Nephrology

While HIV and tuberculosis are hitting the headlines daily, thousands are quietly dying of lifestyle diseases, many which can be prevented if diagnosed and treated early.

CAPE TOWN: Are you suffering from Type 1 diabetes? You better watch that weight around your waist. Researchers from the University of Washington, Seattle, have found that adults with Type 1 diabetes who are obese, especially those who carry excess weight around the waist, are at an increased risk of developing kidney disease.

September is 'Heart-awareness Month and, in the interest of keeping the nations collective hearts pumping, private hospital group Netcare will be conducting free screening tests for anyone visiting one of their medical facilities on Thursday 28 September!

Guidelines published this week on the management of hypertension and cardiovascular risk factors in sub-Saharan Africa aim to deal with the growing epidemic of cardiovascular disease in the area with the limited resources available. Hypertension was placed second only to AIDS in the health challenges facing countries in Africa at a meeting of the African Union in 2001. This resulted in the Durban Decision being adopted by African heads of state and governments, which emphasised the need to tackle hypertension and cardiovascular risk factors in the face of the emerging epidemic of cardiovascular disease in African countries. Figures from the World Health Organization predict that cardiovascular disease will be the commonest cause of death in developing countries by the year 2020. As a result, the European Commission has provided funding and resources to develop guidelines for the management of cardiovascular risk factors. The new guidelines, published in the Journal of Hypertension ( 2003;21: 1993-2000)[Medline], argue that particular consideration has to be given to cost effectiveness and affordability because many countries in sub-Saharan Africa have severe resource constraints. In some countries, the health budget per person is less than $10 (£5.80; €8.35) a year. As a result, the panel that developed the guidelines—including clinicians from several African countries—followed the main recommendations made in previous relevant guidelines (including the 2003 statement of management of hypertension by WHO and the International Society of Hypertension) but adapted them to make them more appropriate to the resources available in many sub-Saharan African countries.The guidelines recommend that low dose thiazide diuretics (for example, hydrochlorothiazide 12.5 mg daily) should generally be used as first line drug treatment for hypertension, with the target blood pressure being <140 mm Hg systolic and <90 mm Hg diastolic in patients with uncomplicated hypertension. A lower target of <130 mm Hg and <80 mm Hg should be the aim in patients with established cardiovascular disease, diabetes, or chronic renal disease. Other drugs should only be used when there are compelling reasons, such as the use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor antagonists in patients who also have diabetes. Generic drugs should be used whenever possible. (Source: Susan Mayor BMJ  2003;327:1305, 6 December)

South Africa has about 15 000 people whose kidney problems cannot be treated because of a lack of organ donations, insufficient dialysis machines and exclusion arising from other significant diseases.The crisis was acknowledged by Health Minister Manto Tshabalala-Msimang, who told Sowetan yesterday that the government was finalising a policy on organ transplantation and chronic renal dialysis. The South African Dialysis and Transplant Registry estimates that about 21 000 South Africans are currently experiencing kidney failure.Of that figure only 5 000 patients receive treatment, leaving more than 15 000 without treatment. There are two types of treatment available to patients with kidney failure -kidney transplants or dialysis, which alleviates the condition. There is a serious lack of kidney donations, said Katz. Similar problems affect thousands of patients, who need heart, liver, lung, pancreas, cornea, tissue and bone transplants, the Organ Donor Foundation said. The machines, however, were interim measures until transplants are performed. Each machine costs R100 000 and treatment for a single patient costs another R100 000 a year. Therefore, only those with the highest chances of living are afforded kidney treatment. The main causes of kidney failure were hypertension, diabetes, HIV/AIDS and toxins people received from using muti.