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Item 2016 Flow rate readings for the Tayside High Lift pumps(2016-05-30) Phillip, NeilItem 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 WDGMC Paediatric Liver Transplant Research Database(REDcap, 2019-12-09) Fabian, June; Botha, Jean; Van der Schyff, Francisca.; Terblanche, Alberta JBiliary atresia (BA) is a progressive fibrosing cholangiopathy of infancy, the most common cause of cholestatic jaundice in infants and the top indication for liver transplantation in children. Kasai portoenterostomy (KPE) when successful may delay the requirement for liver transplantation, which in the majority offers the only cure. Good outcomes demand early surgical intervention, appropriate management of liver cirrhosis, and in most cases, liver transplantation. These parameters were audited of children with BA treated at the Steve Biko Academic Hospital (SBAH) in Pretoria, South Africa.Item Dataset from Ark Consortium - Understanding kidney disease in rural central Uganda - Findings from a qualitative study.(2016-11-09) Saraladevi, Naicker; June, Fabian; Working group ARK Consortium,; Seeley, Janet; Kabunga, Elizabeth; Laurie, Tomlinson; Liam, Smeeth; Moffat, Nyirenda; Robert, Newton; Robert, Kalyesubula; Dominic, Bukenya; Joseph SsembatyaItem 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 Outcomes of paediatric liver transplant for biliary Atresia(2021) Gamiet, Yentl LeighBackground: Despite the widespread use of Kasai Portoenterostomy (KPE) for biliary atresia, more than two thirds of these patients require liver transplant. Liver transplantation is not widely available in South Africa, and Wits Donald Gordon Medical Centre is one of two centres performing paediatric liver transplantation in the country, and the only centre performing living related donor transplants. The study aims to outline the experience with liver transplant for biliary atresia in terms of the post-operative complications and one-year survival outcomes, with the goal to ascertain the factors which govern those outcomes. Methods: A retrospective review was performed at the centre. Demographic data was collected, and tabulated. Survival analysis was performed using Kaplan Meier curves. Complication rates were categorised into biliary, vascular and enteric complications, and classified as early and late. Mortality was analysed according to cause and timing which was categorised as early and late. Results: Sixty-seven first time liver transplants were performed for biliary atresia, at WDGMC from 2005 to 2017. Sixty-nine percent were female patients and thirty-one percent were male patients. Forty-eight percent of patients under the age of 5 years, had a z-score of -2 or worse for mid upper arm circumference (MUAC). The rates of biliary complications, enteric complications and vascular complications were 34%, 12% and 12%, respectively. One-year overall survival of the cohort is 84.5%, and overall graft survival is 82.9%. Overall mortality was 22% but cause of death was difficult to corroborate. Conclusion: Complication rates and survival outcomes are comparable to international single centre studies despite the high rates of malnutrition in our study cohort. Early referral of all patients with biliary atresia to a paediatric liver transplant centre is essential for early detection of indications, and medical and nutritional optimisation of patientsItem Dataset from:Combination antiretroviral therapy (Atripla) in diabetes exacerbates diabetogenic effects on hippocampal microstructure, neurogenesis, and cytokines levels in male Sprague Dawley rats(2021-11-25) Johnson, Jaclyn Asouzu; Ndou, Robert; Mbajiorgu, Ejikeme F; Our appreciation goes to our co-workers, Dr Eguavoen Idemudia and Vaughan Perry for excellent collaborative efforts. And special appreciation goes to Mrs Hasina Ali for her technical and laboratory assistance.Combination antiretroviral therapy (cART) has effectively reduced the scourge of HIV infection. However, with the increasing incidence of diabetes, HIV/AIDS-diabetes co-morbidity has become prevalent in society with chronic cART therapy in diabetes. Therefore, this study investigated the neuronal effects of cART and type two diabetes (T2D) on the levels of cytokines, lipid peroxidation, histomorphology and neurogenesis in the hippocampus. Adult male Sprague Dawley rats were divided into 4 groups: DB (diabetic rats), DAV (diabetic rats treated with cART (efavirenz, emtricitabine, and tenofovir), AV (normal rats treated with cART) and NC group (with no treatment). Following ninety days treatment, the rats were terminated, and the brains excised. Immunoassay (IL-1α, IL-6, TNFα and MDA), immunohistochemical (Ki67 and DCX) and Cresyl violet histomorphology analysis were carried out on brain homogenate and sections, respectively. In comparison to the control, the results show that cART significantly elevated IL-1α, IL-6, TNFα and MDA levels but had no effect on FBG, NFBG and glucose tolerance. While DB and DAV significantly reduced body weight ,glucose tolerance, IL-1α, IL-6, TNFα and MDA levels. Hippocampal neuronal density was reduced in cART (in DG), diabetes group (in CA1 and DG only) and in cART therapy in diabetes (in all hippocampal regions). Also, the expression of Ki67 and DCX were reduced in diabetic both the DB and DAV groups. Furthermore, increase in DG neuronal nuclei of DB and DAV is significantly corelated to FBG, NFBG, AUC, and inversely corelated to neuronal density and neurogenesis. These findings indicate that cART treatment in diabetes maintains diabetic effects of impairing cytokine and inducing oxidative stress, but it cumulates in exacerbated neurotoxicity by significantly reducing DCX compared to DB and reduction in the density and nuclei size of CA3 hippocampal neurons, unlike cART or diabetes independently.Item Kidney transplant related knowledge and health education needs of patients with chronic kidney failure in two academic hospitals in Gauteng(2021) Nkadimeng, Mmabje CalvinBackground: Patients living with chronic kidney failure endure a lot of stress, as they have to adjust their lifestyle, stop smoking, eat a healthy diet, and refrain from self-medication. Currently, South Africa has dearth in literature regarding the knowledge of these patients about kidney transplant, which is so far the best treatment for chronic kidney failure. Patients are provided with health education before any transplant, this is done to equip them with adequate knowledge regarding the disease and its management. However, there are no methods to examine whether the patient comprehended the information or not. Purpose: The purpose of this study was to describe the kidney transplant related knowledge and health education needs of patients with Chronic Kidney Failure on haemodialysis awaiting kidney transplant in two hospitals in Gauteng. Methods: The study was a quantitative, descriptive and cross-sectional survey and data was collected using a kidney transplant understanding tool (K-TUT) questionnaire. Data analysis: Data was analysed using the statistical package for Social Science computer Programme and quantitative content analysis. Setting: The setting for this study was the renal units at two academic hospitals in Gauteng, South Africa. Results: Of the n=124 aimed sample size, n=70 patients gave consent to participate in the study, based on the set objective of describing the knowledge of patients on dialysis about their knowledge on kidney transplant, a large number n=58 (82.86%) scored above 50% indicating adequate knowledge and n=12 (17.14%) scored below 50%, which is regarded as inadequate knowledge. However, at the mean score of 55%, only half (n=35; 50%) of the participants had adequate knowledge. When considering the 55% as adequate knowledge indicator, half of the participants had inadequate knowledge regarding kidney transplant. The health education needs revealed three themes: firstly, the health education needs related to kidney transplant (quality of life, reproductive health and risks and side effects). Secondly the additional information needs to understand kidney transplant process such as donors and support system and lastly the family member involvement theme which entailed their family member understanding of the risk of rejection and infectionItem 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 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.