Epidemiology and prevention of kidney disease in Africa

There is relatively little published information about renal disease in childhood in Africa but clinical experience in many centres, taken in conjunction with available reports on endemic diseases and renal disease, suggest that renal disease may contribute significantly to morbidity and mortality. There are indications that congenital renal malformations and urinary tract infection could be more prevalent than is currently realized and that malnutrition may exaggerate the latter. Acute post-streptococcal glomerular nephritis is a frequent occurrence. Streptococcal skin infection complicating scabies appears to be a more frequent cause than upper respiratory infection, and complicating cardiac failure is common. The nephrotic syndrome associated with quartan malaria is highly prevalent and is poorly responsive to all types of treatment and has a bad prognosis. The nephrotic syndrome also occurs in association with schistosomiasis and as a complication of acute nephritis. Endemic schistosomiasis is a very common cause of renal pathology including obstructive uropathy and bladder pathology. Bladder stone disease is endemic in Egypt and affects mainly young boys. Malnutrition and sickle cell anaemia, both highly prevalent in Africa, also contribute to the prevalence of renal disease. It is likely that improved nutrition, improved hygiene, especially as it relates to control of skin sepsis, and control of malaria and schistosomiasis, will lead to a significant reduction in renal disease.