"Leading with Excellence"

Department of Medicine

  • About

    The Past

    The Hypertension Clinic was founded by Dr Maurice Nellen, one of the original members of the Cardiac Clinic, in about 1960. In 1968 Professor Willem Lubbe together with Coenie Marais, father of Prof. David Marais, further developed the clinic, but in 1978 Professor Lubbe left for New Zealand. Professor Lionel Opie ran the clinic until 1998 when Professor Brian Rayner took over the reins.

    Professor Lennox Eales stimulated initial interest in renal medicine at Groote Schuur Hospital. Owing to his interest in porphyria, the renal/porphyria laboratory was a prominent feature and supported the clinical service as well as much of the early research.

    Dr Geoff Thatcher (1972-1976) carried this work forward, and established the Renal Unit developing transplantation and a chronic dialysis service. His successors were Dr Martin Gregory (1977-1979), Professor Roal van Zyl Smit (1979-1998), Dr Michael Pascoe (1999-2008), and Professor Brian Rayner (2008-2022).

    Professor Rayner combined the Nephrology and Hypertension Clinics under one division of Nephrology and Hypertension, with the assistance of 3 full-time consultants. Associate Professor Nicola Wearne was appointed Head of the Division in November 2022, with 4 consultants, and a full time Medical Officer.

     

    The Present

    Teaching

    Although there is currently only one permanent sub-specialist training post for a senior registrar/fellow, the division is fortunate to be able to access regular funding for 2 or 3 other trainees at most times, as well as functioning as an affiliated Training Centre of the  International Society for Nephrology (ISN).  Registrars in internal medicine rotate through the unit every 3 months.

    Kidney Transplant Team

    Initially, surgeons of the general surgical service did kidney transplants. This included a single kidney transplant carried out by Professor Christiaan Barnard. Since the early 1990s when Professor Del Kahn returned from the USA after completing his training as a transplant surgeon,  he ran the kidney and liver transplant programme, followed by Professor  Elmi Muller who pioneered the 1st HIV  positive-to-positive kidney transplant. The unit performed 67 kidney transplants in 2023, has an active living donor program, offers access to a donation after circulatory death program, and recently performed the first case of hypothermic machine perfusion of a deceased donor kidney on the African continent. The unit is also responsible for creating and maintaining access for different dialysis modalities. Currently, Tinus du Toit is Head of Abdominal Transplantation in the Renal Unit.

     Research

    Research interests involve, amongst others, HIV-related kidney disease; hypertension, particularly pregnancy-induced hypertension, glomerulonephritis, adolescent care and peritoneal dialysis.  

    Nephrology Ward

     

    Clinical services

    The Division provides a very active outpatient and consultative service, running busy outpatient clinics in hypertension, "Under-10" (low clearance and immunosuppression) clinic, transplant follow-up clinics, new patient clinic, HIV kidney disease clinic, Kidney Adolescent and Young Adult Clinic (KAYAC), a post-partum hypertension follow-up service and “Nephritic” (general nephrology) clinic in the Outpatients Department (OPD) building.

    Dialysis comprises a large part of the service. Besides dialysing all patients with acute kidney injury, the unit maintains about 150 patients on chronic outpatient dialysis - around 75 on haemodialysis and 75 on peritoneal dialysis. This would be impossible without our dedicated nursing and technologist staff.

    The only way to get patients off dialysis is to provide a kidney transplant service The transplant team is critical in the ability of the service to accept new patients onto dialysis.. The unit performs between 50 and 60 kidney transplants per year. These are either Living Related, Deceased Donation or ABO incompatible transplants.  Follow-up of the transplant operations takes place at the Renal Transplant Clinic in E13.

    Unfortunately, due to resource constraints the Division has limited dialysis slots resulting in Priority Setting procedures. Therefore, difficult decisions are made by multiple stakeholders, utilising guidelines which have been developed in collaboration with the Western Cape Government. These guidelines are communicated transparently and are strictly adhered to.

    Choice-restricted conservative kidney management is offered to patients who are turned down for dialysis and we also follow guidelines specifically developed for these circumstances.

    In an ideal world we would like to be able to offer more dialysis slots.

    The Future

    As a Division we would like to be able to offer a steady increase in the availability of transplantation opportunities, including paired donations, further ABO incompatible and more complex sensitisation strategies.

    Importantly more outreach opportunities at Primary Level Care are required to improve awareness of chronic kidney disease, as well as improved connections with the community for better care for patients who are not candidates for dialysis.

    We hope for the expansion and the continued impact of the KAYAC (Kidney Adolescent and Young Adult Clinic) project with Red Cross Children’s Hospital. This clinic is unique in Africa and shows promise for adaptation in other Sub-Saharan countries.

    The Division would also like to see greatly improved outcomes for pregnancy-induced hypertension, as these patients are very vulnerable. Their hypertension is identified during pregnancy and is not successfully followed up, with too-frequent poor outcomes. In an effort to address this we started the first dedicated post-partum hypertension follow-up service in sub–Saharan Africa. We would like to see significant advances in implementing effective follow-up strategies.

    Future Research

    We envision expanding current research projects and developing a research unit in which we can host PhD and Masters candidates. We aim to develop grants within the unit to support clinical and transitional research capacity.

  • A/Prof Nicola Wearne

    Associate Professor Nicola Wearne is Head of the Division of Nephrology and Hypertension at the Groote Schuur Hospital and University of Cape Town, South Africa. She is currently the secretary of the South African Nephrology Society, a member of the African Nephrology Society executive committee (Chair of the teaching and education committee as well as and President of Women in Nephrology -Africa.

    She graduated with both a Bachelor of Medical Science and Bachelor of Medicine and Surgery from the University of Sydney and completed her physician and nephrology training at the University of Cape Town. She is head of both the HIV kidney service and peritoneal dialysis service in the division. She has research interests in both these areas. She has 50 publications in peer reviewed journals as well as book chapters in these areas as well as on the topic of dialysis allocation when there are resource constraints.

    Nicci has a strong passion for kidney supportive and palliative care programmes in South Africa and was involved in the production of guidelines on this topic for South Africa.

    Her heart has always been in undergraduate and postgraduate education. She has run educational courses both locally and on the African continent, playing an active role in the design, drive and management of these programs. She is actively involved with the International Society of Nephrology and is responsible for managing the fellowship programme in the division.

  • Staff

    Nephrologists

    Associate Professor Nicola Wearne (Head of Clinical Unit)

    Associate Professor Erika Jones

    Associate Professor Bianca Davidson

    Dr Zunaid Barday

    Dr Zibya Barday

    Medical Officer

    Dr Marli Matthysen  

    Surgeons

    Dr Tinus du Toit

    Dr Laurie Bertels

     

  • Clinical Contact Details

    1. Specialist Hypertension Clinic (E17) - Phone 021 404 5378/6102
    2. 24 hour blood pressure monitoring (E17) 021 404 5378
    3. Chronic Haemodialysis (E12/E13) -021 404 3310/3215/3275
    4. Acute haemodialysis (intermittent, SLED, CVVHD), plasma exchange and charcoal haemoperfusion -021 404 3310
    5. CAPD (E12) – 021 404 3297
    6. Renal Transplantation (E12 Transplant Unit)- 021 404 3312/3327
    7. Renal Transplant Clinic (E13 Clinic on Mon/Wed/Fri AM) - Phone 021 404 3311/3314
    8. Living Donor Workup/Transplant Coordinators - Phone 021 404 4300/3316
    9. Under 10 Clinic ie. low clearance/immunosuppression clinic (E13 Clinic Tue AM) -021 404 3311/3314
    10. Nephritic Clinic ie. general nephrology (OPD building Wed PM) -021 404 5326
    11. KAYAC Clinic (Kidney Adolescent and Young Adult Clinic) 021 404 3379/3311
    12. In patient nephrology consultation – 021 404 3301/3312
    13. HIV associated nephropathy clinic (E13 Clinic Thur AM) -021 404 3379/3311
    14. Private practice nephrology services at UCT Academic Hospital - call 021 442 1816/1966
    15. University of Cape Town Private Hypertension Clinic. Contact: 021406 6490
    16. Conservative kidney management, combined with palliative care. Social Worker Ongezwa Nongabe 021 404 3229