A serendipiditous start to 2021

~ Secretary@Renal Association ~ Leave a comment

It was far from planned! The chance discovery that Dr Sanju Sobnach was a newly trained liver and kidney transplant and that he was spending a few weeks in Mauritius with his family led to our first meeting where he recounted his recent fascinating experience as a trainee transplant surgeon as well as his views on how kidney transplant could be relauched in Mauriitus after hiatus of 4 years. Dr Davy Ip opened the evening with a quick review of the state of kidney disease and history of kidney transplantation in Mauritius.

The Renal Association was honoured by the attendance of the Honorable Dr Kailash Jagutpal, the Minister of Health and Wellness, and several senior officials from the ministry.

Lest we forget…

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2020 comes to an end and as we get ready to welcome the new year, it is time to look back at a most disruptive and tragic year. Time to have a special thought for those we have lost. Lest we forget.

For the local medical community, the most shocking and heartbreaking event was the passing away of Dr Bruno Cheong. Dr SBM Gaya, Consultant in Charge in Internal Medicine at JN Hospital and founding member of the Renal Association, has known Dr Cheong for a long time. Here is his tribute written in June of this year.

                                 
Dr Bruno Cheong  proceeded to study medicine at Cardiff University Wales following his secondary education at College du St Esprit. He subsequently specialized in internal and respiratory medicine and then came back to Mauritius. I still remember the day that we both joined the Ministry of Health in July 1989. We both started as medical and health officers and then followed the same pathway from specialist to consultant in charge . His last posting was consultant in charge internal medicine at Flacq Hospital.


Bruno was a very down to earth person, very devoted to his work and dedicated to his patients. He was a very jovial and friendly person and was very appreciated by his peers, all hospital staff and patients alike. We had many fruitful discussions pertaining to health issues in the public service during meetings of the consultants  in charge medicine. He had many bright ideas and he certainly contributed to the improvement of our health service over the years.


Bruno was also a very  good teacher and taught many undergraduate and postgraduate students . His junior doctors, MHOS and specialists must have learnt a lot from his vast experience. As a hobby, he enjoyed playing golf.


Sadly, Bruno was infected with Covid 19 while treating a patient with this disease and he passed away on 27 April 2020. He leaves behind his wife and 2 chidren. He will be missed by his family and all the staff of the Ministry of Health who have had the privilege of knowing him.


Thank you, Bruno, for all that you have done for the country. There is no better tribute and acknowledgement of your contribution to the medical profession than naming Flacq Hospital as the Dr Bruno Cheong Hospital.

May your soul rest in peace

We will also remember Dr Raj Purgus, a great Mauritian nephrology friend. You can read our tribute here.

Finally, we have some special words for Hussein A. Sheashaa, Professor of Internal Medicine (Nephrology), Urology and Nephrology Center, Mansoura University, Mansoura-Egypt. This indefatigable figure never stopped in his clinical, research and especially teaching activities. He organised and personally taught in innumerable tutorials, seminars, webinars and conferences. Four of the Renal Association members were invited by the Egyptian government to attend dialysis conferences in the last 6 years. Professor Sheashaa’s energy and enthusiasm for sharing knowledge (and getting photos taken) with a big smile was infectious. He was still doing a webinar the day before he passed away suddenly on the 30 October 2020. May he rest in peace.

The 40th Anniversary of the First Kidney Transplant in Mauritius

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Today is a very special day to commemorate. Forty years ago, on the 17th December, the first kidney transplant was performed in Mauritius.

There are many remarkable aspects to this story. The surgery was performed in the Clinique Mauricienne by Dr Mahen Modun, urologist and Dr Marcello Li Sung Sang, nephrologist, both recently back from training at Dublin’s National Renal Unit. Helped by the paramedical staff, the sequential donor nephrectomy and transplantation took 4 hours.

What a daring feat! Such procedures are usually done by two different surgical teams in hospital settings with full diagnostic and therapeutic backup. The blood samples for cross match had to be sent to South Africa and the immunosuppressive drugs brought from Ireland. Try to imagine the medical scene in Mauritius 40 years ago.

Le Cernéen, 19 December 1980

In 1980, advanced renal failure was a death sentence. Dialysis had not started in Mauritius then. What was the chain of events that allowed the desperate 20 year old man suffering from oedema, breathlessness and high urea to find these two doctors? What led to the patient, the donor (his 18 year old sister) and their family to believe in the surgical intervention?

Since 1992, some 350 transplants have been performed in Mauritian public hospitals. Foreign teams started the transplantation programme and local surgeons took over. Unfortunately, the local transplant surgeons retired four years ago and patients have since been sent abroad for transplantation by the Ministry of Health and Wellness. Behind the scenes, there are serious efforts to restart local kidney transplantation with up to date standards and techniques in the near future.

Le Mauricien, 19 December 1980

One last detail about this great anniversary. The most amazing of all. Both the transplant recipient, now 60 years old, and the donor, 58 years old, are alive and well with the transplant kidney still working every minute…

Mauritius and African Nephrology

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Mauritius may be some 2000 km away in the south-west Indian Ocean but Africa is the closest continent to our country. There are also important historical and cultural ties between Mauritius and Africa even though most Mauritians are descendants of immigrants from Asia.

The Renal Association is linking up with overseas nephrology societies. Building relationships with Africa is a priority. In addition to having a representative on the International Society of Nephrology (ISN) African Regional Board, the Renal Association is also joining the Africa Association of Nephrology (AFRAN).

It is therefore fitting to read this recent article in Kidney International – Nephrology in Africa: forgotten no more

Africa, home to 1.34 billion people distributed over 54 countries, has been called the cradle of humanity. Despite being endowed with immense natural and human resources as well as great cultural, ecological, and economic diversity, Africa remains the most underdeveloped of all continents. Africa’s share of global income has been dropping consistently, and African countries occupied 30 of the 32 lowest spots on the 2018 United Nations Human Development Index.

Africa has the youngest (median age, 18 years) and most rapidly growing (annual growth rate, 2.5%) population in the world. Infectious diseases and neonatal and/or maternal deaths are the major causes of death and disability. An overwhelming majority of global deaths attributable to tuberculosis, malaria, and HIV infections occur in Africa. At the same time, the burden of noncommunicable diseases, including kidney diseases, is also rising. According to the Global Burden of Disease Study, apart from a few countries in Central America and Southeast Asia, African countries have the highest age-standardized rates of disability-adjusted life years attributable to chronic kidney disease.

The above article starts with a paragraph with a tribute to the stalwarts of African nephrology that have unfortunately passed this year.

During a time when the world is grappling with the coronavirus disease 2019 pandemic, African nephrology suffered a major setback, with the passing of 3 of its stalwarts: Oladipo Akinkugke (Nigeria), Jacob Plange-Rhule (Ghana)—whose obituaries are featured in this issue—and Mohamed Abdullah (Kenya). These individuals bookend the period during which nephrology took roots in the continent. This editorial discusses the highlights of African nephrology during this development phase and recalls some of the individuals who made them possible.

To this list, we also have to regretfully add Dr. Anthony J.O. Were, President of the African Association of Nephrology (AFRAN), Head of @KNH_hospital Renal Unit, and Deputy Director of the East African Kidney Institute who passed away 3 weeks ago. We have missed an opportunity to collaborate with him.

The Renal Association is now affiliated with the ISN!

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This a great moment for Nephrology and for kidney patients in Mauritius. By joining up with the International Society of Nephrology (ISN), we hope to make Nephrology grow into a fully fledged specialty in our country. to the benefits of our patients. We can also now participate in the global effort in education, training and research spearheaded by the ISN against kidney disease.

The First Kidney Symposium

~ Dr K Fagoonee ~ Leave a comment

At long last, The Renal Association held The First Kidney Symposium on Sept 19 and 20, 2020 at Le Cannonier Hotel, Grand Baie. It was an event that was long overdue, and had been postponed several times due to the COVID 19 situation. But where there’s a will there’s a way, and with sheer perseveration from all members, unflinching support from various corporate partners, a great number of leading doctors of Mauritius flocked together for this symposium. We thank all those who made this event a successful one!

First Educational Meeting

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On Thursday 16 July 2020, the Renal Association had its first educational meeting ever. It should have occurred in early April but the Covid-19 lockdown put paid to that. Dr O Bheekharry presented “The Filter, the Pump and the Pill”, a review of the latest SGLT2 inhibitors trial.

It was an opportunity to invite 2 prospective members of the association Dr Guttee, Dr Purrunsing and Dr A Rughoobur Bheekhee. The latter was able to follow the presentation from 550km away in Rodrigues via a web link. Another innovation was the video recording of the presentation which hopefully will become the norm for our educational meetings.

You can access the abstract, the slides and the video of the talk here.

10 Causes of Chronic Kidney Disease (CKD)

~ Dr Davy Ip ~ Leave a comment

The causes of CKD are numerous. For each cause, there is much to write about. The following is a summary and should not be viewed as personalised advice.

1

In Mauritius, diabetes is by far the biggest cause with just over half of all cases of CKD. This is no surprise! A third of mauritian adults have diabetes or borderline diabetes ( ‘pre-diabetes’). Diabetes usually takes 10 years or more to damage the kidneys. Do note though many Mauritians discover they have diabetes many years after it started. Act now to reduce the risk of becoming diabetic and get regular tests for diabetes.

2

Hypertension is high blood pressure. A quarter of adults have it but only 60% are on treatment. Of those on tablets, 70% still have uncontrolled blood pressure readings. Hypertension take many years to damage kidneys but, in severe cases, only a few weeks suffice. As for diabetes, act now to reduce your risk of developing high blood pressure, get your blood pressure measured frequently and get treated if needed.

3

Vascular disease is fairly common and is the narrowing of arteries with cholesterol deposits (atheroma). Main risk factors include diabetes, hypertension, smoking, obesity, poor diet, lack of exercise and family factors. It shows up as heart attacks, strokes, poor leg circulation and CKD. Diabetes, hypertension and vascular disease are responsible for most of local CKD cases. Many Mauritians have more than one of these 3 conditions.

4

The remaining causes altogether are responsible for less of a quarter of CKD cases. Long term or repeated kidney infections can also damage kidneys. Such infection are more frequent and severe in diabetic patients. The worrying thing is that they occur with few symptoms.

5

Mauritius, like most hot countries, is likely to have 1 in 8 people affected with kidney stones. These can block the urine flow from one or both kidneys. The most dangerous of many types of stones is the staghorn calculus (really looks like ‘coray’). These grow very fast and harbour chronic kidney infections. To avoid getting kidney stones, drink enough water, cut down on salt and soft drinks and don’t become diabetic.

6

Gout causes severe pain in the joints especially the base of the big toe. High uric acid level in the blood leads to uric acid crystals forming in joints. In severe gout, these crystals also build up in the kidney tissue and in kidney stones. Gout therefore can cause CKD. For pain, many patients take anti-inflammatory painkillers (NSAIDS – see below) that can also harm the kidneys.

7

NSAIDS is short for non-steroidal anti-inflammatory drugs. Widely used for joint and muscle pains and headaches, they can be bought without a doctor’s prescription. They can precipitate kidney failure in people who already have CKD. Some people without any previous kidney disease, can develop CKD with long term use and, if allergic, just a few doses. NSAIDS are best avoided.

8

The immune system normally protects the body against viruses, bacteria and parasites. In glomerulonephritis, it also attacks the kidneys causing inflammation. Ankle swelling, hypertension, froth or blood in the urine are some of the possible features. There are many types of glomerulonephritis. It occurs at any age but it is the main cause of CKD in young adults.

9

Prostate enlargement occurs frequently in older men. The urine flow slows down with a wait to get started and dribbling at the end. Frequent urge to pass urine day and night occurs. When urine infection and retention occur in advanced cases, the kidneys get damaged too. In a minority of cases, prostate disease can be due to cancer.

10

Some children are born with small, misshapen or poorly draining kidneys due to abnormal development in the mother’s womb. People can also be born with genetic diseases. The commonest one is adult polycystic kidney disease. These developmental and genetic diseases are rare but are the main causes of CKD in children. However, they can manifest much later in life.

First Year Anniversary

~ Dr K Fagoonee ~ Leave a comment

Our team met on June 26th, 2020 to celebrate the First Year Anniversary of our long awaited Renal Association. It was a time of rejoicing for all members, especially as it gave us all a few moments of respite, in the post COVID 19 phase, when all members, being frontliners, had been working with no break for weeks on end.

It was also the perfect occasion to officially launch our website, which was created with much effort from the side of Dr Davy Ip. Such a website is not built in 1 day, and in due time with input from one and all, I am sure it will evolve into the place to be for doctors and the public at large, to get information about nephrology and renal services in Mauritius .