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RDcongo

Program:

Starting Date: 2015

Leadership: Luc Malemo, General surgeon Supplies have been donated
to the Goma Heal Africa teaching hospital

Data in 2016: First treatments have occurred in 2015

 

Settings: 

The PD for AKI program in The DRC started at the HEAL Africa teaching hospital in Goma. The hospital is recognized by the Medical Inspection of North Kivu as the tertiary referral hospital for the province, one of only three tertiary referral hospitals in the DR Congo.
It has grown to become a major 155-bed reference hospital. Medical specialty areas include general surgery, orthopedics, obstetrics and gynecology, internal medicine, pediatrics and family medicine. It offers a residency program for medical school graduates, continuing medical education, and supplies to rural health centers.

 

Trainings:

Drs. Luc Malemo and Kitoga Mumanywa went to train for 3 months on PD for AKI with Georgi Abraham in India through the ISN fellowship.

 

Thursday, 23 June 2016 13:55

Saving Young Lives in Cameroon

Cameroon2

Program:

Starting Date: 2013

Leadership: Dr. Dennis Palmer, US missionary trained clinician.

Two nephrologists from the US helped assist the program by working at the hospitals for brief stays,
providing background information and training of physicians and nurses.

Data in 2016: The program has treated an average of 1-2 children per month.

 

Settings:

The PD for AKI program in Cameroon is run by the the Mbingo Baptist Hospital. The center is a referral hospital in Cameroon in the West Africa Sub Region. By March 2013, the Hospital had 579 workers with a bed capacity of over 280. It provides a complete package from outpatient consultation to inpatients services. The hospital runs a 24 hours service (three shifts system) with an average of 72,000 outpatients seen annually.
The hospital is supported by the North American Baptist Conference (NABC), a USA based entity.
Peritoneal dialysis(PD) was started at Mbingo Baptist Hospital in May 2013. This happened thanks to Dr Bill Lawton, a Nephrologist and Professor at the University of Iowa Carver College of Medicine. After an initial donation of supplies, the hospital has started to make their own PD solution. The PD catheters are placed by the general surgeons. 

 

Thursday, 23 June 2016 12:24

Saving Young Lives in Benin

SYL Benin

Program:

Starting Date: December 2012

Leadership: Dr. Francis Layla, a fully trained paediatric nephrologist.

Data in 2016: The program has treated an average of 1-2 children per month.

 

Settings:

Benin, a West African country with 10 million people, had no pediatric dialysis services prior to 2012; AKI was managed conservatively without RRT.  In 2012, SYL met with Dr. Francis Lalya, a pediatric nephrologist based in Cotonou, the capital of Benin. Dr. Lalya was anxious to start a PD program to treat children with AKI who needed RRT.

In December 2012, SYL began to provide PD supplies (commercial solutions and cuffed catheters) and Dr. Lalya started the PD/AKI program based  at the National Teaching Hospital CNHU-HKM in Cotonou as an integral part of the pediatric ward.

The program is staffed by a team composed of a pediatric nephrologist, a registrar, and three nurses.  

PD catheters are, in general, inserted at bedside by the nephrology team. Commercial PD fluids have been used, although in some cases locally made solutions (Lactated Ringer’s solution and glucose), have been utilized when commercial solutions were not available.

All patients have been treated with standard manual exchanges with the frequency of exchanges dictated by the clinical status of the patient. Since the start of the program, 109 cases of AKI were hospitalized and 26 needed RRT and received PD.

  

Picture palestineEC Institute: Al Najah National University Hospital, Nablus, Palestine

EC Liaison officer: Zakaria Hamdan

SC Institute: Royal Liverpool University Hospital

SC Liaison officer: Abdul Hammad

 

Name of STC-TTS Pair: Palestine - UK

Pair Level: Level C

 

Short description of the project or abstract:

Delivery of integrated RRT:

In order to achieve this, we need to make sure that patients with CKD are identified early, referred to nephrology services as early as possible, and measures to slow the progress of the disease are taken.
Also we need to put care pathways to make sure patients are managed in a timely fashion when they reach CKD4-5, by planning their vascular access, and negate the need for neck lines with associated mortality and morbidity, and encourage pre-emptive transplantation.

Establish a viable system for Kidney Transplantation:

Kidney transplantation is the best treatment option for patients with kidney failure. It improves quality of life and survival. Also it is the most cost effective treatment. UK figures show that kidney transplantation is highly successful, with 5-year graft survival is 93% for live donor kidney transplants and 85% for Deceased donor kidney transplant.

Kidney transplantation is highly specialised discipline, which requires multi disciplinary team approach. It is bitterly disappointing to look at kidney transplantation as a surgical procedure. To achieve best results, and to make impact on the healthcare system, kidney transplantation should be approached as a complete system. The aim is to give every patient suitable for kidney transplantation the chance of getting one. All involved in patient care should work together to achieve this. This requires high degree of planning, discipline, and political will.
Many countries in the region may perform kidney transplants, but unfortunately they lack kidney transplant system. Our aim is to establish a complete kidney transplant program similar to programs in developed countries. Teaming up with the Royal Liverpool University Hospital will help to transfer skills and technology to the proposed transplant unit at Al Najah University Hospital.

 

Learning objectives:

  • Training the multi disciplinary team
  • Build infra- structure
  • Change legislation and start a cadaveric program

 

Thursday, 23 June 2016 09:42

SRC Program Level C : Sri Lanka - USA

picture sri lankaEC Institute: Kandy Hospital

EC Liaison officer: Nishantha Nanayakkara

SC Institute: Stanford University

SC Liaison officer: Shuchi Anand

 

Name of SRC Pair: Sri Lanka - USA

SRC Level: Level C

 

Short description of the project or abstract:

Kandy hospital / Peridenya University is one of the few nephrology centers caring for patients with CKD in Sri Lanka. Since hemodialysis is expensive and difficult to access for patients living in remote areas where the disease is endemic, nephrologists working at Kandy are attempting to expand provision of peritoneal dialysis, using a central clinic at Kandy that then engages less specialized providers in two remote clinics.
A team of researchers and clinicians at Stanford University plans to implement a quality improvement project that supports and expands peritoneal dialysis use.

What we do: 

  • Needs assessment for how Stanford can help support peritoneal dialysis
  • Create an intake form for identified major complications
  • CME (led by Dr Saxena) on customized solutions to major complications
  • Online peritoneal dialysis educational modules for nurses and non-nephrology physicians
  • Post intervention assessment

Learning objectives:

  • Understand major complications related to peritoneal dialysis use in rural Sri Lanka
  • Implement a customized education program on peritoneal dialysis for nurses and non-nephrology physicians

 

picture ethiopia2EC Institute: Addis Ababa University College Of Health Sciences Department Of Pediatrics

EC Liaison officer: Bezaye Abebe

SC Institute: St John’s National Academy of Health Sciences, Dept of Pediatric Nephrology

SC Liaison officer: Arpana Iyengar

MC Institute: Montreal Childrens Hospital, Department of Pediatric Nephrology

MC Liaison officer: Martin Bitzan

Name of SRC TRIO: ETHIOPIA - INDIA - CANADA

Pair Level: Level B

Short description of the project:

The SRC trio of Ethiopia, India and Canada was established in the year 2014 with the goal of:

  • Introducing better quality pediatric nephrology services for Ethiopian children.
  • Establishing a formal pediatric nephrology training teaching program to spread knowledge of kidney diseases that commonly affect local children and how to manage them effectively.

Dr Beza completed a 1 year training visit with the SC culminating in her return to Ethiopia to initiate a successful acute PD program for children with Acute Kidney Injury. The SC has also supplied Dr Beza with important equipment like dialysis catheters and BP manometers with pediatric cuffs as these were hard to find locally. The MC has visited Addis Ababa University and provided invaluable feedback and advice regarding improvement of pediatric nephrology services to our population.

Activities: 

  • WKD focused on children. We took the initiative, based on our experience, to organize WKD from our SC. We kept the children front and center of the day. We had a public lecture in 2 schools and a national theatre hall for the general public, given by pediatric nephrologists and a medical student who used to be our patient. We had BP screening as well. We also have involved our patients in an art competition where they had to draw how they see kidneys and their problems
  • We will strengthen the AKI care given at the EC by procuring more equipment and training nurses on acute PD and patient care.
  • Training of fellows in pediatric nephrology will begin, and will include a visit to the SC.
  • We will conduct a CME for general pediatricians and postgraduate students with faculty from EC, SC and MC.
  • The EC needs access to the medical literature -We will provide the EC with access to different journals and educational materials to help establish a library for the fellowship program and postgraduates.

Learning objectives:

  • Improve quality of care for Ethiopian children with kidney diseases by (a) Setting up a separate dialysis unit for pediatric AKI (b) Initiate a nephron-urology clinic staffed by pediatric nephrology and urology to manage common urology problems (c) Improve the management of children with CKD (d) Begin to Create awareness in the Ethiopian ministry of Health about the plight of children with kidney diseases and the need to support our initiatives.
  • Educate the pediatric community about care of children with kidney problems a) The EC conducted it’s first ever WKD celebrations b) A pediatric nephrology training course is due to begin in 2016 c) The trainee will spend at least 3 months observing / learning in the SC
  • The SC and MC will conduct a CME along with the EC in Ethiopia in November 2016.

EC Institute: Fundatia Renala / Republican Clinical Hospital

EC Liaison officer: Igor Codreanu

SC Institute: Fundatia pentru Cercetare Biomedicala „Gr T Popa” • /C.I.Parhon Hospital

SC Liaison officer: Adrian Covic 

Name of SRC Pair: Romania – Republic of Moldova

Moldova Romania 2 Moldova Romania 4 Moldova Romania 6

SRC Level: Level A

Short description of the project : 

Romania and Republic of Moldova are neighboring countries, that have a similar culture and speak the same language. However, medicine is more developed in Romania, therefore, the Moldavians young doctors can learn about the management and prevention of renal diseases from the more experienced doctors from Romania. The nephrologists from the “Dr. C.I. Parhon” Hospital, have experience in assessing the fluid status using medical ultrasonography devices and electrical bioimpedance. Using these techniques, one can obtain a clear picture about the fluid status of all patients. More importantly, these techniques are relatively cheap, which is a very important aspect in the actual economic state of the country.

Activities: 

  • May 2016 – Conference of Nephrology “Latest News in Nephrology”
  • June 2016 – Traineeship for a medical resident in Nephrology in Iasi, Romania on the following topic “Fluid status assessment using pulmonary ultrasonography and electrical bioimpedance in patients with chronic kidney disease”
  • July 2016 – Cooperation of the HLA medical labs from Moldova and Romania in defining the HLA frequency in Moldova and Romania, as well as assessing the benefits and limits of following methods: serological testing vs. molecular biology assessment.
  • September 2016 – Renal Failure Academy, a group of nephrologists from Moldova will attend the 14th Renal Failure Academy, official ERA-EDTA CME course.
  • September 2016 – NefroCarDia, a group of nephrologists from Moldova will attend the 5th NecroCarDia conference, an interdisciplinary conference 
  • December 2016 – Nephrologists from Republic of Moldova will attend the conference dedicated to the “Dr. C.I. Parhon” Hospital from Iasi 
  • Implementation of the joint research project in assessing the fluid status using medical ultrasonography devices and electrical bioimpedance

Learning objectives: 

  • Training of the nephrology medical residents from Republic of Moldova in the “Dr. C.I. Parhon” Hospital from Iasi, Romania
  • Studying the fluid status assessment using pulmonary ultrasonography and electrical bioimpedance in patients with chronic kidney disease
  • Implementing of new renal disease preventive strategies in Moldova
  • Implementation of the new methods of diagnosis in the HLA laboratory at the Republican Clinical Hospital, Chisinau

 

 

Colombia colombia

EC Institute: Hospital Susana López de Valencia

EC Liaison officer: Eliana Zemanate

SC Institute: Clínica Fundación Valle del Lili

SC Liaison officer: Jaime Restrepo

MC Institute: CHILDRENS HOSPITAL BOSTON

MC Liaison officer: Ghaleb Daouk

Name of SRC Trio: Colombia-Colombia-USA

SRC Level: B

Short description of the project :

Through the SRC program we are looking for the implementation of educational activities in two cities of Colombian southwest (Cali and Popayán), in order to start our main projects : Detection and follow up of CAKUT detected in utero; Evaluation of renal health in an aboriginal population, and creating an AKI network in PICU in Popayán.

Activities: 

  • “Congreso Colombiano de Nefrología”, Pereira-Colombia, by Colombian Society of Nephrology and Hypertension. Doctor Helmut Renke attended as guest speaker through CME. Topics: workshop nephropathology, Nephrotic Sindrome and Vascular Diseases of the Kidney.
  • Eliana Zemanate MD and Claudia Castro nurse, traveled to Boston Children´s Hospital for training (1 month: 15th May to 15th June) in RRT acute and chronic at PICU, in order to support the PICU in Popayán when they back to Colombia.
  • We are making every month a working day in pediatric nephrology in the Emergent Center (Popayán), it includes inpatient and outpatient in Hospital Susana Lopez de Valencia and Hospital San José.
  • We have scheduled Pablo Gómez, pediatric urology from Florida Hospital For Childrens (Orlando, FL) to attend the Annual Pediatric Meeting (Popayán) through CME. September 4 to 7th 2016.
  • Matthew Sampson MD, pediatric nephrology, from University of Michigan comes as speaker to “Congreso Nacional de Genética” (Bucaramanga- Colombia), which is organized by Colombian Association of Genetic. October 26 to 29th 2016. Our SRC program supports this activity.

Learning objectives:

  • Implementation of educational activities (booklets , meetings and video) in Pediatric Nephrology topics, especially in the International Kidney Day
  • We are setting up a Pediatric Nephrology program in the Emerging Center (Popayán). At the begining we are supporting the two pediatric centers at the main hospitals of Department of Cauca (Colombia), and we´ll reinforce the RRT in the Popayán´s PICU and NICU.
  • To develop a Transition program from pediatric kidney transplant services to adult services in the Fundación Valle del Lili (supporting center)
  • To continue making projects to improve the quality of life and the renal health in indigenous communities “Prevalence of urinary tract infection in children between 6 and 16 years old at the Agricultural Educational Institution, Totoroes” 

 colombia2

image sigwadiName: Patience Sigwadi

Hospital / Affiliation: Steve Biko Academic Hospital

Home Country: South Africa

Host Country: South Africa

Year: 2012

Status of your program: COMPLETED

 

 

Title of the project: 

Can urine β2-microglobulin excretion be used as a screening test for detection of renal tubular dysfunction
in HIV infected children less than five years old?

Topic: 

Pediatric Nephrology 

Short description of the project or abstract:

Aim:

  • To compare the urine β2-microglobulin:creatinine ratio (u-β2M:Creat) of HIV infected children age 6 week to 5 year old with those of healthy children in the same age range
  • To determine if u- β2M: creatinine ratio can be used as a screening tool for early detection of renal tubular dysfunction

Method:
This is a cross-sectional observational study evaluating u-β2M: creatinine ratio of HIV infected and healthy children age 6 weeks to 5 years. The study group included HIV infected children attending 3 different immunology clinics in Pretoria, South Africa. The control group was healthy HIV negative children of the same age groups attending a single immunization clinic. Exclusion criteria for study patients were: babies born incomplete

Results:
A total of 95 participants were enrolled, 57/95 were study patients (Group A) and 38/95 control (Group B). Groups A and B consisted of 33 and 23 participants ≤24 months old and 24 and 15 participants >24 months old respectively. Proteinuria was detected in 7/57 (12.3%) HIV infected and 3/38 (7.9%) healthy infants. Mean (±SD) u-β2M: Creat ratios were 0.220 ± 0.551 and 0.276 ±0.948 in children ≤ 24 months and 0.082 ± 0.192 and 0.018 ± 0.008 in children >24 months old in Groups A and B respectively. (P= 0.12). U-β2M:Creat ratio were elevated >0.052 mg/mmol in 27/57 (47.4%) and 4/38 (10.5%) children in groups A and B respectively. Mean (±SD) U-β2M: Creat ratios were 0.174 (±0.742) in Group B. Serum HCO3 levels (Normal 21-29 mmol/L) were decreased in the study group 17.1 ± 3.5 and 17.5 ± 2.6 in children ≤24 months and >24 months respectively. S-HCO3 levels were 18(±2.3) and 17(±3.5) mmol/L in Bactrim and no Bactrim treated groups respectively refuting the notion that Bactrim is the cause of acidosis in this population. It was not possible to analyze the effect of different antiretroviral drugs on urine beta2 microglobulin excretion as there were too many drug combinations.

 

Conclusion:

Higher levels of urine β2-microglobulin excretion were observed in healthy children and in HIV infected children. HIV infected children >2 years had higher U-β2M:Creat ratio compared to healthy children of the same age. HIV children had significantly low HCO3 levels compared to the normal reference laboratory level.
In conclusion this study does not support the use of U-β2M: Creat ratios to screen for renal tubular disease in HIV infected children less than 5 years old.

 

Name: Hequn Zou 

Hospital / Affiliation: The Third Affiliated Hospital of Southern Medical University    

Home Country: China    

Host Country: China    

Year: 2013    

Status of your program: In progress

 

Title of the project:

Protocol of novel KHDC Program under the background of new Chinese community medical model

Topics: 

Chronic Kidney Disease, Interventional nephrology

 

Short description of the project or abstract: 

KHDC prevention and treatment face serious challenges in developing countries: the weak social KHDC awareness; lack of the working mechanism featuring government taking the lead with multi-sector cooperation and whole society participation; lack of sound KHDC prevention and treatment networks; inappropriate allocation of health resources and the urgent need for qualified health personnel.
However, more attention has come from Chinese government and current policy activities for the prevention and treatment of chronic non-communicable diseases during the last years. New Chinese community medical model is inducing more expectation to NCD control in China. Now is the beginning of new model for KHDC prevention and intervention in China. We stand at a new crossroads, our path forward is clear, while no one knows the final results of next 5 or 10 years. But for sure, the strong support from community health center will help the KHDC prevention and intervention more successful.

 

Learning or Research objectives:  

Screening:

  • To identify the individuals with chronic kidney disease, hypertension, diabetes and cardiovascular disease in community residents of Guangzhou City in Southern China.
  • To determine the prevalence and current risk factors of chronic kidney disease, end stage renal disease, hypertension and diabetes in Guangzhou community residents.
  • To define the overall risk factor score for cardiovascular disease in Guangzhou community residents.

Patient Management:

  • To reduce the total mortality rate of screened patients with chronic kidney disease, hypertension, diabetes and cardiovascular disease by undertaking a comprehensive management strategy including health education, lifestyle modification and effective pharmacological treatment mainly based on the management of insulin resistance and metabolic syndrome.
  • To assess changes in albumin/protein excretion and renal function as well as blood pressure.
  • To assess the changes of end stage renal disease incidences (including dialysis and transplantation) and cardiovascular events.

 

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