The complications of peritoneal dialysis in children with end-stage renal disease in Johannesburg, South Africa: a 5-year experience

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Medicine in Paediatrics (MMed) Johannesburg, 2017Children with end-stage renal disease are commonly placed onto chronic peritoneal dialysis (PD) while awaiting transplant. Mechanical, infectious and metabolic complications of PD may lead to technique failure, morbidity or mortality. This study aims to describe the complications and associated risk factors in children on chronic PD. It consists of a retrospective record review of patients less than 18 years old enrolled on the chronic PD program between 1 January 2009 and 31 December 2013. Seventy one percent of the patients had one or more complications while on PD. The most common complication was peritonitis (54%) followed by catheter obstruction in 29%. Patients on automated peritoneal dialysis (APD) were significantly less likely to develop peritonitis than those on continuous ambulatory PD (OR 23.14, 95% CI 2.45 – 218.0, p = 0.002). We therefore recommend that PD patients be preferentially placed on APD.MT201

Idiopathic nephrotic syndrome in South African children.

Background: Different histo-pathological types and treatment response patterns of Idiopathic nephrotic syndrome (INS) have been associated with differences in ethnicity and geographical location.Objective: To provide an update on the steroid response and renal histo-pathological pattern in children treated for INS.Method: Medical records of children with INS treated at the Charlotte Maxeke Johannesburg Academic Hospital were reviewed.Results: Mean age was 5.3 years ± 2.8. The majority (68.1%) of the 163 children were of the black racial group. The highest rate of INS was seen in the 2-6 year age group (71.2%). The black racial group had the highest rate (42/111; 37.8%) of focal segmental glomerulosclerosis (FSGS), and the white race had the highest rate (9/14; 64.3%) of minimal change disease (MCD). Ninety four (57.7%) patients were steroid sensitive (SSNS) while 69 patients (42.3%) were steroid resistant (SRNS). Minimal change disease was the most common histo-pathological type seen in SSNS (60%), while FSGS was the most common observed in patients who had SRNS (65.2%).Conclusion: There appears to be a higher rate of FSGS in all the racial groups, and also a higher rate of MCD in the black race group, when compared to previous reports.Keywords: Idiopathic, nephrotic syndrome, children