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Saraladevi Naicker,1,* Therese Dix-Peek,2,* Roland Manfred Klar,2 Glendah Kalunga,1 Pulane Mosiane,3 Caroline Dickens,2 Raquel Duarte2 1Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Department of Internal Medicine Laboratory, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 3Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa*These authors contributed equally to this workCorrespondence: Saraladevi NaickerDepartment of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaTel +27 83 6429575Email saraladevi.naicker@wits.ac.zaBackground: There is a wide spectrum of kidney pathology in human immunodeficiency virus (HIV) infection, affecting all structures of the kidney. The histology of HIV chronic kidney disease (CKD) is diverse, ranging from HIV-associated nephropathy (HIVAN) to focal glomerulosclerosis (FSGS), HIV-immune complex disease (HIV-ICD), other glomerulopathies and tubulo-interstitial nephritis. Definitive diagnosis is by kidney biopsy, an invasive procedure. However, serum and urinary biomarkers may be useful in predicting the histological diagnosis of HIVAN.Purpose: We wished to determine the utility of serum and urinary biomarkers in predicting the histological diagnosis of HIVAN.Patients and Methods: We measured neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, transforming growth factor (TGF)-β isoforms and bone morphogenetic protein (BMP)-7 in the serum and urine in patients with different histological forms of HIV glomerular disease.Results: In HIVAN, we demonstrated increased levels of serum cystatin C and increased levels of serum and urinary NGAL. Urinary TGF-β 1 and TGF-β 2 levels were elevated in HIV-positive patients with CKD but were not significantly different in the different HIV histologies, while urinary BMP-7 levels were elevated in minimal change disease.Conclusion: This study confirmed the presence of increased serum and urinary biomarkers of tubular injury in patients with HIVAN, and increased urinary biomarkers of fibrosis in HIV CKD, and may indicate their value as a non-invasive diagnostic tool for the diagnosis of HIVAN.Keywords: cystatin C, neutrophil gelatinase-associated lipocalin, NGAL, transforming growth factor (TGF)-β isoforms, bone morphogenetic protein (BMP)-7, HIV chronic kidney disease

Aliyu Abdu,1 Akinfenwa Atanda,2 Sunusi M Bala,3 Babatunde Ademola,1 Aishat Nalado,1 Patience Obiagwu,4 Raquel Duarte,5 Saraladevi Naicker5 1Nephrology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria; 2Department of Histopathology, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria; 3Department of Medicine, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria; 4Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria; 5Department of Medicine, University of Witwatersrand, Johannesburg, South AfricaCorrespondence: Aliyu AbduNephrology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, NigeriaEmail aliyuabdu2000@yahoo.co.ukIntroduction: Kidney biopsy in patients with HIV-associated kidney diseases allows for histopathologic diagnosis and institution of appropriate treatment as well as proper prognostication. There is a paucity of data on the histopathological pattern of HIV-associated kidney diseases in most sub-Saharan African countries. This study was aimed at evaluating the histopathologic patterns of kidney diseases seen among HIV-infected treatment-naive patients in our center as this will allow for proper diagnosis and institution of appropriate treatment.Methods: In this cross-sectional study, consecutive patients who satisfied inclusion criteria and consented to participate were recruited. Percutaneous kidney biopsies were carried out as day procedures under real-time ultrasound guidance using an automatic spring-loaded biopsy gun as per our unit protocols. Baseline investigations including urea, creatinine, electrolytes, CD4 count, complete blood count, and glomerular filtration rate (eGFR) calculations, urinalysis and urine protein creatinine ratios were done on all the participants.Results: Fifty-five patients who satisfied the inclusion criteria were studied. The mean age of the study population was 38.34± 9.26 years, with 32% females. Mean serum creatinine was 249.6± 164.6 μmol/L, and mean CD4 count was 238 ± 210 cells/mL. The commonest histological type was FSGS seen in 20 patients (37.7%), followed by HIVAN seen in 17 (32.1%) patients; chronic interstitial nephritis in 7 patients (13.2%) and 6 (11%) had no significant pathological finding. Compared to non-HIVAN, HIVAN patients tended to have higher systolic BP (p= 0.05); higher serum creatinine levels (p= 0.05); lower eGFR (0.03) and higher urine protein to creatinine ratio [uPCR; p= 0.02].Conclusion: Kidney involvement is still a form of presentation among HIV-infected treatment-naïve patients and though a wide range of glomerular and tubulointerstitial lesions may be seen, FSGS and HIVAN are still the most common. We recommend assessment of kidney function, including urinalysis, as part of the routine evaluation of newly diagnosed HIV patients and biopsy where indicated to prognosticate and institute appropriate early treatment.Keywords: HIV, kidney disease, histology

Bala Waziri,1,2 Raquel Duarte,1 Saraladevi Naicker1 1Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Department of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Minna, NigeriaCorrespondence: Bala WaziriDepartment of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Km 10, Paiko Road, Minna, NigeriaEmail balawaziri@gmail.comAbstract: Despite the availability of global and regional guidelines to curtail the adverse clinical outcomes associated with chronic kidney disease–mineral and bone disorder (CKD-MBD), most CKD patients are still affected by the consequences of abnormalities of CKD-MBD. This important clinical complication of CKD continues to be studied, in order to improve the understanding and management of CKD-MBD. Some notable discoveries include the role of fibroblast growth factor 23 (FGF23) in the pathogenesis of CKD-MBD, leading to a shift from the previous well-established classic trade-off hypothesis to the updated trade-off hypothesis. More recently, there has been a shift from the treatment of CKD-MBD based on a single level of biomarkers to serial measurements of calcium, phosphate and parathyroid hormone (PTH). Furthermore, some clinical trials have emerged after the 2009 Kidney Disease-Improving Global Outcomes (KDIGO) Guidelines, leading to the 2017 KDIGO updated recommendations. Hence, this review gives an overview of the rapidly evolving trends in CKD-MBD, linking the past and current concepts of CKD-MBD.Keywords: chronic kidney disease–mineral and bone disorder, updated pathogenesis, emerging trends, management

Aishatu Mohammed Nalado,1,2 Johnny N Mahlangu,3 Bala Waziri,1 Raquel Duarte,1 Graham Paget,1 Gbenga Olorunfemi,4 Saraladevi Naicker1 1Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; 2Department of Internal Medicine, College of Health Sciences, Bayero University, Kano, Nigeria; 3School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 4Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa Introduction: Anemia is a complication of chronic kidney disease (CKD) that can greatly impact on its prognosis. However, the risk factors for anemia, including the influence of ethnicity, are not well established among the CKD population in Johannesburg.Methods: This was a cross-sectional study of 353 adult CKD patients attending the renal outpatient clinic of the Charlotte Maxeke Johannesburg Academic Hospital (Johannesburg, South Africa) from June 1, 2016 to December 30, 2016. Sociodemographic and clinical characteristics were obtained using a proforma. Blood samples were collected for serum electrolytes and hematological parameters. Predictors of low hemoglobin and iron deficiency anemia (IDA) were evaluated using multivariable binary logistic regression.Results: The mean age and prevalence of anemia among the CKD participants were 55.3±15.0 years and 43.18% (95% CI: 38.1%–48.4%), respectively. Blacks had the highest prevalence of anemia (46.9%), while Indians/Asians had the lowest (18.2%). Although the odds of anemia was 3.8-fold higher (odds ratio =3.8, P-value =0.059) among CKD stage V participants as compared to CKD stage I, the relationship between anemia and stages of CKD was non-linear. Diabetes mellitus (odds ratio =2.31, P-value =0.005) had a strong association with anemia among the CKD participants.Conclusion: Almost half of the CKD participants were anemic, and the odds of anemia did not increase linearly with increasing severity of CKD. There was a marked ethnic disparity in anemia prevalence. Our study highlights the need for risk-based management of anemia among CKD patients. Keywords: chronic kidney disease, hemoglobin, risk factors, iron deficiency anemia, ethnicity, Johannesburg, South Africa, kidney stage

Stephen Olawale Oguntola,1 Muzamil Olamide Hassan,2 Raquel Duarte,3,* Therese Dix-Peek,3 Caroline Dickens,3 Gbenga Olorunfemi,4 Ahmed Vachiat,5 Graham Paget,1 Pravin Manga,5 Saraladevi Naicker1,* 1Department of Internal Medicine, Division of Nephrology, University of Witwatersrand, Johannesburg, South Africa; 2Department of Internal Medicine, Dialysis Unit, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria; 3Department of Internal Medicine Laboratory, University of Witwatersrand, Johannesburg, South Africa; 4Department of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa; 5Department of Internal Medicine, Division of Cardiology, University of Witwatersrand, Johannesburg, South Africa *These authors contributed equally to this work Background: Despite remarkable improvement in renal function attributable to kidney transplantation, the burden of cardiovascular disease (CVD) among kidney transplant recipients (KTRs) remains high in the post-transplant period. Aggressive use of statins in KTRs may make lipoprotein ratios correlate better with atherosclerotic vascular disease (AsVD) when compared with traditional lipid profile parameters. We therefore evaluated the clinical and echocardiographic correlates of AsVD among non-diabetic, stable, black KTRs in South Africa.Methods: This was a cross-sectional study of 41 adult (18–65 years), non-diabetic, stable KTRs and 41 age- and sex-matched healthy controls. An interviewer-administered questionnaire was used to obtain information on participants’ sociodemographic and cardiovascular risk factors. Anthropometric parameters were measured. Urine and blood samples were obtained and analyzed. Echocardiography was performed and carotid intima media thickness (CIMT) was assessed in both right and left carotid arteries. Spearman’s rank correlation and binary logistic regression were performed to determine the relationship between CVD risk factors and AsVD. Results: AsVD was present in 46.3% of KTRs compared to 17.1% of healthy controls (p = 0.004). Left ventricular hypertrophy was present in 92.7% of the KTRs. There were statistically significant differences in waist–hip ratio, systolic blood pressure, mean arterial pressure, urine albumin–creatinine ratio, serum fibrinogen, serum creatinine, estimated glomerular filtration rate, left atrial diameter, left ventricular mass (LVM), and left ventricular mass index (LVMI) between KTRs and controls. A positive relationship was seen between CIMT and certain risk factors for CVD including LVM, LVMI, and mitral valve deceleration time, (p

Nina E Diana, Saraladevi Naicker Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Abstract: The prevalence of HIV-associated chronic kidney disease (CKD) varies geographically and depends on the definition of CKD used, ranging from 4.7% to 38% globally. The incidence, however, has decreased with the use of effective combined antiretroviral therapy (cART). A wide variety of histological patterns are seen in HIV-associated kidney diseases that include glomerular and tubulointerstitial pathology. In resource-rich settings, there has been a plateau in the incidence of end-stage renal disease secondary to HIV-associated nephropathy (HIVAN). However, the prevalence of end-stage renal disease in HIV-positive individuals has risen, mainly due to increased longevity on cART. There is a disparity in the occurrence of HIVAN among HIV-positive individuals such that there is an 18- to 50-fold increased risk of developing kidney disease among HIV-positive individuals of African descent aged between 20 and 64 years and who have a poorer prognosis compared with their European descent counterparts, suggesting that genetic factors play a vital role. Other risk factors include male sex, low CD4 counts, and high viral load. Improvement in renal function has been observed after initiation of cART in patients with HIV-associated CKD. Treatment with an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker is recommended, when clinically indicated in patients with confirmed or suspected HIVAN or clinically significant albuminuria. Other standard management approaches for patients with CKD are recommended. These include addressing other cardiovascular risk factors (appropriate use of statins and aspirin, weight loss, cessation of smoking), avoidance of nephrotoxins, and management of serum bicarbonate and uric acid, anemia, calcium, and phosphate abnormalities. Early diagnosis of kidney disease by screening of HIV-positive individuals for the presence of kidney disease is critical for the optimal management of these patients. Screening for the presence of kidney disease upon detection of HIV infection and annually thereafter in high-risk populations is recommended. Keywords: chronic kidney disease, HIV infection, current management

A new species Cigaritis meghamalaiensis sp. nov. (Lycaenidae, Aphnaeinae) is described from the Meghamalai Hills of the Periyar landscape of the southern Western Ghats. Images of adults and illustrations of male genitalia are presented. Information on myrmecophilous immature stages is provided and its ecology is discussed. The new species is very distinct from all the known Cigaritis species in WG, and is diagnosed based on the following combination of characters–upper side of both wings marked extensively blue in males; discal and post-discal bands on forewing underside conjoined and lying parallel from their origin at the costa; post-basal band in hindwing underside continuous and not broken into three smaller bands and this post-basal band ends at vein1b, is not continued along it to reach discal band. The discal and post-discal bands on the underside of the forewing is conjoined and lying parallel from their origin at the costa which is a unique feature that distinguishes the new species from all other Cigaritis species occurring in Peninsular India and Sri Lanka. A key to all known species of Cigaritis from the Western Ghats is provided. [ABSTRACT FROM AUTHOR]

Background. National response mechanisms, including lockdown regulations and financial and food aid, have exacerbated adversity and provided support. They have also exposed existing inequalities, with individuals and families able to cope and recover to varying degrees. Families with young children, specifically those under the age of 5, are rarely the focus of outreach, although they care for the most vulnerable group in our society. Objective. To rapidly gather as much nationally representative information as possible on the challenges experienced by families with children under 5 years of age and the support they most urgently require. Methods. A short online survey was launched in late 2020 on a zero-cost mobile application reaching over 2 million users. A total of 15 912 individuals were eligible for participation and 13 224 parents (caring for 18 858 children under 5 years) were included in the analytic sample. Outcomes were grouped by (a) negative impacts of the pandemic, including disruptions in childcare, missed clinic visits, feeding challenges, difficulties in showing affection, behavioural challenges, and violence in the home; and (b) support received and required by the family. Chi-squared tests examined outcomes across the socio-demographic variables and standardised adjusted residuals were calculated to measure strength of differences. Results. Fathers made up 30% of the sample. Just over half of parents cared for one child under 5 and 41% for 2 - 3 children under 5. More than three-quarters (82%) of parents reported experiencing at least one challenge, with the most common being disruptions in childcare (69%), difficulties feeding their child (50%) and showing affection (41%). The main underlying factors were fear of infection, lack of money and negative affect in the household including stress, tension and a sense of hopelessness and depression. Fathers and families living in rural areas reported the most challenges. They were more likely to report difficulties showing affection, struggles in providing meals for young children, and higher levels of violence towards children in the home. Although needs considerably outweighed support received, government compared with civil society organisations and communities had the highest penetration of support to families, reaching between a quarter and a third of families. Conclusion. Families with young children face many challenges with little outside support for their material and psychosocial needs. It is essential that those mandated with ensuring the wellbeing of young children understand the needs of families and have the capacity to reach them in general, and particularly during times of crisis. [ABSTRACT FROM AUTHOR]

A new butterfly taxon, Nacaduba sinhala ramaswamii ssp. nov. (Lepidoptera: Lycaenidae: Polyommatini), is described from Agasthyamalais of southern Western Ghats in peninsular India. The new taxa can be diagnosed from all other Nacaduba of southern India and N. sinhala Ormiston, 1924 from Sri Lanka, by its distinct male genitalia. The early stages, larval hostplants, flight periods, ecology and the known distribution of the new taxa are discussed. The revised keys to all known Nacaduba of Western Ghats of peninsular India are provided. [ABSTRACT FROM AUTHOR]