Background: 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.

Background: 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.

No description available.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2016 / The purpose of the study was to determine knowledge of nephrology nurses’ on evidence based guidelines for the prevention of haemodialysis catheter related infections. The study was done in 5 haemodialysis units from two university-affiliated, public sector and tertiary level hospitals in Gauteng which are: “Baragwanath Hospital and Charlotte Maxeke Academic Hospital”. Face and content validation of the research instrument “Evaluation questionnaire concerning nurses’ knowledge of interventions for prevention of haemodialysis catheterrelated bloodstream infections” was done by a panel of experts to ensure applicability of the instrument to the South African context. Prior to commencement of the study, ethical clearance and permission to conduct the study was obtained from the relevant authorities and the university committee. A non-experimental, descriptive, prospective study design was utilised in order to meet the objectives of the study. Descriptive and comparative statistics were used to analyse the data which was done in consultation with a statistician. Knowledge was reorganised as poor (0-50%), average (50-70%) and good (71% and above). Overall, participants performed well in the second part of the questionnaire where their knowledge was tested regarding evidence based guidelines in prevention of vascular access infection; the majority 72.50% (n=58) scored more than 71%, indicating they have knowledge of evidence based guidelines on prevention of vascular access infection, 20% of participants scored between 51 and 70%, whilst only 2% scored below 50%. A positive correlation (with moderate strength) between age and experience (r=0.563) was established indicating that as age increases the experience will also increase moderately. A slight negative correlation, which was very weak (null correlation) was also established between years of experience and performance as most respondents were above and below the regression line. Therefore years of experience has no influence over performance. / MT2016

<p>Begreppen ”compliance, adherence och concordance” används inom många delar av omvårdnadsforskningen. Dessa begrepp används frekvent inom det njurmedicinska forskningsfältet eftersom njurmedicin är ett område med komplexa behandlingar som ställer stora krav på både vårdpersonal och patienter. Syftet med denna litteraturstudie var att beskriva vad dessa begrepp egentligen betyder och hur de används. För att uppnå dessa mål har artiklar sökts i flera databaser och därefter noga lästs igenom och analyserats metodiskt. Resultatet visar att det saknas entydiga definitioner av begreppen. Dessutom råder det en viss begreppsförvirring då man i vissa studier använder begreppen som synonymer trots att de enligt de flesta definitioner inte är det. Sammantaget gör detta att det blir svårvärderat hur man skall använda resultaten i utförda studier med dessa begrepp som mätpunkter och det leder dessutom till svårigheter i jämförelser mellan olika studier. En annan slutsats i denna litteraturstudie är att compliance anses en aning förlegat och att adherence är det man framförallt använder idag medans concordance tycks vara på frammarsch. Sammanfattningsvis kan man säga att det krävs mer forskning på området för att finna konsensus i nomenklaturen så att studier som utförs kan värderas och jämföras mot varandra.</p> / <p>The terms ”compliance, adherence and concordance” are used in several areas of nursing research. These terms are often used in research covering the field of nephrology since renal medicine is an area with complex treatments that demand much from both health care providers and patients. The aim of this literature review was to clarify these terms actual meaning and how they are used. To reach these goals, articles have been sought in several databases, and articles included have thereafter been read thoroughly and methodically analyzed. The results show that there is no unambiguous definition of the terms. Furthermore there are some confusion regarding how to use the terms and in some studies they are even used as synonyms even though this is wrong according to most definitions. Taken together these points makes it hard to evaluate how to use results from studies with these terms as points of measure it also leads to difficulties in comparing studies with each other. Another conclusion in this study is that compliance is considered a bit obsolete and adherence is what is generally used today while concordance is upcoming. More research is warranted to reach agreement on defining these terms to enhance comparability between studies.</p>

Begreppen ”compliance, adherence och concordance” används inom många delar av omvårdnadsforskningen. Dessa begrepp används frekvent inom det njurmedicinska forskningsfältet eftersom njurmedicin är ett område med komplexa behandlingar som ställer stora krav på både vårdpersonal och patienter. Syftet med denna litteraturstudie var att beskriva vad dessa begrepp egentligen betyder och hur de används. För att uppnå dessa mål har artiklar sökts i flera databaser och därefter noga lästs igenom och analyserats metodiskt. Resultatet visar att det saknas entydiga definitioner av begreppen. Dessutom råder det en viss begreppsförvirring då man i vissa studier använder begreppen som synonymer trots att de enligt de flesta definitioner inte är det. Sammantaget gör detta att det blir svårvärderat hur man skall använda resultaten i utförda studier med dessa begrepp som mätpunkter och det leder dessutom till svårigheter i jämförelser mellan olika studier. En annan slutsats i denna litteraturstudie är att compliance anses en aning förlegat och att adherence är det man framförallt använder idag medans concordance tycks vara på frammarsch. Sammanfattningsvis kan man säga att det krävs mer forskning på området för att finna konsensus i nomenklaturen så att studier som utförs kan värderas och jämföras mot varandra. / The terms ”compliance, adherence and concordance” are used in several areas of nursing research. These terms are often used in research covering the field of nephrology since renal medicine is an area with complex treatments that demand much from both health care providers and patients. The aim of this literature review was to clarify these terms actual meaning and how they are used. To reach these goals, articles have been sought in several databases, and articles included have thereafter been read thoroughly and methodically analyzed. The results show that there is no unambiguous definition of the terms. Furthermore there are some confusion regarding how to use the terms and in some studies they are even used as synonyms even though this is wrong according to most definitions. Taken together these points makes it hard to evaluate how to use results from studies with these terms as points of measure it also leads to difficulties in comparing studies with each other. Another conclusion in this study is that compliance is considered a bit obsolete and adherence is what is generally used today while concordance is upcoming. More research is warranted to reach agreement on defining these terms to enhance comparability between studies.

Background: Kidney stone disease is a common and often debilitating disorder, yet its pathophysiology is poorly understood. This dissertation studies predisposition to kidney stone formation from diurnal variation in physiochemical and physiologic properties of urine and in response to increased fluid intake. Methods: Urine volume, flow rate and constituents were measured in multiple timed specimens from healthy volunteers in a day. Further, subjects were asked to provide specimen over a period of increased fluid intake. Results: A 24-hour specimen missed significant periods of supersaturation in individual urine samples throughout the day. Despite a significant reduction in nocturnal urine flow rate, calcium concentration as well as urine pH and divalent phosphate remained unchanged. Finally, increased water intake did not dilute urine evenly. Conclusion: Mixing multiple urine samples obscures information about periods of increased calcium phosphate precipitation risk over 24 hours. Further, increased fluid intake does not uniformly provide risk protection.

Background: Kidney stone disease is a common and often debilitating disorder, yet its pathophysiology is poorly understood. This dissertation studies predisposition to kidney stone formation from diurnal variation in physiochemical and physiologic properties of urine and in response to increased fluid intake. Methods: Urine volume, flow rate and constituents were measured in multiple timed specimens from healthy volunteers in a day. Further, subjects were asked to provide specimen over a period of increased fluid intake. Results: A 24-hour specimen missed significant periods of supersaturation in individual urine samples throughout the day. Despite a significant reduction in nocturnal urine flow rate, calcium concentration as well as urine pH and divalent phosphate remained unchanged. Finally, increased water intake did not dilute urine evenly. Conclusion: Mixing multiple urine samples obscures information about periods of increased calcium phosphate precipitation risk over 24 hours. Further, increased fluid intake does not uniformly provide risk protection.

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