What is the speciality of paediatric nephrology?
Paediatric nephrology is a sub-speciality of paediatrics. To practise paediatric nephrology, doctors need to be qualified paediatricians and thereafter devote themselves solely to the care of children with diseases of the renal tract. The renal tract is a term that encompasses all organs such as the kidneys, ureters, bladder and genital organs. The age range of patients looked after is from birth to late adolescents. Doctors who practise paediatric nephrology are not surgeons but do perform minor surgical procedures, such as kidney biopsies, when required.
Describe some of the diseases of the renal tract in children.
Renal tract diseases in children are either congenital in nature or acquired. They comprise a very diverse range of conditions but are mostly related to structural anomalies or functional problems of the renal tract which may be related to primary illnesses or other diseases that may affect the renal tract. Doctors in this sub-speciality also treat children with conditions related to high blood pressure, inflammatory diseases, which often involve the kidneys, and critically ill neonates and children in acute renal failure in intensive care, or those in chronic renal failure. As a consequence of renal failure many children need treatment with dialysis and transplantation.
What is the incidence of renal tract disease in children?
For every child in end-stage renal failure (ESRD - kidney function is so poor, so as not to be able to perform any of its physiological functions) there are probably another 50 children with renal tract disease. In North America children under 20 years of age account for less than 2% of the total ESRD patient population, which is estimated to be 450 000 or 1.509 per million of the population at the end of 2003. Worldwide more males are affected with ESRD than females by a ratio of 1,72:1 and more black than white children are affected irrespective of gender.
What does dialysis entail?
When a child is in ESRD the kidneys are non-functional and the child cannot survive without supportive treatment. This can take the form of dialysis or transplantation in order to make available for the child an artificial means of replicating kidney function (dialysis), or transplantation of a kidney from a living donor or, if unavailable, from a deceased individual (cadaver). Dialysis is either haemo-(blood) dialysis or peritoneal-(the lining of the abdomen) dialysis.
When a child is in ESRD the kidneys are non-functional and the child cannot survive without supportive treatment. This can take the form of dialysis or transplantation in order to make available for the child an artificial means of replicating kidney function (dialysis), or transplantation of a kidney from a living donor or, if unavailable, from a deceased individual (cadaver). Dialysis is either haemo-(blood) dialysis or peritoneal-(the lining of the abdomen) dialysis.
Haemodialysis is achieved by filtering the blood of the child through a dialysis machine for 4 hours a week, 3 times per week. Blood is taken and returned via an indwelling catheter (large drip), that remains permanently inserted, or via a fistula (connection of an artery and vein) into which a needle is inserted. Haemodialysis is performed at the Morningside Children’s Kidney Treatment Centre.
Peritoneal dialysis occurs when a catheter is inserted into the abdominal cavity and specialised fluid is inserted into the abdominal cavity and then drained 4 times a day in the process of continuous ambulatory peritoneal dialysis (CAPD) or continuously overnight (automated peritoneal dialysis – APD). Dialysis is usually a temporary treatment until transplantation. Peritoneal dialysis can be done at home by older children themselves or by the parents of younger children.
Please discuss some concepts around organ transplantation.
Children with ESRD (end-stage renal disease) are managed preferably with a kidney transplant. Some children with ESRD and diabetes require a kidney and pancreas transplant and some children with a condition called oxalosis require a kidney and liver transplant. Organs are preferably obtained from relatives and, in the case of children, mostly from parents or from cadavers where the kidneys have been unaffected. The workup of a patient for kidney transplantation is extensive and can take many months. Blood tests, specialised investigations and consultations with the transplant coordinators and surgeons all need to be done and completed before a transplant can proceed. A transplant is a highly specialised procedure and currently patients of the Morningside Children’s Kidney Treatment Centre are transplanted at the Witwatersrand University Donald Gordon Medical Centre. The average admission period for a child is between 2 - 4 weeks although the living donor is often able to leave hospital after 5 – 7 days.
The new kidney is implanted into the right or left flank and the ureter is joined to the existing ureter or implanted into the bladder. In most situations the native non-functioning kidney is not removed. Post-transplant patients need to be closely monitored and remain on drugs (immunosuppressives) throughout their lives in order to prevent rejection of the transplanted organ.
Please describe the range of activities in which the trust is involved.
The KidneyBeanz Trust supports the non-medical needs of our patients and their families.
The trust supports educational programmes for children while they are on dialysis or in the ward. These educational programmes extend into an interactive computer-based information service regarding transplantation that is electronically available in the dialysis centre for both the children and their families. The trust also funds a social worker in the unit, transport grants for many of our needy families as well as toys, clothing and nappies for many of our underprivileged patients who stay in hospital for lengthy periods of time. The main project for the trust for 2008 will be to raise sufficient funds to develop a KidneyBeanz home close to Morningside Medi-Clinic. The home will provide accommodation for children and families from out of the area or for those who need prolonged treatment. It will also provide relief care for children whose parents need a recuperative time away from caring for a severely chronically ill child. It is also envisaged that the home will provide terminal care for those children with irreversible kidney disease.
Who are the trustees of the KidneyBeanz Trust?
There are 4 trustees: Dr Errol Gottlich, Professor Peter Thomson, Mrs Janelle Gottlich and Mrs Annemarie Wagner.
What has the KidneyBeanz Trust achieved so far?
The trust has enabled a social worker to start providing services to patients who require them due to the impact of their severe kidney diseases on them and their families. It has enabled educational material to be made available for pre- and post-transplant education and has also been able to secure sponsorship for a specific patient for 2 cellular telephones (so that we can keep in touch with him and his mother in case a kidney becomes available for a transplant, which he requires) as well as transport money to enable him to attend regular follow-up appointments as he lives far from the centre and would not be able to afford the regular transport costs that are incurred. More recent appointments have been Lauri Isserow who is assisting our patients with much needed dietary advice and nutritional management and Annemarie Wagner, an occupational therapist, who is providing a critical service in regard to developmental assessment and treatment.
Where is the KidneyBeanz Trust based?
The trust supports patients and their families who attend the Morningside Children’s Kidney Treatment Centre and it operates out of that centre. The centre is based at Morningside Medi-Clinic. The clinic is situated in Sandton, Gauteng, South Africa.
