Browsing by Subject "Paediatric Nephrology"
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- ItemOpen AccessA 15-year retrospective review of urodynamic studies in Children at Red Cross War Memorial Childrens Hospital (RCWMCH), Cape Town, South Africa(2022) Mosalakatane, Thembisile Dintle; Coetzee, Ashton; Wright, Anne; Raad, Jeanette; Lazarus, John; Nourse, Peter; Howlett, Justin; McCulloch, MignonBackground: Despite the undeniable diagnostic benefits of urodynamic studies (UDS), their adoption into clinical practice in Africa has been slow. This study aimed to review the use of invasive UDS in children at a tertiary paediatric hospital in South Africa. Methods: A retrospective analysis of 1108 UDS was conducted. Patient demographic characteristics, primary diagnosis, indication and urodynamic outcomes were reviewed. Presence of urodynamic high-risk features were documented, and a comparison was made between the first study and follow-up study. Results: This study revealed increasing trends in the use of UDS from 2015. Referrals were from Urology (37.7%), Spinal defects clinic (34.4%), Nephrology (20.8%) and other departments (7.0%). The most common reason for referral was review of medical treatment (36.5%). Spinal dysraphism (58.3%) accounted for the majority of conditions seen. Majority (59.1%) of the patients were receiving more than one type of bladder treatment at the time of their first study, with clean intermittent catheterisation (46.5%) being the most common form of bladder management. 97.5% of studies were performed using transurethral bladder catheterization. Urodynamic diagnosis was neurogenic in 74.0%, anatomical (12.2%), functional (8.8%) and normal (5.0%). There was statistically significant improvement in bladder compliance, detrusor leak point pressure and detrusor sphincter dyssynergia between the first study and a subsequent study following therapeutic intervention. Conclusion: The unique ability of UDS to demonstrate changes in detrusor pressures, which is a common reason for therapy failure, makes UDS an invaluable tool in the diagnosis and management of children with lower urinary tract dysfunction.
- ItemOpen AccessAcute post streptococcal glomerulonephritis at Red Cross War Memorial Children's Hospital, Cape Town, South Africa - a five-and half-year descriptive review(2022) Abugrain, Khadija; Buys, Heloise; McCulloch, MignonBackground: Acute post streptococcal glomerulonephritis (APSGN), although not a common cause of progressive kidney failure, is an important cause of paediatric hospital admission, parental worry, and acute kidney injury (AKI). In well-resourced settings, there has been a decline over the last three decades in the incidence of APSGN in children with this condition almost disappearing in Central Europe. However, this is not the case in less privileged countries such as in South Africa (SA) where APSGN is still a major public health problem and a frequent cause of paediatric hospital admission and AKI. Nevertheless, APSGN in South Africa has not been studied adequately in recent times and not currently addressed as an important public health issue. Objectives: In this retrospective study we describe the occurrence of APSGN, the aetiology, clinical presentation, and complications among children (<14years) admitted to the Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town, SA from January 2015 to June 2020. Methods: The hospital electronic database with recorded ICD-10 coding was used to identify potential cases of acute nephritic syndrome. Children were included if they presented with at least two signs of acute nephritis, associated with evidence of activation of an alternative pathway complement system (low C3 serum level) or clinical and serological evidence of previous or current streptococcal infection. Demographic, clinical features, investigations, management, and outcome data were collected. Data were presented as median and interquartile ranges (IQR) or means and standard deviation (SD) depending on normality of data while proportions of categorical data were presented as percentages. Population incidences were calculated from the four major health districts within the drainage areas for RCWMCH. This study was conducted in accordance with the 2013 Declaration of Helsinki and was approved by RCWMCH administration and the University of Cape Town's Human Research Ethics Committee, (HREC: 623/2020). Results: There were 157 children with suspected acute nephritic syndrome (haematuria, oedema, oliguria and hypertension), of whom 96 met the inclusion criteria and were recruited. Of the 96 children included in the study, 89 (93%) cases had confirmed APSGN, and seven (7%) children had a clinical diagnosis of rapidly progressive glomerulonephritis (RPGN), with positive streptococcal serology and crescentic glomerulonephritis in the kidney biopsy. APSGN occurred in 61 (63%) children aged five to ten years with 62 (65%) males (ratio of 1.9:1). APSGN was more often associated with streptococcal skin infections (55%). The majority 95 (99%) of cases presented with haematuria, while proteinuria was noted in 85 children. Seventy-one (74%) children presented in stage 2 hypertension, with 10 (10%) presenting with hypertensive seizures. Serum C3 levels were low in 83 (87%) children. 90 (94%) children had elevated anti-deoxyribonuclease B antibodies (anti-DNase-B) levels, and 77 (80%) also had elevated anti-streptolysin O titres (ASOT) titres at presentation. Eighty-eight (92%) children received a diuretic agent, 60 (63%) required an anti-hypertensive agent, and 90 (94%) received a penicillin antibiotic for 10 days. The median length of hospital stay was five (IQR 3-6) days. There were no deaths. Eighty-one (85%) children with APSGN recovered. Five (5%) progressed to end stage kidney disease (ESKD). A percutaneous kidney biopsy was indicated in eleven (11%) children. Seven (64%) biopsies confirmed type II crescentic glomerulonephritis, and four (36%) biopsies showed histological features of post-infectious nephritis. Conclusion: APSGN during childhood remains an important health problem in SA and commonly follows streptococcal skin infection. The outcome is favourable in most children; however, our study revealed an important sub-group with crescentic glomerulonephritis who progressed to ESKD. We recommend active case seeking at primary care level by checking urine dipstick, blood pressure and serum creatinine and better post-discharge follow up.
- ItemOpen AccessAudit of posterior urethral valve (PUV) in children at Red Cross Children Hospital, Cape Town, January 2002 - January 2009(2009) Antwi, Sampson; McCulloch, Mignon; Gajjar, Priya; Nourse, PeterPosterior urethral valve (PUV) is a congenital obstructing membrane of the male urethra. It is the commonest cause of bladder outlet obstruction in male children. PUV as a cause of obstructive uropathy is an important cause of end stage renal failure (ESRF) in children. Early detection and surgical intervention can slow down progression to ESRF.
- ItemOpen AccessDrop-out of children with end stage kidney failure from chronic Peritoneal dialysis and associated factors; a ten year review at Red Cross War Memorial Children's Hospital (RCWMCH), Cape Town, South Africa(2022) Aujo, Judith Caroline; Mcculloch, Mignon; Nourse, PeterIntroduction: Dialysis is a temporary renal replacement therapy (RRT) to keep the child healthy and alive when in end stage kidney failure (ESKF) while being worked up for kidney transplant, the preferred treatment. Chronic peritoneal dialysis (PD) is the preferred first choice of dialysis modality in many centers because of its advantages over hemodialysis (HD). In recent years, there have been advances to improve the performance and survival of PD as a modality for renal replacement. Despite these improvements, complications still arise, sometimes warranting a switch to HD. We sought to investigate the extent to which children at Red Cross War Memorial Children's Hospital (RCWMCH) drop-out from chronic PD and describe some of the reasons for this drop-out. Objectives: To describe the rate of drop-out of children with ESKD from chronic PD, the timing and factors associated with this drop-out at RCWMCH. Methods: This was a retrospective descriptive study, carried out in the renal ward, E2, of RCWMCH in Cape Town. Eligible participants were identified from the renal transplant waiting lists over the study period. Patient folders were retrieved following ethical approval, for extraction of relevant data. Outcome measures: Proportion dropping-out during the study period (permanent switch to HD or death from PD related complications), factors associated with dropout and time from initiation of chronic PD to drop-out. Utility of the study: Findings from this study will help in designing strategies to improve chronic PD patient outcomes, prolongation of PD technique survival and reducing the costs of chronic dialysis at RCWMCH. Results: A total of 111 children were listed for transplantation between January 2009 and December 2018, 67 were treated with PD. Complete data was available for 52 of the 67 children who received PD. Overall, 17/52 (32.7%) dropped-out during the study period. Most (>50%) of them dropped-out within the first 1-2 years of being on PD. The only significant associated factor was one or more episodes of peritonitis. Recommendation: There is a need to step up measures to prevent peritonitis in chronic PD patients so as to prolong stay on PD until a kidney transplant is available, as well as improve kidney transplantation rates. Dissemination of results: Results were presented at the Department of Pediatrics and Child Health Research Day 2019 and at the world congress of nephrology international conference 2021. Results will be submitted for publication in a peer reviewed journal.
- ItemOpen AccessA ten year retrospective study of the aetiology and outcome of crescentic glomerulonephritis in children presenting to the Red Cross Children's Hospital, Cape Town, South Africa(2017) Mwaba, Chisambo; Gajjar, Priya; Nourse, Peter; Pillay, KomalaBackground: Crescentic glomerulonephritis represents the extreme end on the spectrum of glomerular injury. It can result from a wide range of disease conditions and clinically is marked by a rapid deterioration in renal function over days, weeks or months. Although rare, crescentic glomerulonephritis is an important entity to recognize because prompt treatment can improve patient outcomes significantly. Literature on the prevalence, clinical presentation, aetiology and outcome of histologically proven crescentic glomerulonephritis among children, in Africa, is scanty. Most of what is known about this entity is extrapolated from adult studies and from paediatric studies that have for the most part been conducted outside the African continent. Objective: This study was conducted in order to determine the incidence, clinical presentation, aetiology and outcome of histologically proven crescentic glomerulonephritis in children presenting to the Red Cross Children's Hospital, Cape Town, South Africa. Methods: This was a retrospective folder review in which the renal biopsy records of children less than 18 years old who had had native kidney biopsies performed between 2004 and July 2015 at the Red Cross Children's Hospital were reviewed. The clinical notes of patients found to have been diagnosed with crescentic glomerulonephritis were traced so as to extract demographic and clinical information which was then recorded onto the study data sheet. No attempt to contact patients or their families was made. Data analysis with regard to the incidence, the clinical features and the outcome of crescentic glomerulonephritis was done using SPSS version 22. Results: A total of 470 native kidney biopsies were performed in the period under review. Of these, 24 had crescentic glomerulonephritis, accounting for an incidence of 5.1 %. The sub-types of crescentic glomerulonephritis were immune-complex in 19 (80%), Pauci-immune in 2 (8 %), unspecified type in 3 (12 %) and no child had the anti-glomerular basement membrane subtype. The underlying aetiology of the immune complex sub-type was post-infectious in 11(57.9%), idiopathic in 4(21%), HSP/IgA nephropathy in 2 (10.5%), SLE in 1 (5.3%) and mesangiocapillary glomerulonephritis in 1(5.3%). Fourteen of the subjects were male thus giving a male to female ratio of 1.4 while the mean age of the children was 8.3 [range- 1 to 14 years]. The commonest clinical features were hypertension (90%), nephrotic range proteinuria (80%), macroscopic haematuria (57%), oedema (94%) and anaemia (88%). None of these had a statistically significant association to the renal outcome. Ten (77%) out of the 13 children with crescentic glomerulonephritis who were followed up for more than a year were found to have either died, had residual renal dysfunction or been transplanted at the last clinical contact. Conclusion: Crescentic glomerulonephritis was diagnosed in 5.1% of paediatric native renal biopsies which is consistent with what has been reported elsewhere. Unlike reports from other geographical areas the vast majority (80%) of the cases had immune-complex glomerulonephritis with a suspected post-infectious aetiology in over half of these. Similar to earlier reports from South Africa the outcome was poor in most (77%) of the patients. Further research is required to characterise the factors that make post-infectious glomerulonephritis particularly severe in this population.
- ItemOpen AccessTuberculosis In paediatric kidney transplant recipients a single centre experience(2022) Makanda-Charambira, Privilage; Mc Culloch, MignonBackground: Tuberculosis remains a major challenge in transplantation particularly in endemic countries. The incidence, clinical manifestations, and optimal investigations for TB specifically in the paediatric post-transplant population have not yet been adequately studied. This study aims to describe the incidence, clinical presentation and outcomes of tuberculosis in paediatric kidney transplant recipients and to assess the impact of Isoniazid prophylaxis. Methods: Single-centre retrospective descriptive analysis of children who received kidney transplants from 1995-2019. The cohort was stratified according to receipt of isoniazid prophylaxis which began in 2005. Results: 212 children received a kidney transplant during the study period. Median age at transplantation was 11.2 years (IQR: 2.2 - 17.9) and 56% were males. Tuberculosis was diagnosed in 20 (9%) children, with almost two thirds (n=12) occurring within the first year post-transplant. The main presenting symptoms included fever (n=13/20), weight loss (n=12/20) and cough (n=10/20). Tuberculin skin test was positive in four of 20 children. Coinfection with Ebstein Barr virus, Cytomegalovirus or Staphylococcus was found in five children. Due to interactions an up to three fold increase in calcineurin inhibitor dose was required to maintain therapeutic blood levels. Isoniazid prophylaxis was protective against development of tuberculosis (p=0.04). ) and was associated with fewer infections within the first year of transplantation although this was not statistically significant (p = 0.3). Gender, age and type of allograft were not significant risk factors for developing tuberculosis. All the tuberculosis infections were successfully treated. There was graft and patient survival of 100%. Conclusion: Kidney transplant recipients have a high risk of tuberculosis. Diagnosis remains a challenge. Frequent and meticulous monitoring of immunosuppression drug levels during treatment of TB is required to avoid loss of patient or graft. Isoniazid prophylaxis protects against development of TB in this population. (HREC 463/2020)