Clinical Services | Teaching and training | ICCS 2012 talks

Staff

Clinical services

• The Paediatric Renal Services at Red Cross Children's hospital is amalgamated with Tygerberg Hospital(TBH), and patients requiring tertiary renal services are managed at Red Cross Children's Hospital, viz. chronic dialysis and transplantation.

• At RXH, the Renal unit is housed in E2, a 25 bedded sub-specialty paediatric ward of which 12 beds are allocated to renal (including up to 5 transplant patients). The unit includes dialysis facilities. There are, in addition seven beds at TBH. We admit between 30-40 patients per month (400/yr). The ward also has six High-care beds and a well staffed day ward.

• The patient profile includes premature infants and newborns through to adolescents; local patients as well as referrals from all over country as well as other African countries; both Private and state funded patients. We provide a broad referral and outreach service, handling 450 telephonic referrals a year.

• Outpatient facilities are available both at RXH and TBH. RXH Renal OPD (S27): Tues 13H00 & Fri 08H00; TBH Renal OPD Fri 08H00. The RXH clinic sees 180 - 200 patients per month (2 200/year).

• We provide a renal support service to an active 26 bedded Intensive care Unit, including provision of acute peritoneal dialysis, acute Haemodialysis and CVVH (continuous veno-venous hemodialysis) .This service extends to all subspecialty services, esp. cardiothoracics, oncology, paediatric surgery. We have four haemodialysis machines (two able to do haemodiafiltration) and one CVVH machine. The two dialysis technicians are paediatric trained and highly committed to the programme. 40 to 50 patients managed with acute PD per year. Peritoneal dialysis equipment is available to dialyse small infants as light as 2kgs. We are able to offer plasmapheresis for children.

• We co-ordinate a large home-based chronic peritoneal dialysis programme, and have 10 HOMECHOICE machines at our disposal, with 7 - 10 patients on chronic PD at a time.

• To facilitate management and treatment of patients we able to confidently perform renal biopsies under U/S guidance using a spring loaded gun; children are referred from Western, Northern and Eastern Cape for renal investigation. An average of 70 biopsies is done per year. This includes graft biopsies post-transplant; In addition, we have an on-site histo-pathologist with whom cases are reviewed weekly.

• We are one of SA's only two active renal transplant services for children; performing transplants in young babies as small as 10kg at the hands of skilled paediatric surgeons. We do on average 10 transplants a year, and follow up around 50 transplant recipients. Potential live donors are managed at Groote Schuur Hospital by the transplant coordinators.

• An integrated paediatric Radiology service is available, including ultrasound, CT, MRI and a reputable Nuclear Med department. A weekly meeting facilitates management and discussion of difficult cases.

• An experienced paediatric urologist with a weekly combined ward round, and surgical slate lends itself to optimal management of urological problems, esp, follow up of antenatally diagnosed renal tract abnormalities.

• We have a dedicated, well equipped Paediatric urodynamics lab run by a skilled technician.
   
• Center for referral and management of paediatric hypertension (ambulatory monitoring available) and children with vasculitides and autoimmune conditions.

• An adolescent transition clinic is run at Groote Schuur Hospital once a month. This is a combined clinic with the Adult renal staff to ensure smooth transfer of young adults. It is run with the help of a psychologist that runs parent and patient support groups.

• The chronic and newly diagnosed renal patients and their families benefit from the specialised services of a dedicated social worker and dietician. In addition, under the supervision of the Child and family unit, consistent psychosocial input is available to all chronic renal and renal transplant patients. This is an important aspect of care for new patients, patients being assessed for suitability for transplantation and the adolescents.

Teaching and training

As an HPCSA accredited Paediatric Nephrology Unit, our Renal unit has historically been in good standing for more than three decades. We have been granted four training numbers for this purpose. The unit has been involved in the training programme of local fellows. Two fellows have successfully completed the Certificate in Paediatric Nephrology through the College of Paediatricians, since its introduction in 2005.

We have also hosted various fellows from Africa under the auspices of International Paediatric Nephrology Association, thus playing a substantial role in promoting the development of sound Paediatric Nephrology services in their respective countries. Four of the African fellows also obtained their Cert of Paed. Nephrology. Two fellows completed their MMed dissertations. A well established renal transplant service with good working relations with Paediatric Surgeons and intensivists, lends itself to a wonderful learning opportunity.

At the Organ Donor Foundation it is our hope to create an informed society who understands the issues surrounding the subject of organ donation.

The Cape Kidney Association is a grassroots non-profit organization that raises funds to assist with the needs of patients and families suffering from chronic kidney disease. 

The National Kidney Foundation of SA is an Incorporated Association is a Public Benefit Organisation, to promote public education, facilitate financial support and promote organ donation.