i.e. proteinuria, renal US is used to delineate the anatomy of the kidney. To our knowledge, this is the first study in sub-Saharan Africa to investigate the complex and dynamic relationship between renal function (eGFR) and renal morphology on US in CKD. The centralization of specialist services such as adult nephrology and hypertension at IALCH makes this center highly representative of CKD within the province catering for more than 10 provincial districts and 50 municipalities (Figure 11).
However, we recognize that this may be a gross underestimate of the true burden of CKD within the province as specialist nephrology services remain largely inaccessible to residents of rural areas. A significant difference in kidney size, presence of US abnormalities and distribution of CKD risk factors was noted between the different ethnic groups in this study. This is understandable since secondary hypertension is a product of advanced kidney disease, which comprised more than 60% of the total cases in this study.
African descent poses a high risk of developing kidney disease with a particularly accelerated course. The ellipsoidal formula used in the calculation of renal volume on US may be inadequate, as the kidney is not ellipsoidal in shape. An increased echogenic pattern and changes in RL can be considered as independent surrogate markers of renal function in CKD.
Therefore, anthropometric adjustment of US indices should be performed to avoid the under- or over-diagnosis of CKD. Echogenicity, which describes the severity of renal sclerosis, is easily determined when compared with the echo pattern of the neighboring liver.18 We confirmed that an increased echogenic pattern is the most significant independent predictor of renal function (MDRD) [-9.29 OR; 95% CI p. An opposite and highly significant effect was seen in the presence of a loss in CMD.
Study limitations
Summary and Recommendations
Prevalence of chronic kidney disease and association with cardiovascular risk factors among teachers in Cape Town, South Africa. Evaluation of the chronic kidney disease epidemiology collaboration equation to estimate glomerular filtration rate in multiple ethnic groups. Estimating glomerular filtration rate in black South Africans using dietary modification in renal disease and the Cockcroft-Gault equations.
Characteristics of South African patients presenting with kidney disease in rural KwaZulu-Natal: a cross-sectional study. A comparison of urban and rural patients with chronic kidney disease referred to the Inkosi Albert Luthuli Central Hospital in Durban, South Africa. Investigating the coexistence of CKD and chronic non-communicable diseases in a PBM company in South Africa.
Sonographic assessment of renal cortical echogenicity and elevated serum creatinine in patients with chronic kidney disease. Relationship between ultrasound-determined renal volume and measured GFR, calculated creatinine clearance and other parameters in chronic kidney disease (CKD). The role of ultrasound in the diagnosis of chronic kidney disease and its correlation with serum creatinine level.
The use of diagnostic ultrasound in the evaluation of the kidneys in HIV-associated nephropathy. Usefulness of ultrasound renal length and volume in determining the severity of chronic kidney disease.
Appendices
Data collection Sheet
