Browsing by Author "Bates, W. D."

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    HIV-associated nephropathy - an initial presentation in an HIV-positive patient
    (Health & Medical Publishing Group, 1994) Bates, W. D.; Muller, N.; Van de Wal, B. W.; Jacobs, J. C.
    The lesions of HIV-associated nephropathy occur in patients with AIDS, AIDS-related complex and in individuals clinically asymptomatic for HIV infection. We report on a 35-year-old black South African woman who presented with nephrotic syndrome and renal failure. The renal biopsy appearance suggested HIV infection and this was subsequently verified. This finding emphasises the possibility that otherwise asymptomatic patients presenting with renal disease may be HIV-positive.
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    Infective endocarditis - The effect of liposomes as carrier substance for α1-antitrypsin and amicillin
    (Health & Medical Publishing Group, 1991) Schaaf, H. Simon; Bates, W. D.; Hanekom, C.; Neiteler, B. F.; Kriegler, A. B.; Van der Merwe, P.-L.
    Infective endocarditis has a high mortality and morbidity rate despite all available treatment. Little attention has been paid to the possible role of polymorphonuclear leucocytes in damage to the heart valves. It was postulated that if the elastases set free from these leucocytes could be neutralised, this would prevent damage to the heart valves. Alpha1-antitrypsin (α1-AT) in liposomes was used to neutralise elastases. This process on its own and in various combinations with ampicillin were compared in animal models. Evaluation was performed by measuring vegetation size, by blood and vegetation cultures, and by light microscopy of the damaged tissue. A statistically significant difference (t-test; P < 0,005, with Bonferroni's correction for multiple comparisons) was found in vegetation size in the groups receiving ampicillin in liposomes, but the hypothesis that α1-AT might reduce valvular damage was not proven.
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    Lupus nephritis. Part I. Histopathological classification, activity and chronicity scores
    (Health & Medical Publishing Group, 1991) Bates, W. D.; Halland, A.-M.; Tribe, R. D.; Rossouw, D. J.
    Renal biopsy has made a major contribution to the understanding and management of patients with lupus nephritis. In a 5-year retrospective study the renal morphology of 55 biopsies from 51 patients with lupus nephritis was classified acccrding to World Health Organisation criteria. In addition, semi-quantitative activity and chronicity scores were documented. The findings were similar to series from other parts of the world. Of the biopsies reviewed, 6 were class II, 13 class III, 32 class IV and 4 class V. In situations of overlap, segmental proliferative features determined the class to which a biopsy specimen was assigned. Twenty-five of the patients, all WHO class IV, showed activity scores in the severe range. Most of the activity score features were common and easily recognised but necrotising angiitis was only seen in 1 patient. Haematoxylin bodies were difficult to document and the nature and value of the haematoxylin body is questioned.
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    Lupus nephritis. Part II. A clinicopathological correlation and study of outcome
    (Health & Medical Publishing Group, 1991) Halland, A.-M.; Bates, W. D.; Tribe, R. D.; Cooper, R.; Chalton, D.; Klemp, P.
    A 5-year retrospective study of lupus nephritis at Tygerberg Hospital was performed in an attempt to document the clinical and histological spectrum of the disease and to study the outcome of the illness. Activity and chronicity scores were used in addition to the World Health Organisation classification system. Of 55 biopsies from 51 patients reviewed, 6 were class II, 13 class III, 32 class IV and 4 class V. There were 19 deaths and in 15 of these the histological classification was IV. Renal failure and infections, often with uncommon pathogens, were the most important causes of death. Serum creatinine values and creatinine clearance at the time of biopsy or follow-up, and hypertension at follow-up showed a significant relationship with outcome. WHO class IV was associated with a poor outcome (P= 0,048) when compared with the other WHO classes combined. Activity scores showed a significant relationship to the outcome (P = 0,018). The anticardiolipin antibodies IgG and IgM were not associated with WHO class or outcome. The study revealed a spectrum of histological results similar to that of other studies, with a high mortality rate, particularly in class IV disease. Poor renal function, persistent hypertension, histological classification IV, and high activity scores were found to be important prognostic indicators.
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    Nephrotic syndrome in Namibian children
    (Health & Medical Publishing Group, 1999) Van Buuren, A. J.; Bates, W. D.; Muller, N.
    Background and objectives. Patterns of nephrotic syndrome vary between regions and countries, and influence approaches to management. In the mid-1970s the University of Stellenbosch became involved in providing tertiary care to Namibia, including a paediatric nephrology service. The aim of this study was to document the clinical, pathological and outcome features of nephrotic syndrome in Namibian children. Subjects. Seventy black Namibian children with nephrotic syndrome were managed from 1975 to 1988. Sixty-eight renal specimens (67 biopsies and 1 autopsy specimen) were evaluated. Results. Twenty-nine of the 70 children (41.4%) were hepatitis B virus (HBV) carriers, of whom 25 (86.2%) were male. Of the 29, 26 had predominantly membranous glomerulonephritis (MGN), 1 mesangiocapillary glomerulonephritis (MCGN), and 1 focal segmental glomerulosclerosis (FSGS); 1 child in advanced renal failure was not biopsied. Five children (7.4%) showed minimal change disease (MCD), 11 (16.2%) FSGS and 15 (22.1%) diffuse mesangial proliferative glomerulonephritis (DMP). The remaining 10 children showed diffuse glomerulosclerosis (6), MCGN (3) and endocapillary proliferative GN (1). Four of the 5 children with MCD went into remission on immunosuppressive treatment. Of the 15 with DMF, 4 improved spontaneously and only 1 of those treated did not improve. Only 2 of those with FSGS improved on treatment. The children with HBV-associated MGN and MCGN were offered symptomatic rather than specific treatment. Thirteen children presented with degrees of chronic renal failure. Eight are known to have died, 3 of relentless nephrotic syndrome and 4 (of whom 3 were HBV carriers) of end-stage renal failure. One child died of penicillin anaphylaxis. Conclusions. The pattern of nephrotic syndrome in black Namibian children differed greatly from the non-African pattern elsewhere in that MCD was uncommon and HBV-associated GN was the most common single group. The most frequent pattern of HBV-associated GN was MGN with some mesangiocapillary features showing marked male predominance. MCD and DMP were potentially treatable and could only be identified by biopsy. HBV carrier rates exert a major influence on the proportions of morphological subgroups of nephrotic syndrome in children. As these HBV carrier rates alter in future due to the influence of vaccination and urbanisation, the relative size of nephrotic subgroups seems likely to alter.