Important causes of chronic kidney disease in South Africa

In hypertensive patients without chronic kidney disease (CKD) the goal is to keep blood pressure (BP) at ≤140/90 mmHg. When CKD is present, especially where there is proteinuria of ≥0.5 g/day, the goal is a BP of ≤130/80 mmHg. Lifestyle measures are mandatory, especially limitation of salt intake, ingestion of adequate quantities of potassium, and weight control. Patients with stages 4 - 5 CKD must be carefully monitored for hyperkalaemia and deteriorating kidney function if angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are used, especially in patients >60 years of age with diabetes or atherosclerosis. BP should be regularly monitored and, where possible, home BP-measuring devices are recommended for optimal control.Guidelines on the use of antidiabetic agents in CKD are presented, with the warning that metformin is contraindicated in patients with stages 4 - 5 CKD.There is a wide clinical spectrum of renal disease in the course of HIV infection, including acute kidney injury, electrolyte and acid-base disturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and side-effects related to the treatment of HIV

‘Sink or swim?’: Learning from stories of becoming academics within a transforming university terrain

The meanings connected with becoming or being an academic are constantly shifting, on account of diverse forces that act on universities. The authors of this article portray their learning as a research team of four academics (including one early-career academic) and a doctoral student who took a narrative inquiry approach to listening and responding to their early-career colleagues’ stories of becoming and being academics within a transforming university landscape. Imaginative engagement with these stories through the evocative and reflexive medium of poetry awakened possibilities for navigating the uncertain terrain of academia. The article draws attention to collegial relationships as critical to the growth of self-belief and self-resourcefulness in becoming and being academics. It demonstrates how, through collective participation, novice and experienced academics can become valuable sources of learning and support for each other

Follow-up of kidney donors at a single center in South Africa

Background:There is a worldwide shortage of organ donors. Inour province, KwaZulu / Natal, this problem is morepronounced as the rate of cadaveric donation is verylow. Thus both patients and nephrology staff areunder pressure to seek living donors.Methods and results:We studied 135 living kidney donors in ten yearsperiod: 85 females and 50 males; 78 (57.8%) were ofIndian origin, 33 (24.4%) Black, 15 (11.1%) Whiteand 9 (6.7%) of mixed race groups. The majority ofdonors (57%) were siblings, while 14.8% wereparents, 6.7% children, 17.8% spouses and 3.7%were cousins. The mean age of donors was 34.2 years(range 21-56 years). Donors were hospitalised for amean peroid of 6.1 days (range 3-15). Post-operativecomplications were left lobe atelectasis and chestinfection in 11.1 %, other infections in 5.2%,pneumothorax in 2.2%, ileus in two cases, depressionin one and prolonged pain at the site of surgery in11.1%. Proteinuria was noted in three cases (0.26gm/d and 0.66 gm/d in two donors at 2 years and 0.27gm/d in the third case at 10 years).Blood pressure levels were virtually unchanged frompre-nephrectomy data.Conclusion:This study confirms that unilateral nephrectomy innormal individuals is associated with few major adverse effects and living donors in renal transplantation is a viable option

Carbohydrate metabolism in twin pregnancy

Carbohydrate metabolism was evaluated in 26 women with a twin pregnancy and 26 women with a singleton pregnancy. The groups were similar in respect of age, parity and gestational age. Each woman had an oral glucose tolerance test. Nosignificant differences in venous blood sugar values or insulin responses were found between singleton and twin pregnancies

tert-Butyl 2-hy­droxy-3-(4-methyl­benzene­sulfonamido)­butano­ate

In the crystal of the title compound, C15H23NO5S, mol­ecules are linked through N—H⋯O and O—H⋯O hydrogen-bond inter­actions, resulting in centrosymmetric dimers in which the N—H⋯O inter­actions generate R 2 2(12) rings and the O—H⋯O inter­actions generate R 2 2(14) rings. Weak inter­molecular C—H⋯O inter­actions are also observed

Important causes of chronic kidney disease in South Africa

In hypertensive patients without chronic kidney disease (CKD) the goal is to keep blood pressure (BP) at ≤140/90 mmHg. When CKD ispresent, especially where there is proteinuria of ≥0.5 g/day, the goal is a BP of ≤130/80 mmHg. Lifestyle measures are mandatory, especiallylimitation of salt intake, ingestion of adequate quantities of potassium, and weight control. Patients with stages 4 - 5 CKD must be carefullymonitored for hyperkalaemia and deteriorating kidney function if angiotensin-converting enzyme (ACE) inhibitors or angiotensin IIreceptor blockers (ARBs) are used, especially in patients >60 years of age with diabetes or atherosclerosis. BP should be regularly monitoredand, where possible, home BP-measuring devices are recommended for optimal control.Guidelines on the use of antidiabetic agents in CKD are presented, with the warning that metformin is contraindicated in patients withstages 4 - 5 CKD.There is a wide clinical spectrum of renal disease in the course of HIV infection, including acute kidney injury, electrolyte and acid-basedisturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and side-effects related to the treatment of HIV

(2R,3S)-Methyl 2-hy­droxy-3-(4-methyl­benzene­sulfonamido)-3-phenyl­propano­ate

In the title mol­ecule, C17H19NO5S, the p-tolyl ring is oriented approximately parallel to the phenyl ring [dihedral angle = 17.2 (1)°], resulting in an intra­molecular π–π inter­ation [centroid–centroid distance = 3.184 (10) Å]. In the crystal, mol­ecules are linked through O—H⋯O and C—H⋯O hydrogen bonds, forming hydrogen-bonded sheets lying diagonally across the ac face

Synthetic approaches to radiochemical probes for imaging of bacterial infections

This present review provides an account on the available synthetic strategies employed to radiolabel commercial and potential bacteria-selective probes fortomographic imaging. These molecular probes encompass leukocytes, antibodies, small molecules, peptides, antibiotics, macrolides, vitamins, oligomers and siderophores. Although this technique has shown to be a valuable tool for non-invasive infection imaging, more development is required to create easy-to-radiolabel kit solutions procedures for the preparation of the probes.http://www.elsevier.com/locate/ejmech2018-06-16hj2017Nuclear Medicin

Establishing a core outcome set for peritoneal dialysis : report of the SONG-PD (standardized outcomes in nephrology-peritoneal dialysis) consensus workshop

Outcomes reported in randomized controlled trials in peritoneal dialysis (PD) are diverse, are measured inconsistently, and may not be important to patients, families, and clinicians. The Standardized Outcomes in Nephrology-Peritoneal Dialysis (SONG-PD) initiative aims to establish a core outcome set for trials in PD based on the shared priorities of all stakeholders. We convened an international SONG-PD stakeholder consensus workshop in May 2018 in Vancouver, Canada. Nineteen patients/caregivers and 51 health professionals attended. Participants discussed core outcome domains and implementation in trials in PD. Four themes relating to the formation of core outcome domains were identified: life participation as a main goal of PD, impact of fatigue, empowerment for preparation and planning, and separation of contributing factors from core factors. Considerations for implementation were identified: standardizing patient-reported outcomes, requiring a validated and feasible measure, simplicity of binary outcomes, responsiveness to interventions, and using positive terminology. All stakeholders supported inclusion of PD-related infection, cardiovascular disease, mortality, technique survival, and life participation as the core outcome domains for PD

Acute tubulointerstitial nephritis complicating Legionnaires' disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Legionnaires' disease is recognized as a multi-systemic illness. Afflicted patients may have pulmonary, renal, gastrointestinal tract and central nervous system complications. However, renal insufficiency is uncommon. The spectrum of renal involvement may range from a mild and transient elevation of serum creatinine levels to anuric renal failure requiring dialysis and may be linked to several causes. In our present case report, we would like to draw attention to the importance of the pathological documentation of acute renal failure by reporting a case of a patient with acute tubulointerstitial nephritis complicating Legionnaires' disease.</p> <p>Case presentation</p> <p>A 55-year-old Caucasian man was admitted to our hospital for community-acquired pneumonia complicated by acute renal failure. <it>Legionella pneumophila </it>serogroup type 1 was diagnosed. Although the patient's respiratory illness responded to intravenous erythromycin and ofloxacin therapy, his renal failure worsened, he became anuric, and hemodialysis was started. A renal biopsy was performed, which revealed severe tubulointerstitial nephritis. After initiation of steroid therapy, his renal function improved dramatically.</p> <p>Conclusions</p> <p>This case highlights the importance of kidney biopsies in cases where acute renal failure is a complicating factor in Legionnaires' disease. If the presence of acute tubulointerstitial nephritis can be confirmed, it will likely respond favorably to steroidal treatment and thus irreversible renal damage and chronic renal failure will be avoided.</p