Background: This paper reports a retrospective audit of new patients referred to the Renal Unit at Universitas Academic Hospital in Bloemfontein, South Africa for the decade 1997-2006.
Methods: All the files kept in the Renal Unit were reviewed for the main clinical presentation, a definitive pathological diagnosis (if obtained), age, race and gender of the patients. No consultations from other disciplines were included.
Results: One thousand two hundred and sixteen patients were included in the study. The main clinical presentations were as follows: chronic renal failure (CRF), 461 (37.9%); nephrotic syndrome, 203 (16.7%); hypertension, 161 (13.2%); and abnormal urinary findings, 128 (10.5%). The nephrotic syndrome was the most common indication for renal biopsy, and histological investigation revealed focal segmental glomerulosclerosis in 46 (3.8%) patients, minimal change in 23 (1.9%), membranoproliferative disease in 36 (3.0%) and membranous glomerular disease (MN) in 28 (2.3%). In CRF, hypertension was suspected in 236/461 (51.2%) cases but was proven histologically in only 13 (2.8%) patients.
Conclusions: Socio-political factors impacting on access to healthcare most likely had an influence on the referral pattern of patients during this period. The largest group of patients were referred to our institution late in their disease with CRF, often requiring renal replacement therapy, and a definitive diagnosis was seldom possible at that stage. With the limited availability of dialysis facilities, the need for early detection and preventative measures with regard to renal disease in this community is evident.