Being a tertiary referral centre, we work closely with colleagues in other parts of the Western Cape, but also with renal units in other provinces. Amongst other functions, we training opportunities for their fellows, and also surgical support. All patients from these units come to Groote Schuur Hospital for their kidney transplant surgery.

Livingstone Tertiary Hospital Renal Unit: Port Elizabeth (Eastern Cape Province)

The Livingstone Tertiary Hospital (LTH) Renal Unit is based in the Port Elizabeth Metropole. It is responsible for providing all nephrology services in the Western region of the Eastern Cape Province, serving a population of approximately 1.6 million. The LTH is a 500-bed adult academic hospital which also currently trains post-graduate medical specialists in affiliation with the Walter Sisulu University (WSU) Faculty of Health Sciences.

Historically, the Eastern Cape Province had for a long time been under-serviced and had only 1 full-time nephrologist for a population of 6.5million. In 2012, the LTH Renal Unit formed a partnership with the University of Cape Town’s (UCT) Division of Nephrology and Hypertension and the Groote Schuur Hospital (GSH) Renal Unit to further nephrology training and research in the Eastern Cape Province of South Africa. Since this partnership formed, the unit has successfully trained a subspecialist nephrologist, participated in a number of research projects, and expanded renal services, including the creation of posts for a renal technologist and transplant co-ordinator. 

Currently, LTH has two full-time nephrologists..  The Unit is headed up by Dr Rob Freercks (since 2012) who is assisted by Dr Jason Ensor since 2016.  Dr Freercks is a nephrologist and undertook his undergraduate and post-graduate training at UCT and GSH; he has a Masters research degree (MPhil) and is also a fellow of the Royal College of Physicians in London.  Dr Ensor is also a nephrologist and received undergraduate training at UCT and further post-graduate training through WSU and later with UCT at the Livingstone Renal Unit and GSH.  He is currently completing his MPhil research degree with UCT.

The LTH Renal Unit is now accredited for the training of nephrology fellows (specialists and sub-specialists) and renal technologists with both the International Society of Nephrology and the Health Professions Council of South Africa.  By the end of 2016, 15 medical officers and 10 rotating medical registrars have been trained in nephrology for periods of between 3 and 12 months.  Further, 1 sub-specialist nephrologist has been trained in the unit in collaboration with GSH and our renal technologist obtained her BTech degree in conjunction with the Central University of Technology.  The unit has several publications and conference presentations and is supervising 4 Master’s students at present. 



The unit provides a full nephrology service including:

  • Acute and chronic (±70 patients) haemodialysis (including CRRT and PLEX)
  • Intensive care nephrology service (16-bed ICU with reverse osmosis loop throughout)
  • Peritoneal dialysis including APD (±60 patients)
  • Inpatient consulting service (>500 patients per year)
  • Transplant clinic including work-up and post-transplant follow-ups (±100 patients)
  • General nephrology clinic (>3500 patient visits per annum)
  • Lupus and low-clearance clinic
  • Combined Infectious diseases and Nephrology clinic
  • Renal biopsy of native and graft kidneys (>100/year)
  • Placement of tunnelled dialysis and Tenckhoff catheters in-unit
  • Vascular and renal ultrasound in-unit

Staffing includes:

  • 2 full time nephrologists
  • 1 full time medical officer
  • 2 rotating medical officers
  • 1 part-time medical officer
  • 1 rotating medical registrar
  • 1 transplant co-ordinator
  • 1 full time renal technologist
  • 1 clerk
  • 25 Nurses
  • 2 General assistants
  • Auxiliary services offered include social worker, psychologist and dietetic support


       Some of the Renal Unit staff                           Weekly histopathology meeting


Current research projects in the LTH Renal Unit:

  • Adult renal pathology and disease patterns in the Eastern Cape, South Africa:  A single-centre biopsy series (MPhil)
  • The burden of tuberculosis in patients with chronic kidney disease stage 5 who are undergoing renal replacement therapy with dialysis (CKD-5D) at Livingstone hospital renal unit in Port Elizabeth. (MMed)
  • The Role of Fetuin A, Matrix Gla Protein, Osteoprotegerin, Pyrophosphate and Fibroblast Growth Factor-23 in Vascular Calcification of Black South African Haemodialysis patients.  (MMed)
  • Cyp450 Genetic polymorphisms in South African Renal Transplant Recipients and their influence on Tacrolimus trough levels. (MMed)
  • Eastern and Western Cape Renal Biopsy Database – collaborative study with GSH (UCT Ethics approved)
  • The South African Cape study on induction Therapy with Mycophenolate Mofetil or cyclophosphamide in patients with lupus nephritis (CAPTAIN Trial): A sub-study of the ALUGEN registry (Ethics approved, recruiting soon)
  • The African Lupus Genetics Network (ALUGEN) registry – collaborator site

Academic articles, posters and projects from the LTH Renal unit 2012-2016:

  • Ensor, J, Freercks R.  Adult renal disease patterns in the Eastern Cape Province of South Africa: The report of a single centre renal biopsy series.  World Congress of Nephrology poster, Cape Town, 2015.
  • Ndamase, S, Freercks R.  High burden of tuberculosis in South African dialysis patients: The report of a single centre in the eastern cape, South Africa. World Congress of Nephrology poster, Cape Town, 2015.
  • K. Simba, M. Borkum,  N.Erasmus, W. Basera, C. Swanepoel, R. Freercks and B. Rayner.  The impact of vascular calcification among dialysis dependent south african CKD patients: a five year follow up study of cardiovascular mortality, morbidity. SA Renal Society Congress poster, Cape Town 2016 (MMed)
  • The utility of urine sulphosalicylic acid testing in the detection of non-albumin proteinuria

Ndamase S, Freercks R.S Afr Med J 2015 Feb; 105(2):153.

  • Liddles syndrome in an African male due to a novel frameshift mutation in the β-subunit of the epithelial sodium channel gene.  Robert Freercks, Jason Ensor, Clarise Weimers-Willard et al.   CVJ Africa  In Press


George Provincial Hospital Renal Unit: George (Western Cape Province):

Kimberley Hospital Complex Renal Unit: Kimberley (Northern Cape):

"Leading with Excellence"

Department of Medicine