Research Articles (Nephrology)

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An audit of 24-hour creatinine clearance measurements at Tygerberg Hospital and comparison with prediction equations
(Health and Medical Publishing Group (HMPG), 2007-10) Le Riche, Mia; Zemlin, Annalise E.; Erasmus, Rajiv T.; Davids, MR
BACKGROUND: Internationally, clinical guidelines recommend the use of creatinine-based equations to estimate glomerular filtration rate (GFR) for assessment and follow-up of kidney disease. The routine use of 24-hour creatinine clearances (CrCl) is no longer advocated. Objectives. To examine the indications for requesting CrCl at Tygerberg Hospital, identify problems associated with the procedure, and evaluate the utility of the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations with different levels of renal dysfunction in the ethnic groups of the Western Cape. Methods. A clinical audit of CrCl was performed. The estimated GFR as predicted by the modified CG and MDRD formulae was compared with CrCl in 252 patients, representing three local ethnic groups. MDRD formulae with and without the correction factor for black ethnic group (MDRD-B) were evaluated. Results. Problems with urine collection or data supplied were identified in one-third of CrCl requests, leading to unreliable results. The CG correlated best with CrCl in the group as a whole. The average absolute and percentage differences from CrCl in the different ethnic groups were as follows: coloured (mixed ethnicity) (N = 186) - CG 13.4 ml/min/1.73 m2 (18%), MDRD 16.8 ml/min/1.73 m2 (23%) and MDRD-B 27.9 ml/mim/1.73 m2 (37%); black (N = 21) - CG 14.8 ml/min/1.73 m2 (19%), MDRD 12.9 ml/min/1.73 m2 (17%) and MDRD-B 25.1 ml/min/1.73 m2 (33%); white (N = 45) CG 13.5 ml/min/1.73 m2 (19%), MDRD 15.3 ml/min/1.73 m2 (21%) and MDRD-B 24.8 ml/min/1.73 m2 (35%). Throughout the renal function levels (chronic kidney disease stages 1 - 5) CG correlated better with CrCl than MDRD. Conclusions. Possible reasons for poor correlations include a high prevalence of obesity, underweight and normal GFR in the study population. There is a need for further research, using a gold standard, into the accuracy of these prediction equations in our unique patient populations before firm recommendations can be made regarding their use. Until then CrCl will continue to be widely used. Greater efforts at patient and health care worker education are required to ensure proper collections.
Bolus administration of intravenous glucose in the treatment of hyperkalemia : a randomized controlled trial
(Karger, 2014-02) Chothia, Mogamat-Yazied; Halperin, Mitchell L.; Rensburg, Megan A.; Hassan, Mogamat Shafick; Davids, Mogamat Razeen
Background: Hyperkalemia is a common medical emergency that may result in serious cardiac arrhythmias. Standard therapy with insulin plus glucose reliably lowers the serum potassium concentration ([K + ]) but carries the risk of hypoglycemia. This study examined whether an intravenous glucose- only bolus lowers serum [K + ] in stable, nondiabetic, hyperkalemic patients and compared this intervention with insulin-plus-glucose therapy. Methods: A randomized, crossover study was conducted in 10 chronic hemodialysis patients who were prone to hyperkalemia. Administration of 10 units of insulin with 100 ml of 50% glucose (50 g) was compared with the administration of 100 ml of 50% glucose only. Serum [K + ] was measured up to 60 min. Patients were monitored for hypoglycemia and EKG changes. Results: Baseline serum [K + ] was 6.01 ± 0.87 and 6.23 ± 1.20 mmol/l in the insulin and glucose-only groups, respectively (p = 0.45). At 60 min, the glucose-only group had a fall in [K + ] of 0.50 ± 0.31 mmol/l (p < 0.001). In the insulin group, there was a fall of 0.83 ± 0.53 mmol/l at 60 min (p < 0.001) and a lower serum [K + ] at that time compared to the glucose-only group (5.18 ± 0.76 vs. 5.73 ± 1.12 mmol/l, respectively; p = 0.01). In the glucose-only group, the glucose area under the curve (AUC) was greater and the insulin AUC was smaller. Two patients in the insulin group developed hypoglycemia. Conclusion: Infusion of a glucose-only bolus caused a clinically significant decrease in serum [K + ] without any episodes of hypoglycemia.
Calcific uraemic arteriolopathy (calciphylaxis) in patients on renal replacement therapy
(Health and Medical Publishing Group, 2017) Sebastian, S.; Jordaan, H. F.; Schneider, J. W.; Moosa, M. R.; Davids, M. R.
Background. Calcific uraemic arteriolopathy (calciphylaxis) is an unusual and potentially fatal condition characterised by small-vessel calcification and ischaemic skin necrosis. It mainly affects patients with end-stage renal disease (ESRD) on haemodialysis, but may rarely occur in the absence of ESRD in conditions such as primary hyperparathyroidism, malignancy, alcoholic liver disease and connective tissue disease. Methods. We reviewed the records of all patients diagnosed with calciphylaxis while on renal replacement therapy at Tygerberg Hospital, Cape Town, South Africa, between 1990 and 2014, to describe its presentation, course and final outcome. Results. Nineteen patients developed calciphylaxis over this period. Their median age was 34 years and 13 (68.4%) were female. Fifteen (78.9%) had received a kidney transplant. All patients had painful skin lesions that rapidly progressed to infarction. Small-vessel calcification was seen on skin biopsy in 13 patients. Twelve patients had hyperparathyroidism. Several of the transplanted patients had been treated for graft rejection in the year preceding the diagnosis. Treatment consisted of good wound care and efforts to normalise serum calcium and phosphate levels. Five patients received an urgent parathyroidectomy. The outcome was fatal in 17 patients, with sepsis being the main cause of death. Conclusions. In our patients, calciphylaxis carried a worse prognosis than previously reported internationally. It should always be considered in the differential diagnosis of painful skin lesions in the dialysis or transplant patient.
Chronic kidney disease for the primary care clinician
(South African Academy of Family Physicians, 2019-10-28) Davids, M. R.; Chothia, M. Y.
ENGLISH ABSTRACT: An epidemic of chronic kidney disease (CKD) is being experienced in South Africa. This is driven by a heavy burden of infections, non-communicable diseases, pregnancy-related diseases and injuries. The serious long-term complications of CKD include end-stage renal disease, heart disease and stroke. Competing priorities such as the high burden of HIV, tuberculosis and other infections, unemployment and poverty result in serious constraints to providing comprehensive renal care, especially in the public healthcare sector. The prevention and early detection of CKD by primary care practitioners is therefore of utmost importance. Annual screening is recommended for patients at high risk of developing CKD. This involves checking blood pressure, urine dipstick testing for albuminuria or proteinuria and estimating the glomerular filtration rate from serum creatinine concentrations. In patients with established CKD, renoprotective measures are indicated to arrest or slow down the loss of renal function. These patients are at high risk of cardiovascular disease and close attention should be paid to optimally managing their risk factors.
Development and evaluation of a multimedia e-learning resource for electrolyte and acid-base disorders
(American Physiological Society, 2011-10) Davids, MR; Chikte, Usuf M. E.; Halperin, Mitchell L.
This article reports on the development and evaluation of a Web-based application that provides instruction and hands-on practice in managing electrolyte and acid-base disorders. Our teaching approach, which focuses on concepts rather than details, encourages quantitative analysis and a logical problem-solving approach. Identifying any dangers to the patient is a vital first step. Concepts such as an “appropriate response” to a given perturbation and the need for electroneutrality in body fluids are used repeatedly. Our Electrolyte Workshop was developed using Flash and followed an iterative design process. Two case-based tutorials were built in this first phase, with one tutorial including an interactive treatment simulation. Users select from a menu of therapies and see the impact of their choices on the patient. Appropriate text messages are displayed, and changes in body compartment sizes, brain size, and plasma sodium concentrations are illustrated via Flash animation. Challenges encountered included a shortage of skilled Flash developers, budgetary constraints, and challenges in communication between the authors and the developers. The application was evaluated via user testing by residents and specialists in internal medicine. Satisfaction was measured with a questionnaire based on the System Usability Scale. The mean System Usability Scale score was 78.4 ± 13.8, indicating a good level of usability. Participants rated the content as being scientifically sound; they liked the teaching approach and felt that concepts were conveyed clearly. They indicated that the application held their interest, that it increased their understanding of hyponatremia, and that they would recommend this learning resource to others.
Effect of improving the usability of an e-learning resource : a randomized trial
(HighWire, 2014-06) Davids, Mogamat Razeen; Chikte, Usuf M. E.; Halperin, Mitchell L.
Optimizing the usability of e-learning materials is necessary to reduce extraneous cognitive load and maximize their potential educational impact. However, this is often neglected, especially when time and other resources are limited. We conducted a randomized trial to investigate whether a usability evaluation of our multimedia e-learning resource, followed by fixing of all problems identified, would translate into improvements in usability parameters and learning by medical residents.
An effective approach to chronic kidney disease in South Africa
(Health & Medical Publishing Group, 2016) Moosa, Mohammed Rafique; Meyers, Anthony M.; Gottlich, Errol; Naicker, Sarala
ENGLISH ABSTRACT: Very few patients with end-stage kidney disease in South Africa receive renal replacement treatment (RRT), despite the rapidly growing demand, because of resource constraints. Nephrologists who agonise daily about who to treat and who not to, and have been doing so since the inception of dialysis in this country, welcomed the opportunity to interact with the National Department of Health at a recent summit of stakeholders. The major challenges were identified and recommendations for short- to long-term solutions were made. While the renal community can still improve efficiencies, it is clear that much of the responsibility for improving access to RRT and reducing inequities must be borne by the national government. The summit marks the first step in a process that we hope will ultimately culminate in universal access to RRT for all South Africans.
Gitelman syndrome in a South African family presenting with hypokalaemia and unusual food cravings
(BioMed Central, 2017-01-26) Van der Merwe, Pieter Du Toit; Rensburg, Megan A.; Haylett, William L.; Bardien, Soraya; Davids, M. Razeen
Background Gitelman syndrome (GS) is an autosomal recessive renal tubular disorder characterised by renal salt wasting with hypokalaemia, metabolic alkalosis, hypomagnesaemia and hypocalciuria. It is caused by mutations in SLC12A3 encoding the sodium-chloride cotransporter on the apical membrane of the distal convoluted tubule. We report a South African family with five affected individuals presenting with hypokalaemia and unusual food cravings. Methods The affected individuals and two unaffected first degree relatives were enrolled into the study. Phenotypes were evaluated through history, physical examination and biochemical analysis of blood and urine. Mutation screening was performed by sequencing of SLC12A3, and determining the allele frequencies of the sequence variants found in this family in 117 ethnically matched controls. Results The index patient, her sister, father and two aunts had a history of severe salt cravings, fatigue and tetanic episodes, leading to consumption of large quantities of salt and vinegar. All affected individuals demonstrated hypokalaemia with renal potassium wasting. Genetic analysis revealed that the pseudo-dominant pattern of inheritance was due to compound heterozygosity with two novel mutations: a S546G substitution in exon 13, and insertion of AGCCCC at c.1930 in exon 16. These variants were present in the five affected individuals, but only one variant each in the unaffected family members. Neither variant was found in any of the controls. Conclusions The diagnosis of GS was established in five members of a South African family through clinical assessment, biochemical analysis and mutation screening of the SLC12A3 gene, which identified two novel putative pathogenic mutations.
Guidelines for the prevention, detection and management of the renal complications of COVID-19 in Africa
(African Association of Nephrology, 2020) Elsayed, Hesham M.; Wadee, Shoyab; Zaki, Mohamad S.; Were, Anthony J. O.; Ashuntantang, Gloria E.; Bamgboye, Ebun L.; Davids, Mogamat Razeen; Hafez, Mohamed H.; Mahamat, Maimouna; Naicker, Saraladevi; Niang, Abdou; Seck, Sidy M.; Swanepoel, Charles R.; Tannor, Elliot K.; Twahir, Ahmed; Yao, K. Hubert
ENGLISH ABSTRACT: Africa trails the rest of the world in COVID-19 cases and deaths. However, as the pandemic spreads through the continent, we expect increases in community infection in the months ahead. Patients with kidney infection, especially those with end-stage kidney disease and those with kidney transplants, are at high risk for acquiring the disease and dying from it. While there is limited evidence for the benefit of interventions, we have the advantage of learning from the experiences of those in China, Europe and the Americas. This document sets forth guidance for dealing with our patients who have acute and chronic kidney disease, including those on renal replacement therapy and the staff involved in their care. Emphasis is placed on preparedness and prevention strategies. As evidence and experience accumulate, it is likely that updated guidance will be needed. L’Afrique suit le reste du monde en termes de nombre de cas et de décès dus à COVID-19. Cependant, alors que la pandémie se propage à travers le continent, nous prévoyons une augmentation de l’infection communautaire dans les mois à venir. Les patients atteints d’une maladie rénale, en particulier ceux atteints d’une maladie rénale chronique en phase terminale et ceux ayant subi une transplantation rénale, courent un risque élevé de contracter la maladie et d’en mourir. Bien que les preuves d’interventions soient limitées, nous avons l’avantage de tirer des enseignements des expériences de ceux qui se trouvent en Chine, en Europe et dans les Amériques. Ce document présente des conseils pour traiter nos patients atteints d’insuffisance rénale aiguë et chronique, y compris ceux sous thérapie de suppléance rénale et le personnel impliqué dans leurs soins. L’accent est mis sur les stratégies de préparation et de prévention. Au fur et à mesure que les preuves et l’expérience s’accumulent, il est probable que des directives actualisées seront nécessaires.
Human resources for nephrology in South Africa : a mixed-methods study
(Public Library of Science, 2020-02-13) Hassen, Muhammed; Archer, Elize; Pellizzon, Adriano; Chikte, Usuf M. E.; Davids, Mogamat Razeen
Introduction: The global nephrology workforce is shrinking and, in many countries, is unable to meet healthcare needs. Accurate data pertaining to human resources in nephrology in South Africa is lacking. This data is critical for the planning and delivery of renal services and the training of nephrologists in South Africa to meet the challenge of the growing burden of chronic kidney disease. Methods: A cross-sectional study of adult and paediatric nephrologists currently delivering nephrology services in South Africa was conducted. Participants were identified using various data sources, including the register of the Health Professions Council of South Africa. This cohort of doctors was described in terms of their demographics and distribution. A survey was then conducted among these nephrologists to collect additional information on their training, scope of practice, job satisfaction, challenges and future plans. Finally, two focus group interviews were conducted to probe themes identified from the survey data. Results: A total of 120 adult nephrologists and 22 paediatric nephrologists were identified (an overall density of 2.5 per million population). There is a male predominance (66%) and the median age is 45 years. The bulk of the workforce (128 nephrologists, 92%) is distributed in three of the nine South African provinces, and two provinces have no nephrologist at all. The survey was completed by 57% of the nephrologists. Most reported positive attitudes to their chosen profession; however, 35 nephrologists (43%) reported an excessive workload, 9 (11%) were planning emigration and 15 (19%) were planning early retirement. A higher frequency of dissatisfaction regarding remuneration (39% vs. 15%) and unsatisfactory work conditions (35% vs. 13%) was observed amongst nephrologists working in the public sector compared to the private sector. A total of 13 nephrologists participated in the focus group interviews. The themes which were identified included that of a rewarding profession, an overall shortage of nephrologists, poor career planning, a need for changes to nephrologists’ training, excessive workloads with inadequate remuneration, and challenging work environments. Conclusion: There are insufficient numbers of nephrologists in South Africa, with a markedly uneven distribution amongst the provinces and healthcare sectors. Qualitative data indicate that South African nephrologists are faced with the challenges of a high workload, obstructive policies and unsatisfactory remuneration. In the public sector, a chronic lack of nephrologist posts and other resources are additional challenges. A substantial proportion of the workforce is contemplating emigration.
Hypernatraemia in South African hospitalized patients
(African Association of Nephrology, 2019) Abohajir, Ali; Rensburg, Megan A.; Davids, M. Razeen
Background: Hypernatraemia is a common electrolyte problem in hospitalized patients and is associated with a high mortality rate. We determined the incidence, causes, management, and outcomes of hypernatraemia in adult hospitalized patients at a large South African tertiary hospital. Methods: A retrospective study was conducted at Tygerberg Hospital in Cape Town, South Africa. Adult patients with hypernatraemia (at least one serum sodium concentration ≥150 mmol/L) during a 3-month period in 2014 were identified from our laboratory database for inclusion. Results: There were 204 patients with hypernatraemia, a prevalence of 1.5%. Of these patients, 101 (49.5%) were male, and the mean age was 53 years. There were 66 patients (32.4%) who had hypernatraemia on admission, and 138 who developed it during the course of their stay in hospital. The overall in-hospital mortality was 38.7%, with higher rates for older patients and those with more severe degrees of hypernatraemia. Contributory causes which were most commonly present included dehydration/hypovolaemia (45%), followed by sepsis (39%). Net sodium gain, rather than water deficit, was identified as the main mechanism in most of the patients who developed hypernatraemia in the intensive care units. We found little evidence of any diagnostic work-up and also found that the details of fluid therapy and intake–output charting were poorly documented. Conclusions: There is a very high mortality rate in our hospitalized patients with hypernatraemia. The diagnostic work-up and therapy were often inadequate or poorly documented. The management of this important condition needs to be improved with the aid of standardized protocols.
Hypodipsic-hypernatremia syndrome in an adult with polycythemia : a case report
(BMC (part of Springer Nature), 2018-12-27) Chothia, Mogamat-Yazied; George, Kiran; Sheik, Muhammed; Davids, Mogamat Razeen
Background: Hypernatremia is a very common electrolyte disorder and is frequently encountered in out-patient as well as in-hospital settings. We describe an adult who was found to have unexplained relative polycythemia and episodic hypernatremia. A diagnosis of idiopathic hypodipsic-hypernatremia syndrome was made and the patient was managed with a water-drinking schedule. Case presentation: A 24-year-old South African-Indian man was found to have polycythemia in association with episodes of hypernatremia. Investigations indicated that he had relative polycythemia. He experienced no thirst at a time when his serum sodium concentration was found to be 151 mmol/L. Further testing indicated that his renal response to arginine vasopressin was intact and magnetic resonance imaging of his brain revealed no hypothalamic lesions. A diagnosis of idiopathic hypodipsic-hypernatremia syndrome was made and he was managed with a water-drinking schedule that corrected his hypernatremia. Conclusion: Hypodipsia should always be considered when a patient without physical or cognitive disability presents with unexplained episodic hypernatremia or with relative polycythemia.
Impact of age, gender and race on patient and graft survival following renal transplantation - developing country experience
(Health & Medical Publishing Group, 2003) Moosa, M. Rafique
Background. Optimising renal allograft survival is crucially important in developing countries because of limited resources to treat irreversible renal failure. However, although many factors can be manipulated to improve outcome, certain demographic factors are immutable in individual patients. The present study evaluated the impact of age, gender and race on the outcome of renal transplantation. Methods. Relevant data were reviewed for 542 patients receiving primary renal allografts over a 23-year period. The survival of patients and grafts were calculated using the Kaplan-Meier method. Both univariate and multivariate analyses were used to determine the association between the demographic factors and patient and graft survival. Results. Actuarial survival of both patients and grafts decreased with increasing age. The most striking differences were demonstrated when patients older than 40 years were compared with younger patients. However, when patient survival was censored for death with functioning grafts - a very important cause of graft loss - then actuarial graft survival improved with increasing age. There was no gender difference in graft survival, but female recipients of renal allografts had a higher mortality than their male counterparts. There were no racial differences in either patient or graft survival. Conclusions. Age is an important determinant of outcome after renal transplantation, but race is not. Gender does not influence graft survival, but females do have a-higher overall mortality rate following renal transplantation at our centre.
Important causes of chronic kidney disease in South Africa
(Health & Medical Publishing Group, 2015) Moosa, M. R.; Van der Walt, I.; Naicker, S.; Meyers, A. M.
In hypertensive patients without chronic kidney disease (CKD) the goal is to keep blood pressure (BP) at ≤140/90 mmHg. When CKD is present, especially where there is proteinuria of ≥0.5 g/day, the goal is a BP of ≤130/80 mmHg. Lifestyle measures are mandatory, especially limitation of salt intake, ingestion of adequate quantities of potassium, and weight control. Patients with stages 4 - 5 CKD must be carefully monitored for hyperkalaemia and deteriorating kidney function if angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are used, especially in patients >60 years of age with diabetes or atherosclerosis. BP should be regularly monitored and, where possible, home BP-measuring devices are recommended for optimal control. Guidelines on the use of antidiabetic agents in CKD are presented, with the warning that metformin is contraindicated in patients with stages 4 - 5 CKD. There is a wide clinical spectrum of renal disease in the course of HIV infection, including acute kidney injury, electrolyte and acid-base disturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and side-effects related to the treatment of HIV.
Increasing access to integrated ESKD care as part of universal health coverage
(Elsevier, 2019) Harris, David C. H.; Davies, Simon J.; Finkelstein, Fredric O.; Jha, Vivekanand; Donner, Jo-Ann; Abraham, Georgi; Bello, Aminu K.; Caskey, Fergus J.; Garcia, Guillermo Garcia; Harden, Paul; Hemmelgarn, Brenda; Johnson, David W.; Levin, Nathan W.; Luyckx, Valerie A.; Martin, Dominique E.; McCulloch, Mignon I.; Moosa, Mohammed Rafique; O’Connell, Philip J.; Okpechi, Ikechi G.; Filho, Roberto Pecoits; Shah, Kamal D.; Sola, Laura; Swanepoel, Charles; Tonelli, Marcello; Twahir, Ahmed; van Biesen, Wim; Varghese, Cherian; Yang, Chih-Wei; Zuniga, Carlos
ENGLISH ABSTRACT: The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle–income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide.
Intradialytic hypertension during chronic haemodialysis and subclinical fluid overload assessed by bioimpedance spectroscopy
(Oxford University Press European Renal Association, 2016-06-19) Sebastian, Sajith; Filmalter, Christelle; Harvey, Justin; Chothia, Mogamat-Yazied
Background: Intradialytic hypertension (IDH) increases morbidity and mortality. The prevalence in South Africa is unknown. The pathogenesis is unclear, but it has been suggested that IDH may be due to subclinical fluid overload. The objective of this study was to determine the prevalence of IDH and to evaluate its association with fluid overload using bioimpedance spectroscopy (BIS). Methods: A cross-sectional study involving 190 chronic haemodialysis patients in the Western Cape province of South Africa was conducted between January 2013 and May 2014. IDH was defined as a >10 mmHg increase in systolic blood pressure in at least four of six prior consecutive haemodialysis sessions. Results: The prevalence of IDH was 28.4% (n = 54). Therewas a trend towards pre-dialysis overhydration in the IDH group when compared with controls {2.6 L [95% confidence interval (CI) 1.7–3.4] versus 1.8 L [95% CI 1.4–2.1], respectively; P = 0.06} as measured by BIS, but no difference in mean ultrafiltration (UF) volume (2.4 versus 2.6 L; P = 0.30). A trend towards greater use of antihypertensive drugs was noted in the IDH group [2.5 drugs (95% CI 2.15–2.87) versus 2.1 (95% CI 1.82–2.30); P = 0.05]. More participants in the IDH group received calcium channel blockers (54 versus 36; P = 0.03). Conclusions: The prevalence of IDH in our treatment centres is much higher than previously reported. Subclinical fluid overload may be a major contributing factor to the mechanism of this condition. The use of BIS identifies patients who may benefit from additional UF.
Misuse of blood
(HMPG, 1977-11) Burman, N. D.
LETTER: In recent months an increasing number of patients have been referred to us by doctors from outside with a standard note: "... breathlessness ... tiredness ... anaemia (4-8 g/100 ml) ... blood transfusion given ... Hb now 12 g/100 ml ... please see and treat"
Pattern of renal amyloidosis in South Africa
(BMC (part of Springer Nature), 2019) Hassen, Muhammed; Bates, William; Moosa, Mohammed Rafique
Background: Kidney disease is a serious manifestation of systemic amyloidosis and a major cause of morbidity and mortality. Tuberculosis (TB) occurs up to 27 times more commonly in human immunodeficiency virus (HIV) infected patients and is also an important cause of renal amyloid; there are however no reports of renal amyloidosis in South Africa in the HIV era. Methods: This was a retrospective record review of cases of amyloidosis diagnosed on renal biopsies at our tertiary referral hospital between January 1985 and December 2016. Results: Forty-six cases of amyloidosis were identified over the study period. The calculated biopsy prevalence was 1.38 per 100 non-transplant renal biopsies (95% Confidence Interval 1.02–1.86). AL amyloidosis was identified in 26 (57%) cases and AA in 20 (43%). The median age at presentation was 51 years and 52% of cases were female. Patients with AA amyloidosis were significantly younger compared to their AL counterparts (age 42 years vs. 58 years, p = < 0.001) and were all significantly non-white. The main clinical presentation was nephrotic syndrome (85%) and 52% of cases also had a serum creatinine value of greater than 120 μmol/L. Of the 20 cases of AA amyloidosis, 12 (60%) were associated with tuberculosis. HIV infection was noted in only two (10%) of the 20 AA cases. Median survival after diagnosis was 2 months. Conclusion: Amyloidosis is a rare cause of kidney disease and typically presents with nephrotic syndrome. A similar number of AA and AL types were observed, and outcomes are worse in cases of AA amyloid. While TB remains the major underlying disease in this type, HIV infection was infrequent in cases of AA renal amyloidosis.
Prevalence of chronic kidney disease and association with cardiovascular risk factors among teachers in Cape Town, South Africa
(Oxford University Press, 2017) Adeniyi, Aderemi B.; Laurence, Carien E.; Volmink, Jimmy A.; Davids, M. Razeen
Background: There is a need to determine the feasibility of conducting studies of chronic diseases among large cohorts of African patients. One aim of the South African feasibility study was to determine the prevalence of chronic kidney disease (CKD) and its association with cardiovascular disease (CVD) risk factors among school teachers. Methods: In a cross-sectional survey of 489 teachers we captured data on demographics, CVD risk factors, anthropometry and blood pressure. Serum glucose, creatinine, cholesterol and urine protein/creatinine ratio was measured. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease study equations. Results: The mean (± standard deviation) age of the participants was 46.3±8.5 years, with 70.3% being female and 74.6% of mixed ethnicity. The crude prevalence of CKD using the CKD-EPI equation was 6.1% while the age-adjusted prevalence was 6.4% (95% confidence interval 3.2–9.7%). CKD was associated with the presence of diabetes and higher diastolic blood pressures. Conclusions: In our study population of relatively young, working individuals CKD was common, clinically silent and associated with cardiovascular risk factors. The long-term complications of CKD are serious and expensive to manage and this, therefore, constitutes an important public health problemfor South Africa.
Pseudohypokalaemia and pseudohypoxaemia in a patient with acute myeloid leukaemia
(African Association of Nephrology, 2020) Chothia, Mogamat-Yazied; Davids, Mogamat Razeen
ENGLISH ABSTRACT: Spurious laboratory results are frequently encountered in patients with haematological disorders and lead to unnecessary additional laboratory investigations and inappropriate treatment. An 80-year-old woman, known with acute myeloid leukaemia, was admitted with suspected sepsis. Laboratory tests revealed a leukocyte count of 358 x 109/L, serum potassium concentration of 2.6 mmol/L and partial pressure of arterial oxygen of 5.3 kPa. The patient did not display any clinical or electrocardiographic features of hypokalaemia and there were no signs of respiratory distress. A diagnosis of pseudohypokalaemia and pseudohypoxaemia was made and inappropriate therapeutic interventions were avoided. Pseudohypokalaemia and pseudohypoxaemia should always be a consideration in patients with hyperleukocytosis due to haematological malignancies, especially when there are no clinical features to support these findings. The inappropriate administration of potassium in such cases may cause serious cardiac arrythmias.

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