Nephrology
Permanent URI for this collection
This collection contains data collected in the course of clinical work in Nephrology across several hospitals
In particular , the CMJAH Living Donor Clinic has a long history . You can see that the work of the unit has inspired or directly produced many thesis. We also have a selection of work on transplants. This collection also includes data on kidney disease from other tertiary hospitals in gauteng
News
PARTICIPANT NOTICE OF DATA SHARING FOR STUDY TITLED ‘EVALUATION OF POTENTIAL KIDNEY DONORS AND OUTCOMES POST-DONATION AT CHARLOTTE MAXEKE JOHANNESBURG ACADEMIC HOSPITAL (1983-2015)’.
Good day, The Division of Nephrology at Charlotte Maxeke Johannesburg Academic Hospital ( Previously JHB GEN)conducted a research study in the unit’s Living Donor Clinic. The study assessed clinical data of all individuals who presented to this clinic from January 1983 to July 2015. Written permission to access clinical records was obtained from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand, Johannesburg. The purpose of the study was to analyze living kidney donation in the South African setting with the hope that the clinical findings of this research may contribute toward the future betterment of care for all potential kidney donors and that this data may expand upon the limited information available in this important field of study. As a patient belonging to this Living Donor Transplant Community, you have the right to direct how your information is shared for use by research platforms. You may engage with the principal investigator of this study should you have any queries regarding how the data from this study is being applied. You may also withdraw consent to share any information you feel is potentially identifying at any point. Should you require any further information regarding the study, please feel free to contact the principal investigator, Dr Chandni Dayal via email or telephonically on 011 489 0467. Please note that prior to accessing your clinical records, approval was obtained from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand, Johannesburg. A principal function of this Committee is to safeguard the rights and dignity of all individuals who are a part of research projects and the integrity of the research. If you have any complaints or concerns over the way the study was conducted, please contact the Chairperson of this Committee who is Dr. Clement Penny, on telephone number 011 717 2301, or by e-mail The telephone numbers for the Committee secretariat are 011 717 2700/1234 and the e-mail addresses are Zanele.Ndlovu@wits.ac.za and Rhulani.Mukansi@wits.ac.za Thank you for reading this notice. 11 March 2022 Dr Chandni DayalBrowse
Browsing Nephrology by Title
Now showing 1 - 20 of 39
Results Per Page
Sort Options
Item Analysis and interpretation of Iron studies and Vitamin C levels in paediatric patients with chronic renal failure(2010-08-24) Lutz, Tracey LeighThis prospective observational study analysed iron studies and vitamin C levels in patients with chronic kidney disease attending Johannesburg Hospital Paediatric Nephrology Clinic. The rationale behind this study was to determine the extent of iron deficiency among patients in chronic renal failure. Vitamin C deficiency is common among dialysis patients, it is easy to test for and easy to prevent. This study may assist in guiding future management with regards to vitamin C supplementation in patients with chronic renal insufficiency on dialysis. The study contained 45 patients of which 27 (60 %) were male and 18 (40 %) were female. The ages of the children varied from 2 years 1 month to 19 years and 7 months. The study included patients from all ethnic groups; 9 were Caucasian, 33 African, 2 Indian and 1 Coloured. Two male patients did not have Vitamin C levels analyzed. The patients were divided into 3 distinct groups; firstly those patients on haemodialysis (12 patients), those on peritoneal dialysis (22 patients) and those not yet dialysed (11 patients). In all patients who were not yet on dialysis the GFR ranged between 18.1 and 45 ml/min/1.73m2. There were no statistically significant differences between the three groups when the results of the iron studies were analysed. However, despite iron treatment 26.6 % of patients were iron deficient as indicated by their transferrin saturation which was less than 20 %. Vitamin C levels were also analysed in this study. Forty one percent of children in chronic renal failure were vitamin C deficient. There was no statistically significant variability among the three groups. Two patients (4.6%) were noted to be Vitamin C toxic. One of these patients was haemodialysed; the other was not yet on dialysis. Vitamin C deficiency in chronic renal insufficient patients on dialysis is easily correctable when identified. Vitamin C in specific well documented doses is safe to administer to this group of patients. It will also enhance the absorption of iron and thereby have an indirect effect on anaemia.Item An analysis of reasons for exclusion of potential live kidney donors(2009-03-23T07:34:50Z) Levy, Cecil StevenItem An argument for a paid and regulated living-unrelated kidney donation system in South Africa(2021) Ewing (Naude), Susan LesleyOne of the biggest challenges that global healthcare is experiencing is the shortage of kidney organ donors. Globally, the demand for organs is far greater than the supply and as a result, people who are on waiting lists will not get a chance to receive a kidney. Those who are waiting for transplants will require ongoing dialysis to survive (Nath & Fervenza, 2018). Dialysis is extremely costly and burdens the healthcare systems. Given the enormous gaps between supply and demand, this report seeks to answer the question: “Should South Africa follow the model of a paid and regulated living unrelated kidney donation system?” I begin with an analysis of South Africa’s current structure, the effects of this system and ultimately seeing the need for a different solution. I analyzed the various models globally in kidney donation, including the only country that allows for a paid system and the objections thereto. Currently, the sale of organs is prohibited in South Africa. My view is that our current South African model is lacking in solutions to the shortage of organ donors, particularly kidneys. There is a need for a better solution as the current system is failing to meet the needs of patients. In this paper, I use the principlism framework consisting of the four bioethical principles namely, autonomy, beneficence, non-maleficence and justice, to highlight the constitutional conflicts and the ethical dilemmas when considering a paid donation system. As I am arguing for a paid system in South Africa, I have included the ubuntu theory to show why objections to a paid and regulated system would fail. In conclusion, a paid and regulated living-unrelated kidney donation system is argued to be the most ethically and practically appropriate system in South Africa, to improve kidney donation rates and the livelihoods of the peopleItem Assessment of GFR in the evaluation of potential living kidney donors at the Wits Donald Dordon Medical Center (WDGMC) and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH)(2018) Okuthe, Jacktone OdhiamboEquations that estimate GFR (eGFR) are widely used in clinical practice to estimate kidney function in sub-Saharan Africa, but have not been validated for use in this region. This study assessed the performance of eGFR equations in adults evaluated for suitability for live kidney donation against a gold standard radionuclear GFR measurement (mGFR) and determined their usefulness for screening live kidney donors in South Africa. This study was a retrospective record review of 350 adults evaluated for living kidney donation from 1996 – 2013 at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Wits Donald Gordon Medical Centre (WDGMC). Their eGFR was calculated using CG, 4-v MDRD and CKD-EPI equations. Plasma clearance of 51Cr-EDTA was used as a reference method for mGFR. The 4-v MDRD (with and without ethnicity adjustment) and the CKD-EPI (without ethnicity adjustment) equations underestimated the mGFR (negative bias of -8 mL/min/1.73m2, -16 mL/min/-1.73m2 and -6.4 mL/min/1.73m2 respectively).However, the bias associated with the average mGFR using the CG and CKD-EPI (with ethnicity adjustment) equations was not significant (2.3 mL/min/1.73m2 and 0.6 respectively).Use of the ethnicity factor resulted in overestimation of mGFR for both the 4v-MDRD equation (by 24.2ml/min/1.73m2 compared to 6.8 ml/min/1.73m2 without it) and the CKD-EPI equation (by 21.8ml/min/1.73m2, compared to 7.6ml/min/1.73m2, without the ethnicity factor). In conclusion, this study showed that almost half of adults screened for living donation in Johannesburg were not eligible due to comorbid hypertension, diabetes and unexplained kidney disease. In addition, the error statistics worsened as mGFR increased and all four prediction equations had a low sensitivity for determining individuals with a GFR <80 ml/min/1.73m2. Based on the findings in this study, use of a gold standard measured GFR should be the preferred method for assessing kidney function in potential living kidney donors in South Africa.Item Attitudes and beliefs of patients with chronic kidney disease in the Rustenburg area, North west regarding kidney dysfunction(2016-02-10) Njoro, Mmampu MagdelineAim: The aim of this study was to investigate the attitudes and beliefs of patients with chronic kidney disease regarding kidney dysfunction in the Rustenburg area. Background: Kidney disease is still regarded as a low risk disease in Rustenburg, particularly among the rural community with low literacy level. Some of the people believe that chronic kidney is caused by driving heavy duty vehicles and hard labour whilst some associate the symptoms of chronic kidney disease with cultural disease resulting from failure to undergo cultural practices after the death of spouse or life partner. Low awareness of kidney disease results in patients seeking traditional cure that may cause further deterioration of their kidney dysfunction and progress to end stage renal disease, and therefore need lifelong dialysis or kidney transplantation. Research Methods: An explorative, descriptive qualitative research method was chosen for this study. Participants were patients with chronic kidney disease attending haemodialysis treatment at a dialysis unit of a level II public sector hospital. This dialysis unit provides both acute and chronic haemodialysis treatment and peritoneal dialysis training, and has eight chronic and two acute haemodialysis machines. Individual, face-to-face, semi-structured interviews were conducted using an interview guide (Appendix A). Participants were conveniently sampled until point of saturation was reached, and nine participants constituted the sample. Inclusion criteria were 18 years old and above, men and women, on haemodialysis for more than six months and willing to be interviewed. Patients who did not attend haemodialysis on the day of the interviews were excluded from the study. The interviews were audio-taped, transcribed verbatim and analysed according to Tesch’s method of qualitative data analysis. Significance of the study: This study uncovered the attitudes and beliefs of patients with chronic kidney disease regarding kidney dysfunction. Uncovering their attitudes and beliefs has enlightened nephrology nurses on future renal care initiatives that may improve both patients and the community’s attitudes and beliefs regarding kidney disease. Findings: The study has shown that chronic kidney disease has a profound and devastating impact on the patient, his family and significant others. The study further revealed that traditional healing and cultural health is still widely practiced by most of the patients with chronic kidney disease particularly in the rural areas. There is poor awareness of kidney disease as well as risk factors associated with kidney disease among this community. Conclusion: This rural population was not knowledgeable about kidney disease nor the risk factors associated with this condition. Nephrology nurses should conduct kidney awareness campaigns in order to educate the patients and public about kidney disease order to correct their attitudes and beliefs towards chronic kidney disease.Item Audit of acute rejection in renal allografts(2020) Thomas, Riju MathewAcute graft rejection is acknowledged to have a negative impact on graft survival in renal transplantation. South Africa provides for limited renal transplantation amidst the increasing burden of chronic kidney disease in the local context. Despite this suboptimal provision and limited resources, amongst many other concerns, the role of acute graft rejection on graft survival has not been characterized in the context of South Africa, as well as the African continent. This study is an audit, characterising acute graft rejection diagnosed at the Charlotte Maxeke Johannesburg Academic Hospital over a ten-year period (2003-2012). The study revealed the incidence of acute rejection in renal transplants to be 34.5%, similar to that reported in international studies. The majority of acute rejections occurred within the first year of transplantation (53.8%), which was lower than that reported in other studies, with 40% of patients having recurrence of acute rejection. The main form of rejection diagnosed was acute cellular rejection (predominantly BANFF grades 1A and 1B), followed by Borderline acute cellular rejection, the combination of which comprised the majority (86.9%) of all rejections diagnosed. This population was found to be a male dominant and Black African dominant study group, in keeping with the racial distribution of the dialysis population of South Africa, commonly influenced by treatment-seeking behaviour. Cadaveric donor grafts were engrafted in 77.7% of this population and 77.8% of the population had less than 40% of HLA antigens in common with their donor. Delayed graft function was observed in 22.4% of recipients with a significant association with more severe acute graft rejection. Hypertension was the most dominant primary aetiology leading to chronic kidney disease of native kidneys in this population. Immunosuppressive regimen, including cyclosporin, mycophenolate mofetil and prednisone, was used in 80% of recipients, with 97.6% of recipients on mycophenolate mofetil and prednisone. The five-year survival of grafts developing acute rejection was 61.7%. Graft function deteriorated more dramatically amongst recipients who progressed to graft loss, with recovery of graft function observed to be more prominent amongst recipients with surviving grafts. This study adds to the literature on this topic, and also describes the characteristics and outcomes of this entity.Item Cardiovascular risk profile of kidney transplant recipients at the Charlotte Maxeke Johannesburg Academic Hospital.(2014-04-25) Muhammad, Aminu SakajikiINTRODUCTION Cardiovascular diseases (CVD) are more common in kidney transplant recipients (KTRs) than in the general population. The high incidence of CVD in the KTRs can be attributed to traditional risk factors, additional risk factors associated with graft dysfunction and those specifically related to transplantation. Carotid intima-media thickness (cIMT) is a proven surrogate of atherosclerosis; it correlates with vessel pathology and is precisely imaged using ultrasound technology. This study was aimed at determining the prevalence and predictors of cardiovascular risk among KTRs at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to examine the relationship between cardiovascular risk factors and carotid intima media thickness. METHODS Patients aged 18 years and above who received a kidney transplant at the CMJAH between January 2005 and December 2009 were recruited. A questionnaire that captured cardiovascular risk factors was administered. Patients records were assessed for information on their post transplant follow up. All patients had echocardiography and carotid doppler done for measurement of intima-media thickness. The Framingham Risk Score was used to categorize patients into low, moderate, high risk and very high risk groups. Results were analyzed using statistical package for social sciences (SPSS) version 17, p value of 0.05 was considered significant. RESULTS One hundred (KTRs) 63 male (63%) and 37 female (37%) were recruited ranging in age from 19 to 70 years, with a mean age of 42.2 ± 12.42. Thirty six patients (36%) were found to have high cardiovascular risk. Multiple regression showed proteinuria (p = 0.022), higher cumulative steroid dosage (p = 0.028), elevated serum triglycerides (p = 0.04) and the presence of plaques in the carotid artery (p = 0.012) as predictors of higher cardiovascular risk.Carotid intima-media thickness correlates with higher CVD risk. Fourteen patients (14%) had a carotid artery plaque. Twenty five patients (25%) had cIMT of >0.7 mm. CONCLUSION Kidney transplant recipients in CMJAH were found to have high cardiovascular risk (36%) and carotid intima-media thickness correlates with this high CVD risk. Routine follow up of KTRs should include measurement of cIMT as it provides a simple non-invasive assessment of subclinical atherosclerosis.Item Challenges faced by Gauteng nephrology nurses regarding implementing evidence based practice(2020) Dube, Elizabeth LeratoIntroduction: Evidence-based practice is an expected core competence of all health care clinicians regardless of discipline. Melnyk and Fineout-Overholt (2014) noted that although there is an explosion of scientific evidence available to guide clinical practice, the implementation of evidence-based care by health professionals is typically not the norm in many healthcare systems across the globe. The researcher undertook this study to gain an understanding of what is preventing the nurses from implementing EBP in the nephrology nursing departments in Gauteng. Purpose of the study was to describe challenges related to EBP implementation that were faced by nephrology nurses in clinical practice and to describe the recommendations that will assist them to successfully implement. Methods. This study followed a qualitative, exploratory, descriptive and contextual approach and was conducted in nephrology units in Gauteng Province. The population of this study included trained nephrology nurses registered with the South African Nursing Council (SANC) and meeting the eligibility criteria. Data was collected from three phases and analysed using Hsieh and Shannon (2005) conventional data analysis method. Results: Sixteen sub categories emerged which were condensed to three categories of Management Practices, Perceived organizational support and leadership practices and Training and Development. Results included studies recommending the middle manager to be the link between nurses at the operational level and top management, who can successfully drive EBP and assist in alleviating experienced challenges. Recommendations were describedItem Combined paediatric liver-kidney transplantation: analysis of our experience(2014-08-27) Strobele, BerndBackground. Renal insufficiency is increasingly common in end-stage liver disease and allocation of livers to this category of patient has escalated. The frequency of combined liver-kidney transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from those for adults and typically include rare congenital conditions; subsequently limited numbers of this procedure have been performed in paediatric patients worldwide. Scant literature exists on the subject. Methods. Subsequent to institutional approval, a retrospective chart analysis of all paediatric CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted. Results. Defining children as younger than 18 years of age, 43 patients had received a liver transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from 6 to 65 months. Conclusions. Although rarely indicated in children, CLKT is an effective treatment option, appropriately utilising a scarce resource and significantly improving quality of life in the recipient.Item A cross-sectional observational study of the vitamin D status in children with chronic kidney disease at Charlotte Maxeke Johannesburg academic hospital(2016-11-04) Raga, Shirika VIntroduction Vitamin D has numerous important functions in the human body. There is limited data available regarding vitamin D status in children with Chronic Kidney Disease (CKD) in South Africa. Objectives To determine the vitamin D status, as well as factors that affect it, in children with CKD in Johannesburg, South Africa. Methods A cross-sectional observational study was performed on 69 patients who attended the Renal Outpatient Clinic, and required routine phlebotomy, at Charlotte Maxeke Johannesburg Academic Hospital, Division of Paediatric Nephrology, between 20/08/2013 and 20/05/2014. Results 71% (n=49) of patients in our study sample were vitamin D sufficient. Significant factors that influenced vitamin D status included albumin levels and the presence of Nephrotic syndrome with relapse. There was a statistically significant positive correlation between albumin and vitamin D (p=0.00). As albumin levels increased so did the vitamin D levels. Patients with Nephrotic Syndrome with relapse had significantly lower vitamin D levels compared to patients with Nephrotic Syndrome in remission (p=0.00). Conclusion The majority of children with Chronic Kidney Disease in Johannesburg, South Africa, are vitamin D sufficient. This is reassuring as it implies that there is no need for routine vitamin D supplementation in this sample of children. However patients, especially those with nephrotic syndrome with relapse, still need to be screened for vitamin D deficiency and insufficiency and supplemented if necessary.Item Data Set : Prevalence, characterization and response to chronic kidney disease in an urban and rural setting in South Africa(2016-11-18) Naicker, Saraladevi; Fabian, June; Jaya A George; Harriet R Etheredge; Manuel van Deventer; Robert Kalyesubula; Alisha N Wade; Laurie A Tomlinson; Stephen TollmanGlobally, chronic kidney disease (CKD) is an emerging public health challenge but accurate data on its true prevalence are scarce, particularly in poorly resourced regions such as sub-Saharan Africa (SSA). Limited funding for population-based studies, poor laboratory infrastructure and the absence of a validated estimating equation for kidney function in Africans are contributing factors. Consequently, most available studies used to estimate population prevalence are hospital-based, with small samples of participants who are at high risk for kidney disease. While serum creatinine is most commonly used to estimate glomerular filtration, there is considerable potential bias in the measurement of creatinine that might lead to inaccurate estimates of kidney disease at individual and population level. To address this, the Laboratory Working Group of the National Kidney Disease Education Program published recommendations in 2006 to standardize the laboratory measurement of creatinine. The primary objective of this review was to appraise implementation of these recommendations in studies conducted in SSA after 2006. Secondary objectives were to assess bias relating to choice of estimating equations for assessing glomerular function in Africans and to evaluate use of recommended diagnostic criteria for CKD. This study was registered with Prospero (CRD42017068151), and using PubMed, African Journals Online and Web of Science, 5845 abstracts were reviewed and 252 full-text articles included for narrative analysis. Overall, two-thirds of studies did not report laboratory methods for creatinine measurement and just over 80% did not report whether their creatinine measurement was isotope dilution mass spectroscopy (IDMS) traceable. For those reporting a method, Jaffe was the most common (93%). The four-variable Modification of Diet in Renal Disease (4-v MDRD) equation was most frequently used (42%), followed by the CKD Epidemiology Collaboration (CKD-EPI) equation for creatinine (26%). For the 4-v MDRD equation and CKD-EPI equations, respectively, one-third to one half of studies clarified use of the coefficient for African-American (AA) ethnicity. When reporting CKD prevalence, <15% of studies fulfilled Kidney Disease: Improving Global Outcomes criteria and even fewer used a population-based sample. Six studies compared performance of estimating equations to measured glomerular filtration rate (GFR) demonstrating that coefficients for AA ethnicity used in the 4-v MDRD and the CKD-EPI equations overestimated GFR in Africans. To improve on reporting in future studies, we propose an 'easy to use' checklist that will standardize reporting of kidney function and improve the quality of studies in the region. This research contributes some understanding of the factors requiring attention to ensure accurate assessment of the burden of kidney disease in SSA. Many of these factors are difficult to address and extend beyond individual researchers to health systems and governmental policy, but understanding the burden of kidney disease is a critical first step to informing an integrated public health response that would provide appropriate screening, prevention and management of kidney disease in countries from SSA. This is particularly relevant as CKD is a common pathway in both infectious and non-communicable diseases, and multimorbidity is now commonplace, and even more so when those living with severe kidney disease have limited or no access to renal replacement therapy.Item Dataset from: Chronic kidney disease (CKD) and associated risk in rural South Africa: a population-based cohort study(2022-07-13) Fabian, June; Gondwe, Mwawi; Mayindi, Nokthula; Khoza, Bongekile; Gaylard, Petra; Wade, Alisha N.; Gómez‑Olivé, F. Xavier; Tomlinson, Laurie A.; Ramsay, Michele; Tollman, Stephen Meir; Winkler, Cheryl; George, Jaya Anna; Naicker, Saraladevi; Study data were collected and managed using opensource REDCap electronic data capture tools hosted at the University of the WitwatersrandStudy Methods This longitudinal cohort study was conducted from November 2017 to September 2018 in the Medical Research Council (MRC)/Wits Rural Public Health and Health Transitions Research Unit (otherwise referred to as "Agincourt") in Bushbuckridge, a rural subdistrict of the Mpumalanga province in north-eastern South Africa. Agincourt is a Health and Socio-Demographic Surveillance System (HDSS) site that includes approximately 115,000 people. For this study, a minimum sample size of 1800 was required to provide at least 80% power to determine CKD prevalence of at least 5%, provided the true prevalence was equal to or more than 6.5%. Proportional allocation of Black African adults aged 20 to 79 years ensured a representative sample based on the most recent annual population census. Sample size was increased proportionately to 2759 individuals to accommodate a 25% non-participation rate. Dataset is 2022 cases Variables are: 1. age 2. Gender 3. Years of Education (refers to completed years of schooling) 4. Height (cm) (one decimal place) 5. weight (kg) (one decimal place) 6. BMI (body mass index) 7. POC random cholesterol (mmol/L) (2 decimal places) 8. POC random glucose (mmol/L) (1 decimal place) 9. HIV status is: Based on (i) prior HIV testing history OR (ii) HIV PCR testing for ARK 10. Using the urine pregnancy test, is this participant pregnant? ( 11. ERY (erythrocytes, blood) 12. Hb (haemoglobin, blood) LEU (leucocytes) 13. NIT (nitrites) 14. PRO (protein) 15. hepatitis B surface antigen 16. Serum creatinine (umol/L) 17. Systolic BP(1) 18. Diastolic BP (1) 19. Systolic BP(2) 20. Diastolic BP (2) 21. Systolic BP(3) 22. Diastolic BP (3) 23. Serum creatinine (umol/L) 24. Urine microalbumin (mg/L) 25. Urine creatinine (mmol/L) 26. Urine microalbumin (mg/L) 27. Urine creatinine (mmol/L) 28. APOL1 haplotypeItem Dataset from: Clinicopathological correlation of kidney disease in HIV infection pre- and post- ART rollout: VERSION 2(2022-04-14) Diana, Nina Elisabeth; Davies, Malcolm; Mosiane, Pulane; Vermeulen, Alda; Naicker, SaraladeviData note Methods Ethics approval for this study was granted in writing by the Human Research Ethics Committee (Medical) of the University of the Witwatersrand, Johannesburg, South Africa (clearance certificate numbers M1511104, M121184, M120874). This approval permitted a record review of all HIV-positive patients who underwent a kidney biopsy at two tertiary hospitals in Johannesburg within the defined study period. Informed consent for this retrospective record review was waived. Data from included patients was anonymised prior to statistical analysis. Renal biopsies performed at these two tertiary hospitals, on HIV-positive individuals, from January 1989 to December 2014 were retrospectively analysed. Demographic data (age, sex and race), clinical parameters (CD4 count, HIV viral load, serum creatinine and urine protein creatinine ratio), indication for biopsy and renal histological pattern was recorded at time of kidney biopsy. The estimated glomerular filtration rate (eGFR) was calculated according to the CKD-EPI creatinine equation without ethnicity correction. ART rollout began in April 2004 in South Africa. Patients were divided into 2 groups - those who were biopsied pre-ART rollout and those biopsied post-ART rollout. These two groups were compared with respect to the above parameters. In a subgroup of the patients biopsied between 2004 and 2014, additional data laboratory parameters (serum haemoglobin, serum albumin, serial serum creatinine and eGFR) and ART use (at time of biopsy) were recorded. All renal biopsies were processed according to standard techniques for light microscopy, immunofluorescence and electron microscopy. All biopsies were reviewed by the National Health Laboratory Service histopathology team who were aware of the HIV status of the patient at time of biopsy. Histological diagnoses were tabulated using the 2018 Kidney Disease Improving Global Outcomes (KDIGO) Controversies Conference guidelines. As per this guideline FSGS (NOS) in the setting of HIV describes all non-collapsing forms of FSGS. Those ICGN with no identifiable comparative etiology other than HIV were categorized as uncharacterized ICGN with no etiology other than HIV. The biopsies with multiple diagnoses were assigned its major clinical-pathological diagnosis for the purposes of analysis. All data was collected by Dr Nina Diana and Dr Alda Vermeulen from paper based patient hospital records and the electronic hospital laboratory system. All data was checked twice to ensure accuracy. Each patient was allocated a study number and data anonymised prior to entry into Microsoft Excel. Shapiro Wilk W testing and visual inspection of the histogram plot indicated non-parametric distribution of baseline characteristics of the cohort; accordingly, central and dispersal measurements were described using the median and interquartile range (IQR), and the Kruskal Wallis ANOVA and Mann-Whitney U tests were used for comparative analyses. Kidney survival, defined by an eGFR above threshold for consideration for dialysis initiation in these institutions (15mL/min/1.73m²), censored for patient default with preserved function, was fitted for patients in the subgroup using the Kaplan Meyer method; histological diagnoses were compared using Log-rank testing.Item Dataset From: Evaluation of potential kidney donors and outcomes post-donation at Charlotte Maxeke Johannesburg Academic Hospital (1983-2015)(Division of Nephrology, Charlotte Maxeke Johannesburg Academic Hospital, 2022-03-23) Dayal, Chandni; Davies, Malcolm; Diana, Nina Elisabeth; Meyers, Anthony M.Data was collected from existing clinical records of the Living Donor Clinic held by the Division of Nephrology at Charlotte Maxeke Johannesburg Academic Hospital. This was performed by the primary investigator / first author in a pseudo-anonymized fashion and stored securely in an Excel database to which only the primary investigator had access along with the data key. Procedures pertaining to original data capturing to clinical records by the data manager (Sister Nancy Makoe), were in accordance with the standard operating procedure set out by the Transplant Unit at Charlotte Maxeke Johannesburg Academic Hospital. Objectives of research Primary Objective • To determine donor morbidity and mortality after donation. • Analysis of morbidity will focus on the development of - New onset hypertension following donation (BP ≥140/90) - Chronic kidney disease following donation, defined as the development of either of the following - New onset proteinuria (AER >300mg/day) - An eGFR <60 ml/min/1.73 m² (using the CKD-EPI formula) Secondary Objectives • To determine the reasons for exclusion of potential donors from living kidney donation • To determine the prevalence of ESKD following donation (eGFR <15 ml/min/1.73 m² using the CKD-EPI formula) • To determine potential risk factors associated with proteinuria and/or a reduced eGFR post kidney donation, by evaluating a. donor demographics b. the presence of isolated medical abnormalities prior to donation, defined by: - a borderline pre-donation 51Cr-EDTA GFR (<80 ml/min/1.73 m²) - pre-existing hypertension (well controlled on a single agent with no end-organ damage) - class I obesity (BMI 30-35 kg/m²) • To determine the proportion of patients lost to follow-up post donation 5.2 Study design A single centre retrospective observational study was conducted of all patients attending the Living Donor Clinic in the Renal Unit at CMJAH over a 32-year period between 01 January 1983 and 31 July 2015. The closing date for sampling reflects the period of protocol submission for this study. The cohort comprised of 1208 potential living donors, of which: • 910 are failed living donors, assessed between 01 January 1990 and 31 July 2015 • 298 are accepted living donors, assessed between 01 January 1983 and 31 July 2015 5.3 Data collection 5.2.1 Data collection for failed living donors Data collection for failed living donors comprised the following parameters: • Demographic data – age at assessment, gender and ethnicity • Family history of the donor • Relation to the intended recipient – whether related, unrelated or altruistic • The outcome of eligibility evaluation • If excluded from living donation, reasons for non-donation will be documented, which were categorised as: - donor-recipient related, - donor-related, - recipient-related, or - miscellaneous. • The indications and findings of any renal biopsy undertaken on a donor was recorded 5.2.2 Data collection for accepted living donors Data collection for accepted living donors comprised the following parameters: • Demographic information – gender, ethnicity, age at donation (as well as age at each follow-up point) • Family history of the accepted donor • Details pertaining to the donation, specifically: - relation to the recipient, as well as cause of renal failure in the recipient - the date of donation - the graft outcome (if known) • The last follow-up date at the Living Donor Clinic and the approximate number of post-donation follow-up visits • Domicile in relation to the Living Donor Clinic (in kilometres from transplant centre) • The reason for lost to follow-up (if known) • Baseline characteristics at donation, including: - Body mass index - Urine albumin: creatinine ratio - Systolic blood pressure - Diastolic blood pressure - Baseline serum creatinine - eGFR as defined by an isotope study, the chromium-51-ethylene-diamine-tetra-aceticacid scan (51Cr EDTA scan) as well as the CKD-EPI formula - Habits, including smoking status and history of alcohol consumption - History of pre-existing medical condition(s) • Characteristics at follow-up (correlated with time after donation), including: - Body mass index - Urine albumin: creatinine ratio - Systolic blood pressure - Diastolic blood pressure - Serum creatinine - eGFR as defined by the CKD-EPI formula - Habits, including smoking status and alcohol consumption - Development of co-morbid disease - History of nephrotoxic drug intake The above variables were retrospectively collected from data recorded at the patients’ first follow-up visit post-donation, one-year post-donation visit, and at the most recent follow-up visit. • Mortality data was collected in accepted living donors that demised during the study period, and will include: - age at death - the time from donation to mortality - cause of death, whether related to renal disease, a cardiovascular event or other cause 5.3 Definition of variables 5.3.1 Classification of donors • Potential living donors (PLDs) – refer to all donors assessed at the CMJAH Living Donor Clinic • Failed living donors (FLDs) – refer to the sub-group of PLDs excluded from living kidney donation • Accepted living donors (ALDs) – refer to the subgroup of PLDs that ultimately donated a kidney 5.3.2 Hypertension Defined as per the Eighth Joint National Committee (JNC8) guidelines for blood pressure targets: • For donors with a current age of more than sixty years: - a systolic blood pressure of more than 150mmHg, with - a diastolic blood pressure of more than 90mmHg • For donors with a current age of less than sixty years: - a systolic blood pressure of more than 140mmHg, with - a diastolic blood pressure of more than 90mmHg 5.3.2 Albuminuria Quantified as per the revised Kidney Disease Improving Global Outcomes (KDIGO) chronic kidney disease classification into three stages of albuminuria based on the albumin excretion rate (AER) in milligrams per day (mg/day): • A1: Normal or mildly increased (AER <30 mg/day) • A2: Moderately increased (AER between 30 - 300 mg/day) • A3: Severely increased (AER >300 mg/day, with nephrotic range proteinuria defined as >3500 mg/day) 5.3.3 Glomerular filtration rate • Pre-donation GFR will be defined: - as per isotope study: 51Cr EDTA scan - as calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, expressed as: GFR = 141 × min (Scr /κ, 1) α × max (Scr /κ, 1)-1.209 × 0.993Age × 1.018 [if female] × 1.159 [if black] where: GFR = glomerular filtration rate in ml/min/1,73m2 Scr = serum creatinine in mg/dL κ = 0.7 for females and 0.9 for males α = -0.329 for females and -0.411 for males min indicates the minimum of Scr /κ or 1, and max indicates the maximum of Scr /κ or 1. • Post-donation GFR will be calculated by the CKD-EPI formula, as expressed above. 5.3.4 Chronic kidney disease Defined as per the revised Kidney Disease Outcomes Quality Initiative (KDOQI) as either kidney damage or GFR<60 ml/min/1.73 m² for ≥ 3 months. Kidney damage encompasses pathological abnormalities or markers of damage, including biochemical or radiological abnormalities. GFR is further classified into stages (table 1.1). Table 1.1 | Revised KDOQI classification for chronic kidney disease GFR Stages GFR (ml/min/1.73 m2) Classification 1 >90 Normal 2 60 – 89 Mildly decreased 3a 45 – 59 Mildly to moderately decreased 3b 30 – 44 Moderately to severely decreased 4 15 – 29 Severely decreased 5 <15 ESKD 5.3.5 Body mass index • BMI will be calculated as weight (in kilograms) divided by height (in meters) squared. • It will then be sub-classified as per the World Health Organisation (WHO) international BMI classification (table 1.2). Table 1.2 | WHO international classification of BMI Classification BMI (kg/m2) Underweight < 18.5 Normal Range 18.5 to 24.99 Overweight Pre-obese Obese - Obese Class I - Obese Class II - Obese Class III ≥ 25 25 to 29.99 ≥ 30 30 to 34.99 35 to 39.99 ≥ 40 5.3.6 Isolated medical abnormalities Refers to donors with any of the following characteristics prior to donation: • A borderline 51Cr-EDTA GFR <80 ml/min/1.73 m2 • Pre-existing hypertension well-controlled on a single agent with no end- organ damage • Class I obesity (BMI 30 - 35 kg/m2 )Item Dataset From: Forgotten but not gone in rural South Africa: Urinary schistosomiasis and implications for chronic kidney disease screening in endemic countries(2022-12-11) Craik,Alison; Mayindi,Nokthula; Chipungu,Shingirai; Khoza,Bongekile; Gómez-Olivé, Xavier F; Tomlinson, Laurie AlexandraStudy information The African Research on Kidney Disease (ARK) Study aimed to determine chronic kidney disease (CKD) prevalence and identify associated risk factors in rural South Africa. The study took place from November 2017 to September 2018 and included a population-based sample (N=2759) of adults aged 20-79 years from the Agincourt Health and Socio-Demographic Surveillance System (HDSS) site in rural Bushbuckridge, Mpumalanga Province. Institutional review board approval was obtained from the University of Witwatersrand (clearance number M170583) Written informed consent was obtained from individual participants prior to enrolment. This is a secondary data analysis nested within the ARK study. In this population-based cohort study, we aimed to characterise the burden of urinary schistosomiasis in rural South Africa and evaluate its relationship with markers of kidney dysfunction with implications for CKD screening. We recruited 2021 adults aged 20-79 years in the Mpumalanga Province, South Africa. Sociodemographic and anthropometric data were recorded, urinalysis performed, and serum and urine samples collected. We measured serum creatinine and urine albumin/creatinine. Kidney dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 and/or urine albumin-creatinine ratio >3.0mg/mmol. S.haematobium infection was determined by urine microscopy. Multivariable analyses were performed to determine relationships between S.haematobium and kidney dysfunction. The methodology for this sub-study is dependent on the larger ARK study processes. Data quality and ethics processes have previously been validated by the ARK consortium . Institutional review board approval was obtained from the University of Witwatersrand (clearance number M170583) Written informed consent was obtained from individual participants prior to enrolment. Additional approval for this sub-study from the London School of Hygiene and Tropical Medicine (reference number 22152). Kalyesubula R, Fabian J, Nakanga W, Newton R, Ssebunnya B, Prynn J, et al. How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study. BMC Nephrol. 2020 Jan 15;21(1):20.Item Enhancing the doctor-patient relationship: living, dying and use of the living will(2009-10-21T10:58:09Z) Etheredge, HarrietThe research aims to establish whether processes around the consideration and execution of the living will help enhance the doctor-patient relationship. Studies have shown that the living will is not used frequently, and that the doctor-patient relationship is often deficient. The research explores the two primary topics – the living will, and the doctor-patient relationship – separately. Each primary topic is approached via a consideration of the relevant literature, and each is then analyzed from a theoretical–ethical point of view. A synthesis of these separate investigations is presented. This synthesis concludes that the living will can help enhance the doctor-patient relationship.Item Establishment of a flow cytometric assay in the setting of renal transplant for T and B cell crossmatching(2014-02-17) Ramparsad, NarishaDonor specific crossmatching is performed prior to renal transplantation in order to determine the presence of pre-existing antibodies against donor HLA antigens which can result in hyperacute rejection. Flow cytometric crossmatching is reported in the literature to be a more sensitive and objective method of testing than the complement dependent cytotoxicity (CDC) method that is currently used in the Gauteng Province. A prospective analysis of the flow cytomeric crossmatch (FCXM) assay using the Luminex technology as the reference method was conducted. Forty-three samples were analysed. The T cell crossmatch (using a cutoff value of 2) revealed a sensitivity of 66.7%, a specificity of 83.8%, a positive predictive value (PPV) of 40% and negative predictive value (NPV) of 93.9%. The B cell crossmatch (using a cutoff value of 5) gave a sensitivity of 100%, specificity of 92.7%, and a PPV and NPV of 40 and100%, respectively. In addition, a retrospective analysis of clinical data for all patients transplanted during the period January 2008 to May 2009 was performed. Of a total of 50 patients assessed post transplant, none of the patients showed signs of hyperacute rejection, while twelve percent (12%) of patients revealed signs and symptoms suggestive of acute rejection. The validation of the flow cytometric crossmatch analysis was complex as there is no gold standard reference method. The assay was validated based on the clinical relevance of its high negative predictive value and the absence of hyperacute rejections in the clinical follow up. The rate of acute rejection found in this study is similar to that reported in literature.Item Evaluation of potential kidney donors and outcomes post-donation at Charlotte Maxeke Johannesburg acdemic hospital (1983 - 2015) a(2019) Dayal, ChandniBackground Living kidney donation has emerged as a key therapeutic modality for end-stage kidney disease due to the global chronic shortage of renal allografts. However, the potential benefits to the recipient of a living donor kidney must be balanced against donor safety. In demographically diverse populations, there is a paucity of data regarding the living donor evaluation process and outcomes following donation. Objectives This study was undertaken to describe donation patterns, characterise reasons for nondonation and evaluate long-term morbidity and mortality following living kidney donation in the South African context. Methods A retrospective analysis of all Potential Living Donors (PLDs) evaluated at a single centre over a 32-year period was conducted. Of the total cohort of 1208 PLDs, 298 were Accepted Living Donors (ALDs), resulting in 910 Failed Living Donors (FLDs). Data collected included donor demographics. In addition, in the ALD group, clinical and laboratory parameters at various points in donor follow-up, as well as mortality data was noted. In the FLD group reason for donor exclusion was documented. Results Of the 1208 PLDs, 697 (58%) were female. The majority (559; 46%) were of Black African descent, and related to the intended recipient (991; 82%). Outcome of PLD evaluation varied significantly by race (p<0.001), with only a third of Black PLDs being accepted for donation. Black vs. Caucasian PLDs were more likely to fail workup (52.1% vs. 39.3%; p<0.001) and be excluded for medical reasons (44% vs. 35%; p<0.001). Leading medical exclusions included hypertension, HIV and obesity. In the ALD cohort, median follow-up time was 44 months (IQR 13.8 – 93.5 months). Hypertension was documented in 12.8% of ALDs at most recent follow-up compared to 4.7% of ALDs pre-donation (p=0.06). There was a significant increase in Albumin Excretion Rate (AER) following donation (p<0.001). There was a significant decline in the CKD-EPI eGFR between pre-donation (91.7 ± 19.1 ml /min/1.73 m2) and the most recent visit postdonation (72.5 ± 20 ml/min/1.73 m2; p<0.001). 27% of ALDs had a CKD-EPI eGFR<60 ml/min/1.73 m2 at most recent visit, however none required renal replacement therapy. There were 5 documented deaths, all unrelated to the development of renal dysfunction. Black ethnicity was not associated with increased risk of adverse outcome following donation. Conclusions There is a high exclusion rate for PLDs. Black PLDs are more likely to be excluded than Caucasian counterparts due to significant comorbidity. Although limited by high rates of donors lost to follow-up, it is concerning that a quarter of ALDs developed an eGFR<60 ml/min/1.73 m2 at last follow-up, with a significant increase in AER.Item Factors influencing CD4+ T cell counts in people living with HIV with end-stage kidney disease(2020) Pretorius, MelanieIntroduction: In South Africa, it is estimated that ~7 million people are living with Human Immunodeficiency Virus (HIV). HIV is associated with an increased risk of kidney disease. For people living with HIV (PLWH) who develop end-stage kidney disease (ESKD), access to renal replacement therapy can be difficult. Kidney transplantation is a cost-effective option, with improved overall survival and better quality of life. Eligibility criteria for kidney transplantation in Johannesburg includes a sustained CD4+ T cell count of >200 cells/μl and suppressed HIV replication. This study aimed to investigate the influence of hemodialysis on the lymphocyte subsets in PLWH with ESKD. Methods: Study participants and controls were recruited from renal dialysis centres in Johannesburg. Demographic data, social data, serial CD4+ T cell counts, serial HIV viral load measurements and blood samples were collected (before and after a haemodialysis session). Lymphocyte subsets were then measured. Results: Our cohort showed a statistically significant increase in the post-dialysis % of CD4+ T cells and the absolute CD4+ T cell counts. The longitudinal trend analysis for the % of CD4+ T cells revealed a significant increase in five participants and a single patient had a significant decrease in the longitudinal trend analysis for the absolute CD4+ T cell counts. The longitudinal trend analysis for HIV viral load revealed the majority of our participants were not virologically suppressed. Conclusion: This study showed that haemodialysis does not negatively impact CD4+ T cell count, suggesting that immunologic recovery is not impeded by treatment of the underlying ESKD.Item Graft survival in South African renal transplant patients during the transition period at Charlotte Maxeke Johannesburg Academic Hospital (graft-sat study)(2020) Chhiba, Priya DarshaniIntroduction: In the developed world, studies performed on the transition of adolescent renal transplant patients have noted high rates of rejection, non-adherence and graft loss. However, there is paucity of data in developing countries, and none in a South African setting. Objectives: The purpose of this study was to assess the rates of acute and chronic rejection, graft and patient survival in adolescents at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods:This study was a retrospective analysis of patients who received a renal transplant from 1 January 1990 to 31 December 2010, in the Paediatric Nephrology Department at CMJAH, in Parktown, Johannesburg, and entered the adolescent period (10 to 19 years old) with a functioning graft. Patients were included whether or not they were transferred to the Adult Nephrology Department at CMJAH.Results: 162 recipients were patients were transplanted during the study period, of which 80 (49.4%) were of black race, 63 (38.9%) were white, 10 (6.2%) were Asian and 9 (5.5%) were of mixed race. 65 (40.1%) were female and 97 (59.9%) were male. The median age at transplant was 13.8 years old (Interquartile range (IQR): 10.6 to 15.9). One hundred, twenty-eight (79.0%) patients received a renal transplant during the adolescent period and 34 (21.0%) were transplanted prior to adolescence. Fifty-four (33.3%) patients were transferred to the adult unit during adolescence. Graft failure occurred in 60 (37.0%) of the patients during the adolescent period, of which 54 (90.0%) occurred in the paediatric unit and 6 (10.0%) occurred in the adult unit. The median age at graft failure in the adolescent period was 16.1 years old (IQR: 14.5 to 17.9). Kaplan-Meier curves were used to analyse graft and patient survival. The following factors were identified as statistically significant in contributing to graft failure: if the transplant occurred during adolescence, previous renal transplant,non-compliance and rejection episodes in the adult unit, (p value <0.05). The 1, 3, 5, and 10-year patient survival rates were 98.8%, 97.6%, 95.1% and 93.9% respectively. Conclusion: This study revealed high rates of graft rejection and loss in South African renal transplant recipients in the adolescent period highlighting the vulnerability of this population group. Consideration should be given to the creation of transition clinics to potentially improve the graft outcomes of this vulnerable group. Further studies are needed on the transition period of adolescent renal transplant patients.