Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420150004&lang=en vol. 105 num. 3 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>The <i>ch </i>in children stands for cherish</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Editor' Choice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Conflict of interest and regulatory authorities</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Inaugural International Association of Student Surgical Societies Symposium</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400004&lng=en&nrm=iso&tlng=en <![CDATA[<b>Eastern Cape treatment dysfunction boosts virulent new XDR-TB strain</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400005&lng=en&nrm=iso&tlng=en <![CDATA[<b>Will Basson come out on top?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400006&lng=en&nrm=iso&tlng=en <![CDATA[<b>Zuma's legal advisors 'led him astray', turned healthcare professionals into criminals</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400007&lng=en&nrm=iso&tlng=en <![CDATA[<b>The risky lives of South Africa's children: Why so many die or are traumatised</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400008&lng=en&nrm=iso&tlng=en <![CDATA[<b>Ajay Makanjee</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400009&lng=en&nrm=iso&tlng=en <![CDATA[<b>Alewyn Petrus Rossouw</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400010&lng=en&nrm=iso&tlng=en <![CDATA[<b>Carbohydrate loading in the preoperative setting</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400011&lng=en&nrm=iso&tlng=en Nutrition support is an evolving field, and modern clinical nutrition practice should actively incorporate strategies to enhance various clinical outcomes. In surgical patients, clinical benefits can be maximised by nutritional support protocols that minimise and manage the perioperative fasting period. This approach, which includes the perioperative provision of clear carbohydrate-containing fluids, has been shown to be safe, is evidence based, and is supported by many professional societies. Such a strategy has been shown to aid the anaesthetic process and maintain an optimal metabolic state, including improved insulin sensitivity and blunted muscle catabolic activity. Some important consequences of this improved metabolic control include shorter hospital stay and fewer postoperative complications. A proactive multidisciplinary team approach is essential to use this nutrition support strategy with success across a hospital's surgical service. <![CDATA[<b>Recommendations for the treatment and prevention of malaria: Update for the 2015 season in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400012&lng=en&nrm=iso&tlng=en Notified malaria cases in South Africa (SA) decreased significantly over the past 14 years, from over 60 000 in the 1999/2000 malaria season to less than 13 000 in 2013/2014. However, the past two seasons have seen increases in both local and imported cases. Mozambique contributes the highest number of imported cases in SA. This update provides recommendations for malaria treatment and prevention (in travellers and residents) for 2015. <![CDATA[<b>Chronic pancreatitis, depression and substance use disorders: A not uncommon combination</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400013&lng=en&nrm=iso&tlng=en Chronic pancreatitis (CP) is a progressive and debilitating disease. A potentially important consideration is the relationship between CP, depression and substance use disorders, which seems to be circular and multiplicative. Pain management is a critical component of intervention, and it would seem that in the context of chronic illness this requires a biopsychosocial approach aiming for a tailored intervention that strikes an appropriate therapeutic balance. <![CDATA[<b>'Over-servicing', 'underservicing' and 'abandonment': What is the law?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400014&lng=en&nrm=iso&tlng=en The Ethical Rules and Policy Document of the Health Professions Council of South Africa (HPCSA) do not define 'over-servicing', 'underservicing' and 'abandonment'. The HPCSA Guidelines on Over-servicing, Perverse Incentives and Related Matters define 'over-service' only. The converse of this definition can be used to define 'underservicing'. The courts do not refer to these concepts, but apply general rules regarding professional negligence and malpractice based on what a reasonably competent doctor in the same position would do. In deciding the standard to be adopted, the courts may consult the ethical rules of the medical profession, but are not bound to take them into account. <![CDATA[<b>The <i>Global Status Report on Violence Prevention 2014: </i>Where to for the South African health sector?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400015&lng=en&nrm=iso&tlng=en The Ethical Rules and Policy Document of the Health Professions Council of South Africa (HPCSA) do not define 'over-servicing', 'underservicing' and 'abandonment'. The HPCSA Guidelines on Over-servicing, Perverse Incentives and Related Matters define 'over-service' only. The converse of this definition can be used to define 'underservicing'. The courts do not refer to these concepts, but apply general rules regarding professional negligence and malpractice based on what a reasonably competent doctor in the same position would do. In deciding the standard to be adopted, the courts may consult the ethical rules of the medical profession, but are not bound to take them into account. <![CDATA[<b>Prevention of Liver Fibrosis and Cancer in Africa: The PROLIFICA project - a collaborative study of hepatitis B-related liver disease in West Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400016&lng=en&nrm=iso&tlng=en The Ethical Rules and Policy Document of the Health Professions Council of South Africa (HPCSA) do not define 'over-servicing', 'underservicing' and 'abandonment'. The HPCSA Guidelines on Over-servicing, Perverse Incentives and Related Matters define 'over-service' only. The converse of this definition can be used to define 'underservicing'. The courts do not refer to these concepts, but apply general rules regarding professional negligence and malpractice based on what a reasonably competent doctor in the same position would do. In deciding the standard to be adopted, the courts may consult the ethical rules of the medical profession, but are not bound to take them into account. <![CDATA[<b>Need for services for the care and prevention of congenital disorders in South Africa as the country's epidemiological transition evolves</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400017&lng=en&nrm=iso&tlng=en The Ethical Rules and Policy Document of the Health Professions Council of South Africa (HPCSA) do not define 'over-servicing', 'underservicing' and 'abandonment'. The HPCSA Guidelines on Over-servicing, Perverse Incentives and Related Matters define 'over-service' only. The converse of this definition can be used to define 'underservicing'. The courts do not refer to these concepts, but apply general rules regarding professional negligence and malpractice based on what a reasonably competent doctor in the same position would do. In deciding the standard to be adopted, the courts may consult the ethical rules of the medical profession, but are not bound to take them into account. <![CDATA[<b>Dementia in rural South Africa: A pressing need for epidemiological studies</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400018&lng=en&nrm=iso&tlng=en The Ethical Rules and Policy Document of the Health Professions Council of South Africa (HPCSA) do not define 'over-servicing', 'underservicing' and 'abandonment'. The HPCSA Guidelines on Over-servicing, Perverse Incentives and Related Matters define 'over-service' only. The converse of this definition can be used to define 'underservicing'. The courts do not refer to these concepts, but apply general rules regarding professional negligence and malpractice based on what a reasonably competent doctor in the same position would do. In deciding the standard to be adopted, the courts may consult the ethical rules of the medical profession, but are not bound to take them into account. <![CDATA[<b>The Vaccine and Cervical Cancer Screen project 2 (VACCS 2): Linking cervical cancer screening to a two-dose HPV vaccination schedule in the South-West District of Tshwane, Gauteng, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400019&lng=en&nrm=iso&tlng=en BACKGROUND: Cervical cancer is a preventable disease with a high prevalence in South Africa (SA), where screening is opportunistic. Primary prevention is now possible through HPV vaccination. In VACCS 1 the feasibility of linking cervical cancer with HPV vaccination was demonstrated. OBJECTIVES: To investigate the feasibility of linking HPV self-testing with a two-dose HPV vaccination schedule and to compare results with VACCS 1. METHODS: The project was conducted in five schools in the South-West District of Tshwane, Gauteng, SA. Leaflet information on cervical cancer and screening was provided, with requests for consent and assent for a two-dose HPV vaccination of schoolgirls. Female caregivers were invited to take part in HPV self-screening. RESULTS: Of 965 girls invited for vaccination, 519 (53.7%) had full consent and 518 (99.8%) received at least one vaccine dose. The invited uptake rate was 53.7% and 495 girls received both doses, giving a completion rate of 95.4% v. 82.6% in VACCS 1. Of 1 135 self-screen kits handed out, 560 (49.3%) were not returned. The mean age (standard deviation) of the 160 women who participated in self-screening was 38.7 (7.7) years. HPV testing was negative in 116 women (72.5%), 15 women (9.4%) tested positive for HPV 16 and/or 18, and 27 (16.9%) were positive for non-16/18 oncogenic HPV. CONCLUSION: Data from the VACCS projects suggest that school-based vaccine programmes can be successfully implemented. A two-dose schedule allowed for higher completion rates. Linking self-collected HPV screening to HPV vaccination is feasible, is a promising and viable screening strategy, and reached the appropriate age group for screening. <![CDATA[<b>Traumatic brain injury, the hidden pandemic: A focused response to family and patient experiences and needs</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400020&lng=en&nrm=iso&tlng=en INTRODUCTION: Traumatic brain injury (TBI) has many potential cognitive, behavioural and psychological consequences, and contributes significantly to the national burden of disease and to ongoing violent behaviour. Few resources are available for the rehabilitation of patients with TBI in South Africa, and access to rehabilitation facilities in the public sector is limited. Consequently, it is the families impacted on by TBI that ultimately carry the care and rehabilitation burden once survivors are discharged from hospital. Families are generally ill equipped to cope with the complex and potentially long-term disabilities that accompany brain injury. METHODS: Reviewing interviews with 175 family members and 354 patients recovering from TBI helped identify the key challenges that the survivors of TBI and their families face. RESULTS: Nine problem areas were identified that formed the basis for development of a discharge resource, the S-Plan, which serves to inform patients and carers and provide practical solutions for the problems they face. CONCLUSION: The experiences of TBI survivors and their family members served to inform the development of simple, integrated coping strategies, namely two S-Plan tools, one for survivors and their families/caregivers and the other for care workers, in conjunction with counselling and support group processes. The S-Plan constitutes a discharge resource to inform patients and carers and provide practical solutions for the problems they face in caring for family members who have suffered TBI. <![CDATA[<b>Hypertension, end-stage renal disease and mesangiocapillary glomerulonephritis in methamphetamine users</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400021&lng=en&nrm=iso&tlng=en BACKGROUND: Methamphetamine abuse has risen dramatically in South Africa. The chronic effects of abuse on the kidneys and blood pressure have not been documented. This study reviewed patients referred for evaluation of kidney disease and/or hypertension, who had been abusing methamphetamines. METHODS: The records of patients referred to the renal unit between 2005 and 2013 who had been using methamphetamines were retrospectively reviewed. Patient demographics, biophysical parameters, blood pressure, renal function, renal ultrasound and biopsy findings, complications of chronic kidney disease and comorbidities were recorded. RESULTS: Forty-seven patients were included in the study. Their mean age was 29 years. Hypertension was present in 42 (89.4%) of patients, with malignant hypertension in 21 (44.7%). Forty-five (95.7%) had chronic kidney disease (CKD), and 26 (55.3%) had end-stage renal disease. Renal biopsies were performed in 24 patients. Twelve (50.0%) of the biopsies showed hypertensive changes and 14 (58.3%) mesangiocapillary glomerulonephritis type 1, with deposition of IgM and C3 complement. CONCLUSION: Methamphetamine use is associated with severe hypertension, mesangiocapillary glomerulonephritis and CKD. <![CDATA[<b>Emergency care research priorities in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400022&lng=en&nrm=iso&tlng=en BACKGROUND: Emergency care research is rarely undertaken in low- and middle-income countries. A manageable 'road map' for research in South African (SA) emergency care is needed to address research gaps. OBJECTIVE: To identify, collate and prioritise research topics from identified knowledge gaps in emergency care in SA. METHODS: Seventy-six individuals were invited to participate in a modified Delphi study. Participants were requested to suggest important research topics before rating them. Consensus was achieved when >75% of participants strongly agreed or disagreed. Participants then ranked the agreed statements before selecting the most appropriate methodology relating to study design, funding and collaboration. RESULTS: Three hundred and fifty topics were suggested by 31 participants. Topics were collated into 123 statements before participants rated them. Consensus was achieved for 39 statements. The highest-ranked priority in the prehospital group was to determine which prehospital interventions improve outcomes in critically ill patients. The competence of emergency care providers in performing common lifesaving skills was deemed the most important in clinical emergency care. Implementing and reviewing quality improvement systems scored the highest under general systems and safety management. Only 22 statements achieved consensus regarding study design. The National Department of Health was the preferred funding source, while private organisations and emergency care societies were identified as possible collaborative partners. CONCLUSION: This study provides expert consensus on priority research areas in emergency care in SA as a guide for emergency care providers to ensure evidence-based care that is relevant to the SA population. <![CDATA[<b>Oral v. pulse intravenous cyclophosphamide: A retrospective analysis of adverse events in a setting with a high burden of infectious disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400023&lng=en&nrm=iso&tlng=en BACKGROUND: Cyclophosphamide (CPM) is still considered to be the first-line treatment for many life-threatening autoimmune conditions. It does, however, carry a significant risk of serious adverse events, especially infections. At present CPM is administered as either a daily oral dose (DOC) or an intravenous pulse (PIVC). There is uncertainty regarding the safety profiles of both regimens in settings with a high burden of infectious diseases. OBJECTIVE: To compare the frequency and nature of adverse events related to the use of DOC and PIVC in such a setting. METHODS: A cohort of patients treated with CPM for autoimmune diseases at Tygerberg Academic Hospital, Cape Town, South Africa, from 1 January 2008 to 31 May 2013 was studied. We compared participants receiving DOC and PIVC with regard to disease characteristics and the occurrence of major adverse events. RESULTS: A total of 134 participants (92 DOC and 42 PIVC) were included. Participants in the DOC group were treated for longer (174 v. 101 days; p<0.01) and with higher cumulative doses (17 276 v. 3 327 mg; p<0.01). Risk of infection was similar in the two groups, although there were 6 deaths from leucopenic sepsis in the DOC group (v. 0; p=0.18). Nadir leucocyte counts were also lower in the DOC group (median 3.8 v. 5.3 χ 10(9)/L; p=0.02). CONCLUSION: Infection rates in the two groups were similar, but DOC was associated with longer treatment duration, greater cumulative CPM doses and more severe leucopenia. If resources allow and available literature provides support for efficacy, consideration should be given to greater use of PIVC. <![CDATA[<b>Prevalence and causes of thrombocytopenia in an academic state sector laboratory in Soweto, Johannesburg, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400024&lng=en&nrm=iso&tlng=en BACKGROUND: Causes of thrombocytopenia range from laboratory errors to life-threatening pathological conditions. To establish the cause, appropriate laboratory investigation is required. OBJECTIVES: To determine the prevalence and causes of platelet counts <100 χ 10(9)/L in state health facilities in Johannesburg, South Africa, as well as the quality of the subsequent laboratory work-up in this setting. METHODS: Full blood counts (FBCs) performed on 7 randomly selected days at the National Health Laboratory Service laboratory at Chris Hani Baragwanath Academic Hospital were retrospectively reviewed. Samples with platelet counts <100 χ 10(9)/L were identified, and pertinent information was extracted from the laboratory database. RESULTS: Of 4 456 FBCs included, 381 (8.6%) had a platelet count of <100 χ 10(9)/L. Thrombocytopenia prevalence rates were high in haematology/oncology wards (34.4%), intensive care units (20.5%) and medical wards (18.7%) and among neonatal inpatients (16.5%), and were lowest in outpatient clinics (1 - 2%). A cause was apparent in ~60% of patients, the commonest causes being chemotherapy and sepsis (each comprising &gt;20% of the recognised causes). Spurious thrombocytopenia, disseminated tuberculosis, aplastic anaemia, immune thrombocytopenia and malignant marrow infiltration each accounted for 5 - 10% of the causes, while malaria, thrombotic thrombocytopenic purpura, HIV effect and liver disease were each identified in <5% of cases. HIV status was documented in ~70% of the patients, of whom ~50% tested positive. The quality of the laboratory work-up showed differences between specialties within the hospital setting, and was poorest in the primary healthcare clinic sector. CONCLUSION: Thrombocytopenia is common in hospitalised patients in the Johannesburg academic state sector. Differences in the quality of the laboratory work-up emphasise the need for a standardised approach to thrombocytopenia investigation and increased awareness among clinicians. <![CDATA[<b>Short-term treatment outcomes of children starting antiretroviral therapy in the intensive care unit, general medical wards and outpatient HIV clinics at Red Cross War Memorial Children's Hospital, Cape Town, South Africa: A retrospective cohort study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400025&lng=en&nrm=iso&tlng=en BACKGROUND: Many HIV-infected children are initiated on antiretroviral therapy (ART) during hospitalisation in South Africa (SA). No published data on these outcomes exist. OBJECTIVES: To assess the short-term outcomes of children initiated on ART in the intensive care unit (ICU), general medical wards (GMWs) and outpatient HIV clinics (OHCs) at Red Cross War Memorial Children's Hospital (RCWMCH), Cape Town, SA. METHODS: We conducted a retrospective cohort study of HIV-infected children aged <13 years commenced on first-line ART between January 2008 and December 2011. Outcomes included death, virological suppression and changes in CD4 count. Kaplan-Meier estimates, multivariate Cox proportional hazard ratios and logistic regression were used to estimate outcomes at 6 months. RESULTS: One hundred and six children were commenced on ART in the ICU, 509 in the GMWs and 127 in the OHCs; 65.7% of all children were <12 months old. Of children qualifying for rapid ART initiation according to the 2013 national treatment guidelines, 182 (24.9%) started therapy within 7 days of diagnosis. Overall mortality was 6.4% (95% confidence interval (CI) 4.9 - 8.4). Of children remaining in care at RCWMCH, 51.0% achieved a CD4 percentage &gt;25% and 62.3% a viral load <50 copies/mL 6 months after ART initiation. Mortality was higher in the ICU cohort (13.2%) than in the GMW and OHC cohorts (5.5% and 3.9%, respectively, log-rank p=0.004). Predictors of mortality included moderate underweight (adjusted hazard ratio (aHR) 2.4; 95% CI 1.1 - 5.2), severe underweight (aHR 3.2; 95% CI 1.6 - 6.5), absence of caregiver counselling sessions (aHR 2.9; 95% CI 1.4 - 6.0) and ART initiation in the ICU (aHR 2.6; 95% CI 1.4 - 4.9). CONCLUSION: These results highlight the importance of understanding the context in which children are initiated on ART, when comparing outcomes in different settings. <![CDATA[<b>An investigation of fingerstick blood collection for point-of-care HIV-1 viral load monitoring in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400026&lng=en&nrm=iso&tlng=en BACKGROUND: Viral load (VL) quantification is an important tool in determining newly developed drug resistance or problems with adherence to antiretroviral therapy (ART) in HIV-positive patients. VL monitoring is becoming the standard of care in many resource-limited settings. Testing in resource-limited settings may require sampling by fingerstick because of general shortages of skilled phlebotomists and the expense of venepuncture supplies and problems with their distribution. OBJECTIVE: To assess the feasibility and ease of collecting 150 μL capillary blood needed for the use of a novel collection device following a classic fingerstick puncture. METHODS: Patients were recruited by the study nurse upon arrival for routine ART monitoring at the Themba Lethu Clinic in Johannesburg, South Africa. Each step of the fingerstick and blood collection protocol was observed, and their completion or omission was recorded. RESULTS: One hundred and three patients consented to the study, of whom three were excluded owing to the presence of callouses. From a total of 100 patients who consented and were enrolled, 98% of collection attempts were successful and 86% of participants required only one fingerstick to successfully collect 150 μL capillary blood. Study nurse adherence to the fingerstick protocol revealed omissions in several steps that may lower the success rate of capillary blood collection and reduce the performance of a subsequent VL assay. CONCLUSION: The findings of this study support the feasibility of collecting 150 μL of capillary blood via fingerstick for point-of-care HIV-1 VL testing in a resource-limited setting. <![CDATA[<b>Chronic kidney disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400027&lng=en&nrm=iso&tlng=en BACKGROUND: Viral load (VL) quantification is an important tool in determining newly developed drug resistance or problems with adherence to antiretroviral therapy (ART) in HIV-positive patients. VL monitoring is becoming the standard of care in many resource-limited settings. Testing in resource-limited settings may require sampling by fingerstick because of general shortages of skilled phlebotomists and the expense of venepuncture supplies and problems with their distribution. OBJECTIVE: To assess the feasibility and ease of collecting 150 μL capillary blood needed for the use of a novel collection device following a classic fingerstick puncture. METHODS: Patients were recruited by the study nurse upon arrival for routine ART monitoring at the Themba Lethu Clinic in Johannesburg, South Africa. Each step of the fingerstick and blood collection protocol was observed, and their completion or omission was recorded. RESULTS: One hundred and three patients consented to the study, of whom three were excluded owing to the presence of callouses. From a total of 100 patients who consented and were enrolled, 98% of collection attempts were successful and 86% of participants required only one fingerstick to successfully collect 150 μL capillary blood. Study nurse adherence to the fingerstick protocol revealed omissions in several steps that may lower the success rate of capillary blood collection and reduce the performance of a subsequent VL assay. CONCLUSION: The findings of this study support the feasibility of collecting 150 μL of capillary blood via fingerstick for point-of-care HIV-1 VL testing in a resource-limited setting. <![CDATA[<b>Significance, definition, classification and risk factors of chronic kidney disease in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400028&lng=en&nrm=iso&tlng=en Renal dysfunction or chronic kidney disease (CKD) is found in 10% of the global population and is classified into five stages according to the estimated glomerular filtration rate (eGFR). No matter where a patient lives, estimation of the GFR is mandatory for decision-making and obtained by the simple measurement of a serum creatinine level. The objective of diagnosing CKD lies in its future prevention, early detection and proper treatment, which will prevent or delay functional deterioration. Primary hypertension (PH) occurs in 25% of South Africa (SA)'s black population and is the putative cause of stage 5 CKD in 40 - 60% of these patients. Moreover, in this group, stage 5 CKD occurs at a relatively young age (35 - 45 years) compared with other population groups in whom stage 5 CKD resulting from PH usually occurs between 60 and 70 years of age. In the cohort study, PH has been found in 12 - 16% of black school learners (mean age 17 years) compared with 1.8 - 2% of other ethnic groups (mixed race, Asian, white). End-stage renal failure (ESRF) is the fifth most common cause of death in SA, excluding post-traumatic cases. In addition, undiagnosed or poorly controlled PH is a potent risk factor for other cardiovascular disease (CVD), e.g. congestive cardiac failure, myocardial infarction, stroke. Significant protein is also associated with CVD and protein >1 g/d is a significant risk factor for ESRF. <![CDATA[<b>Diagnostic approach to chronic kidney disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400029&lng=en&nrm=iso&tlng=en Chronic kidney disease (CKD) can be considered to be present if a patient has a glomerular filtration rate <60 mL/min or markers of kidney disease that have been present for &gt;3 months. These include proteinuria, haematuria and radiological abnormalities. Regardless of the stage of CKD, the approach is mainly similar. As stated in the South African Renal Society Guidelines for the early detection and management of CKD, early and appropriate investigation and timeous referral of these patients enable one to establish a specific diagnosis; treat reversible diseases; optimise management to slow the progression of CKD; identify and optimally manage comorbid conditions; and plan renal replacement therapy well before the patient develops end-stage kidney disease. <![CDATA[<b>Management of patients with chronic kidney disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400030&lng=en&nrm=iso&tlng=en Co-operation between primary healthcare workers (clinic staff and general practitioners) and nephrologists is essential and the ability to refer patients timeously should be on a pre-negotiated and organised basis. This article deals with these aspects, including follow-up guidelines and management and treatment strategies, including lifestyle changes where indicated and referral for end-stage renal failure, i.e. for dialysis and transplantation. <![CDATA[<b>Clinical aspects of chronic kidney disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400031&lng=en&nrm=iso&tlng=en Any patient seeking any form of medical advice at any clinic or hospital, or from a doctor or other healthcare worker, should have their blood pressure recorded and a urine dipstick test done. The most useful indication of a diagnosis of any stage of chronic kidney disease, is the presence of either hypertension, urinary dipstick abnormality or both. Many practitioners frequently refer such patients to urologists, which must be discouraged. Referral should be to a nephrologist or specialist physician. <![CDATA[<b>Chronic kidney disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000400032&lng=en&nrm=iso&tlng=en Any patient seeking any form of medical advice at any clinic or hospital, or from a doctor or other healthcare worker, should have their blood pressure recorded and a urine dipstick test done. The most useful indication of a diagnosis of any stage of chronic kidney disease, is the presence of either hypertension, urinary dipstick abnormality or both. Many practitioners frequently refer such patients to urologists, which must be discouraged. Referral should be to a nephrologist or specialist physician.