John Ngigi - Academia.edu (original) (raw)
Papers by John Ngigi
Transplantation, Sep 1, 2022
Kidney International Reports, Feb 1, 2022
Kidney International Reports, 2019
Kidney International Reports, 2022
International Journal of Sciences: Basic and Applied Research, 2017
This article provides summary of sociodemographic and clinical characteristics of the kidney tran... more This article provides summary of sociodemographic and clinical characteristics of the kidney transplant donors and recipients from 2010-2015 from Kenyatta national hospital, Nairobi, Kenya, East Africa. Only living-related organ donation is practiced in Kenya. Accelerated kidney transplantation activities picked up in Kenyatta national hospital from the 2010.
International Journal of Sciences: Basic and Applied Research, 2017
Vascular access is key in patients with end stage renal disease on maintenance haemodialysis. Thr... more Vascular access is key in patients with end stage renal disease on maintenance haemodialysis. Thrombosis is a significant contributor of access-associated morbidity. There are several documented risk factors that predispose to thrombosis in patients with end stage renal disease. These include: inflammation, erythropoietin therapy, hypotension, diabetes and old age among others. Treatment of thrombosis in these patients is challenging. We present three cases of acute vascular thrombosis attended to in the Kenyatta National Hospital, Nairobi-Kenya, East Africa, renal department in one week and literature review.
International Journal of Sciences: Basic and Applied Research, 2016
We present a 61-year-old male, retired driver and a farmer from rural Kenya, East Africa, who had... more We present a 61-year-old male, retired driver and a farmer from rural Kenya, East Africa, who had end-stage renal disease for 2 years with a background of diabetes mellitus and hypertension. He was on haemodialysis since September 2011. He got kidney graft transplant from a living-related donor in October 2013. Six months later, presented with subcutaneous swellings on lower limb and trunk, for 2 months which were identified to be Aspergillosis and Mucormycosis. The history, clinico-laboratory picture and brief management are given. A review of literature on fungal infections in kidney graft recipients is also presented. Fungal infections are an important cause of morbidity and mortality in renal transplant recipients. The risk factors and the causative agents differ depending on the period after the kidney transplant and the incidence varies depending with the geographical area. The emerging fungal infections and paucity of data regarding their management pose a challenge to the tr...
International Journal of Sciences: Basic and Applied Research, 2016
We present N.K, a 31-year old male from Kenya, East Africa, who is a kidney graft recipient from ... more We present N.K, a 31-year old male from Kenya, East Africa, who is a kidney graft recipient from 2013. He suffered endstage kidney disease from poorly controlled hypertension. Subsequently was transplanted from a living related haploidentical donor. He presented barely two years later with asthenia, general body malaise and back pain. He was diagnosed with an abscess in the transplanted renal bed in the right iliac fossa, which yielded Mycobacteria tuberculosis on polymerase chain reaction, which was rifampicin sensitive. We started him on an anti-TB regimen which include isoniazid, pyrazinamide, ethambutol and moxifloxacin. Tuberculosis poses diagnostic and treatment challenges in transplant recipients. Balancing between drug-drug interactions, and raising immunity without adversely affecting the kidney graft is paramount.
Kidney International Reports, 2020
Renal involvement in systemic lupus is present in approximately 60% of adults. It remains one of ... more Renal involvement in systemic lupus is present in approximately 60% of adults. It remains one of the most severe complications of systemic lupus, influencing treatment and prognosis. It is a glomerular disease but tubulointerstitial and vascular involvement can play an aggravating role and must be evaluated. Thus, we conducted this study with the aim of determining the epidemiological, clinical, biological, histological, therapeutic, evolutive and prognostic aspects of lupus nephritis and the prognostic impact of tubulointerstitial lesions associated. Methods: it was a descriptive retrospective study for an analytical purpose over a period of six years from January 1, 2010 to December 30, 2016 performed in the nephrology department at Aristide Le Dantec University Hospital. Patients aged 17 years and older with systemic lupus and lupus nephritis confirmed by renal biopsy were included. Results: We included 99 patients with an average age of 33.33 AE 10.44 years. Our series included 13 men and 86 women, a sex-ratio of 0.15. Lupus was known in 53% of patients. Among the renal signs, edema of lower limbs were present in 55.55% of patients and HBP found in 39% of patients. Proteinuria was present in 40% of patients, hematuria in 26% and leukocyturia in 11% of patients. Extra-renal signs were dermatologic in 45% of patients and rheumatologic in 35% of patients. The average serum creatinine was 23.48 AE 32 mg / l with an average eGFR of 87.96 AE 66.13ml / min / 1.73m 2. Renal function was altered in 33% of patients. Anti-nuclear antibodies were positive in 15 patients and Anti-native DNA antibodies positive in 22 patients. Class V lupus nephritis was 68% representative, associated with class II in 4 patients, class III in 25 patients, and class IV in 9 patients. Class III was found in 35 cases, Class IV in 17 cases, Classes I and II in 4 cases each. Tubular atrophy was present in 38% of patients and necrosis was found in 11% of patients. A cellular infiltrate at the interstitial level was noted in 45% of patients. Interstitial fibrosis was present in 41% of patients. At the induction phase, 56% of patients were on Prednisone. 53% under Methylprednisolone for 3 days followed by an oral Prednisone. And 71% of patients were immunosuppressed whose 68% under cyclophosphamide, 25% under mycophenolate mofetil and 7% under azathioprine. In the maintenance phase, all patients were on corticosteroids. Immunosuppressive drugs were maintained in 64% of patients. Among them, 40% were on cyclophosphamide, 32% on MMF, 16% on Azathioprine and 12% on unspecified treatment. Among of the 99 patients, 31 were followed for 6 months, 6 of whom 6 were lost. Of these 31 patients, 6 were in complete remission, 10 in incomplete remission, 9 patients had resistance. Two CKDs were noted as well as one relapse. A correlation was found between class IV and the presence of hypertension, renal failure and hematuria. There was also a statistically significant relationship between class V and the presence of hypertension, as well as tubulointerstitial achievement and impaired renal function. Conclusions: Lupus nephritis is common in our exercise context. The most common pathological lesion is membranous glomerulonephritis, often associated with proliferative glomerulonephritis. The occurrence of renal failure was correlated with proliferative classes as well as with tubulointerstitial involvement.
Kidney International Reports, 2019
Kidney International Reports, 2019
African Journal of Nephrology
Delivery of kidney care in Africa is significantly constrained by various factors. In this review... more Delivery of kidney care in Africa is significantly constrained by various factors. In this review, we used International Society of Nephrology–Global Kidney Health Atlas (ISN–GKHA) data for Africa to address sub-regional differences in care delivery in the continent with focus on infrastructure, workforce, and the economic aspects of kidney care. Forty two African countries participated in the survey conducted in 2018. North Africa had the highest proportions of nephrologists [12.53 per million population (pmp)], nephrology trainees (2.19 pmp) and haemodialysis (HD) centres (8.58 pmp); whereas southern Africa had the highest proportions of peritoneal dialysis (PD) centres (0.89 pmp) and kidney transplant (KT) centres (0.29 pmp); West Africa had the greatest nephrology workforce shortages. The annual median costs of HD (US$22,731 [interquartile range (IQR): US$1,560–43,902]) and PD (US$34,165 [US$34,165–34,165]) were highest in Central Africa and only Algeria, Egypt and South Africa ...
Transplantation, Sep 1, 2022
Kidney International Reports, Feb 1, 2022
Kidney International Reports, 2019
Kidney International Reports, 2022
International Journal of Sciences: Basic and Applied Research, 2017
This article provides summary of sociodemographic and clinical characteristics of the kidney tran... more This article provides summary of sociodemographic and clinical characteristics of the kidney transplant donors and recipients from 2010-2015 from Kenyatta national hospital, Nairobi, Kenya, East Africa. Only living-related organ donation is practiced in Kenya. Accelerated kidney transplantation activities picked up in Kenyatta national hospital from the 2010.
International Journal of Sciences: Basic and Applied Research, 2017
Vascular access is key in patients with end stage renal disease on maintenance haemodialysis. Thr... more Vascular access is key in patients with end stage renal disease on maintenance haemodialysis. Thrombosis is a significant contributor of access-associated morbidity. There are several documented risk factors that predispose to thrombosis in patients with end stage renal disease. These include: inflammation, erythropoietin therapy, hypotension, diabetes and old age among others. Treatment of thrombosis in these patients is challenging. We present three cases of acute vascular thrombosis attended to in the Kenyatta National Hospital, Nairobi-Kenya, East Africa, renal department in one week and literature review.
International Journal of Sciences: Basic and Applied Research, 2016
We present a 61-year-old male, retired driver and a farmer from rural Kenya, East Africa, who had... more We present a 61-year-old male, retired driver and a farmer from rural Kenya, East Africa, who had end-stage renal disease for 2 years with a background of diabetes mellitus and hypertension. He was on haemodialysis since September 2011. He got kidney graft transplant from a living-related donor in October 2013. Six months later, presented with subcutaneous swellings on lower limb and trunk, for 2 months which were identified to be Aspergillosis and Mucormycosis. The history, clinico-laboratory picture and brief management are given. A review of literature on fungal infections in kidney graft recipients is also presented. Fungal infections are an important cause of morbidity and mortality in renal transplant recipients. The risk factors and the causative agents differ depending on the period after the kidney transplant and the incidence varies depending with the geographical area. The emerging fungal infections and paucity of data regarding their management pose a challenge to the tr...
International Journal of Sciences: Basic and Applied Research, 2016
We present N.K, a 31-year old male from Kenya, East Africa, who is a kidney graft recipient from ... more We present N.K, a 31-year old male from Kenya, East Africa, who is a kidney graft recipient from 2013. He suffered endstage kidney disease from poorly controlled hypertension. Subsequently was transplanted from a living related haploidentical donor. He presented barely two years later with asthenia, general body malaise and back pain. He was diagnosed with an abscess in the transplanted renal bed in the right iliac fossa, which yielded Mycobacteria tuberculosis on polymerase chain reaction, which was rifampicin sensitive. We started him on an anti-TB regimen which include isoniazid, pyrazinamide, ethambutol and moxifloxacin. Tuberculosis poses diagnostic and treatment challenges in transplant recipients. Balancing between drug-drug interactions, and raising immunity without adversely affecting the kidney graft is paramount.
Kidney International Reports, 2020
Renal involvement in systemic lupus is present in approximately 60% of adults. It remains one of ... more Renal involvement in systemic lupus is present in approximately 60% of adults. It remains one of the most severe complications of systemic lupus, influencing treatment and prognosis. It is a glomerular disease but tubulointerstitial and vascular involvement can play an aggravating role and must be evaluated. Thus, we conducted this study with the aim of determining the epidemiological, clinical, biological, histological, therapeutic, evolutive and prognostic aspects of lupus nephritis and the prognostic impact of tubulointerstitial lesions associated. Methods: it was a descriptive retrospective study for an analytical purpose over a period of six years from January 1, 2010 to December 30, 2016 performed in the nephrology department at Aristide Le Dantec University Hospital. Patients aged 17 years and older with systemic lupus and lupus nephritis confirmed by renal biopsy were included. Results: We included 99 patients with an average age of 33.33 AE 10.44 years. Our series included 13 men and 86 women, a sex-ratio of 0.15. Lupus was known in 53% of patients. Among the renal signs, edema of lower limbs were present in 55.55% of patients and HBP found in 39% of patients. Proteinuria was present in 40% of patients, hematuria in 26% and leukocyturia in 11% of patients. Extra-renal signs were dermatologic in 45% of patients and rheumatologic in 35% of patients. The average serum creatinine was 23.48 AE 32 mg / l with an average eGFR of 87.96 AE 66.13ml / min / 1.73m 2. Renal function was altered in 33% of patients. Anti-nuclear antibodies were positive in 15 patients and Anti-native DNA antibodies positive in 22 patients. Class V lupus nephritis was 68% representative, associated with class II in 4 patients, class III in 25 patients, and class IV in 9 patients. Class III was found in 35 cases, Class IV in 17 cases, Classes I and II in 4 cases each. Tubular atrophy was present in 38% of patients and necrosis was found in 11% of patients. A cellular infiltrate at the interstitial level was noted in 45% of patients. Interstitial fibrosis was present in 41% of patients. At the induction phase, 56% of patients were on Prednisone. 53% under Methylprednisolone for 3 days followed by an oral Prednisone. And 71% of patients were immunosuppressed whose 68% under cyclophosphamide, 25% under mycophenolate mofetil and 7% under azathioprine. In the maintenance phase, all patients were on corticosteroids. Immunosuppressive drugs were maintained in 64% of patients. Among them, 40% were on cyclophosphamide, 32% on MMF, 16% on Azathioprine and 12% on unspecified treatment. Among of the 99 patients, 31 were followed for 6 months, 6 of whom 6 were lost. Of these 31 patients, 6 were in complete remission, 10 in incomplete remission, 9 patients had resistance. Two CKDs were noted as well as one relapse. A correlation was found between class IV and the presence of hypertension, renal failure and hematuria. There was also a statistically significant relationship between class V and the presence of hypertension, as well as tubulointerstitial achievement and impaired renal function. Conclusions: Lupus nephritis is common in our exercise context. The most common pathological lesion is membranous glomerulonephritis, often associated with proliferative glomerulonephritis. The occurrence of renal failure was correlated with proliferative classes as well as with tubulointerstitial involvement.
Kidney International Reports, 2019
Kidney International Reports, 2019
African Journal of Nephrology
Delivery of kidney care in Africa is significantly constrained by various factors. In this review... more Delivery of kidney care in Africa is significantly constrained by various factors. In this review, we used International Society of Nephrology–Global Kidney Health Atlas (ISN–GKHA) data for Africa to address sub-regional differences in care delivery in the continent with focus on infrastructure, workforce, and the economic aspects of kidney care. Forty two African countries participated in the survey conducted in 2018. North Africa had the highest proportions of nephrologists [12.53 per million population (pmp)], nephrology trainees (2.19 pmp) and haemodialysis (HD) centres (8.58 pmp); whereas southern Africa had the highest proportions of peritoneal dialysis (PD) centres (0.89 pmp) and kidney transplant (KT) centres (0.29 pmp); West Africa had the greatest nephrology workforce shortages. The annual median costs of HD (US$22,731 [interquartile range (IQR): US$1,560–43,902]) and PD (US$34,165 [US$34,165–34,165]) were highest in Central Africa and only Algeria, Egypt and South Africa ...