UKZN’s School of Clinical Medicine has formally partnered with the Extension for Community Healthcare Outcomes (ECHO Institute), an international outreach project located at the University of New Mexico (Albuquerque, USA) as well as ECHO India to strengthen its reach to healthcare professionals in peripheral hospital sites in KwaZulu-Natal.

Additionally, the Adult and Paediatric Nephrology Outreach programme was launched recently at UKZN’s Nelson R Mandela School of Medicine.

“We are excited to partner with the ECHO Institute and ECHO India in facilitating the link between primary care clinicians at hospitals across the province with specialist faculty from the School of Clinical Medicine,” said Dr Serela Ramklass, ECHO Project Manager at UKZN. “Collectively, we can improve the health outcomes and quality of lives in patients at peripheral sites through shared knowledge on patient assessment and management through mentoring and feedback.”

Professor Rajendra Bhimma, team leader for the Adult and Paediatric Nephrology UKZN-ECHO programme, said: “We will focus on nephrology conditions (both paediatric and adult nephrology) that are most common in our region. The discussions will be general, allowing all regional hospitals and district hospitals to participate. The project will deal with clinical cases presented by doctors either at the central or peripheral hospital and followed by a clinicopathological discussion around the case. In this way, doctors at the peripheral hospitals will be able to participate in the discussion and be refreshed on the acute and chronic management of the patient. Optimal management of the patient at the base hospital before transfer to the higher care facility will greatly improve the outcome of these patients.”

Dr Sudesh Hariparshad, Head of UKZN and Inkosi Albert Luthuli Central Hospital Nephrology mentioned that in South Africa, there is only one nephrologist for a population of 2.5 million. “It is important to note that chronic kidney disease (CKD) in its early stages is a silent disease, and may only become apparent when more than 50% of the function of the kidneys is lost. It is therefore essential that patients be screened, managed and referred appropriately at the primary healthcare level.

“Further, CKD is the fifth highest cause of death in low and middle-income countries. The main risk factors in South Africa are hypertension, Diabetes Mellitus and HIV. At the tertiary level, we get to see patients at an advanced stage of the disease; 99% present at phase 3-5 of CKD. It is therefore vital that at the primary healthcare level there is sufficient urinary testing done to assess for albuminuria or proteinuria, which is vital to risk stratify patients. Other markers include low estimated glomerular filtration rate (EGFR) and raised protein excretion, which are associated with a massively greater likelihood (15 to 16 times) of advanced CKD or end stage kidney disease.

Academic Leader of Medical Registrars at UKZN and Head of the Clinical Unit of Paediatrics at the King Edward VIII hospital, Dr Kimesh Naidoo presented on Glomerulonephritis (GN). Naidoo presented a case study of an 11-year-old patient who presented at a local clinic with “coke-like” or “tea-coloured” urine, a slight headache and no health issues at school. He was discharged but presented a week later with mild pedal oedema and a high blood pressure, as well as macroscopic haematuria. At this stage, he was diagnosed with nephritis.

Naidoo commented: “There is a need to determine when such cases require referral to specialists and sub-specialists; levels of care with most cases of nephritis can be adequately managed at primary health care levels.”

The next ECHO workshop scheduled in June will focus on hypertension in adults and children. The UKZN team has extended an invitation to public and private sector doctors to join this exciting partnership.

Contact Dr Serela Ramklass for further details at ramklasss@ukzn.ac.za