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Introduction: Despite being a leading cause of morbidity and mortality globally, acute kidney injury (AKI) is worse in resource-limited areas. This study explores AKI incidence, inhospital mortality, and long-term outcomes in resource-limited settings. Methods: This was a prospective study of children with AKI from 2014 to 2019. KDIGO 2012 defined AKI. We assessed the etiology, inhospital mortality, and long-term outcome of AKI in a mission hospital. Results: Only 169 of 201 AKI patients had complete data. The ages ranged from 1.08 months to 17.5 years; 65.7% were male and 65.1% were from lower socioeconomic class. The incidence of AKI was 59.6 cases per 1,000 persons (95% CI: 5.42, 47.1). Most patients had stage 1 KDIGO AKI (91; 53.8%). 1–5 years old had the highest incidence of AKI (65; 38.5%); sepsis (26.6%), severe malaria (15.4%), and nephrotic syndrome (14.8%) were common AKI causes. Fever (72.8%), pallor (52.1%), and vomiting (45.6%) were the most common symptoms. Thirty-two (27.8%) patients had high blood pressure. Inhospital mortality was 14.8% (95% CI: 9.8, 21.1). The cumulative incidence of AKI-related mortality was 93.2 per 1,000 person-years. Poor outcome was associated with breathlessness, hyponatremia, and leukocytosis. Kaplan-Meier survival curve showed 81% (CI: 74–87%) survival after 5 years of AKI. On Cox proportional-hazards analysis, the absence of breathlessness (HR: 2.537, 95%: CI 1.210–5.317) and hyponatremia (HR: 2.914, 95% CI: 1.343–6.324) were associated with increased survival. Conclusion: In resource-limited settings, infectious diseases and nephrotic syndrome are common causes of AKI. Factors associated with mortality include breathlessness and hyponatremia.

Graft survival after kidney transplantation may be influenced by both donors' and recipients' Apoprotein 1 (APOL1) risk variant status. There are several conflicting reports on screening, eligibility, and inclusion of APOL1 risk variant testing in the Kidney donor risk index. We developed a search strategy that included medical subject headings (MeSH), text words, and entry terms in order to search nine databases. The primary measurable outcome is the recipient's post-transplant graft survival time from APOL1 high-risk variant donors. The secondary outcomes are the proportion of APOL1 high-risk variants in end-stage kidney disease requiring a kidney transplant, the proportion in graft recipients and kidney donors; the effect of APOL1 high-risk variant on donor's kidney function post-kidney donation, recipient kidney allograft survival in APOL1 low and high-risk recipients. Confidence and comprehensive meta-analysis software will be used for the meta-analysis. Methodological, clinical, and statistical heterogeneity will be assessed. Publication bias will be visually assessed using the funnel plot. Results will be presented in forest plots with pooled survival time, standard error, and variance. Sub-group analysis will be performed using moderators such as sociodemographic characteristics, hypertension, HIV status, forms of rejection and other environmental factors. The primary outcome effect size is the standardized mean difference in survival time for APOL1 high risk variants in kidney transplants. The differences in kidney function between donors and recipients before and after transplantation would be examined. The suitability of donors with APOL1 high risk variants will be explored in terms of graft survival time, donor kidney function, and the aforementioned moderators.

Background Graft survival post-kidney transplant may be influenced by APOL1 risk variant status of both donors and recipients. There are several conflicting reports on screening, eligibility and inclusion of APOL1 risk variant testing in the Kidney Donor Risk Index. We aimed to produce a protocol for synthesizing evidence from available data on Apoprotein L1 risk variants and kidney transplantation.Methods We developed a search strategy using MeSH, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Research gate and Scopus. Only observational studies retrievable in the English Language will be included. The primary measurable outcome is the recipient’s post-transplant graft survival time from APOL1 high-risk variant donors. The secondary outcomes are the proportion of APOL1 high-risk variants in End-Stage Kidney Disease requiring kidney transplant, the proportion in graft recipients and kidney donors; effect of APOL1 high-risk variant on donor's kidney function post-kidney donation, recipient kidney allograft survival in APOL1 low and high-risk recipients. Deduplication, screening and selection of identified studies will be done using Covidence software while CMA software version 3 will be used for meta-analysis. All studies will be assessed for methodological, clinical and statistical heterogeneity. Publication bias will be visually assessed using the funnel plot. Results will be presented in forest plots with pooled survival time, standard error and variance. Subgroup analysis will be performed using moderators such as socio-demographics: race, age, gender and socio-economic status; hypertension, HIV status, forms of rejection and other environmental factors.Discussion: The effect size for primary outcome is standardized mean difference in survival time for APOL1 high risk variants in kidney transplants. The changes in kidney functions of donors and recipients pre and post-transplantation would be examined. The suitability of donors who have APOL1 high risk variants will explored in relation to graft survival time, donors kidney function and moderating effects of socio-demographics and environmental determinants. Trial Registration Number: This protocol is registered in PROSPERO, with registration number CRD42021230358