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Tackling kidney disease in children across Africa
02 April 2025 | Story Myolisi Gophe. Photos Nasief Manie. Voice Cwenga Koyana. Read time 7 min.
Kidney disease remains a major global health challenge, affecting millions of children globally, particularly in low-resource settings where access to treatment is limited – but there is hope.
In her inaugural lecture, titled “First aid for kids’ kidneys in Africa and beyond”, Professor Mignon McCulloch said addressing kidney disease requires a multifaceted approach, incorporating early detection, accessible treatment options, skilled healthcare workers, and supportive policies. “Only through global collaboration can we ensure that no patient is left behind,” she said.
She had evidence aplenty to back her lecture held on 27 March.
Professor McCulloch is the head of the Clinical Unit of Paediatric Nephrology and Solid Organ Transplantation at the Red Cross War Memorial Children’s Hospital (RCWMCH), and a senior lecturer at the University of Cape Town (UCT).Her presentation focused on using alternative forms of dialysis – a medical treatment that helps remove excess fluid and waste products from the blood when the kidneys can no longer perform these functions – that do not rely on sophisticated technology.
“For many patients the lack of infrastructure means kidney failure is effectively a death sentence.”
Her work over the years demonstrates that African solutions for African problems exist, and with good results that can be applied elsewhere in the world, through providing any child in need with dialysis as well as the opportunity to receive such treatment.
According to McCulloch, chronic kidney disease (CKD) affects approximately 10% of the global population, yet many individuals remain undiagnosed until the disease has progressed to a critical stage. Risk factors such as diabetes, hypertension, and genetic predisposition contribute significantly to CKD. “We must prioritise early detection through routine screenings. Simple blood pressure checks, and urine tests can identify CKD before it reaches a life-threatening stage.”
Challenges in treatment access
A key theme of the lecture was the disparity in access to life-saving treatments like dialysis and kidney transplantation. “In high-income countries, patients with kidney failure have access to advanced medical care. However, in many low-resource settings, dialysis remains an unattainable luxury. I remember a young mother in rural Africa who was diagnosed with end-stage renal disease. Without access to dialysis, her prognosis was grim. Her only option was to travel hundreds of miles to the nearest hospital – a journey she could barely afford.”
The high costs associated with haemodialysis machines, water purification systems, and trained medical staff create barriers to care. “For many patients the lack of infrastructure means kidney failure is effectively a death sentence.”
One of the promising solutions highlighted in the talk is peritoneal dialysis (PD), which can be performed at home with minimal equipment. “PD offers a cost-effective and accessible alternative to traditional haemodialysis. It does not require large dialysis centres or continuous electricity, making it ideal for rural settings,” she explained.
However, McCulloch acknowledges that PD also comes with challenges. “Sterile conditions are critical to prevent infections. Our goal is to train local healthcare workers and patients in safe PD techniques to expand its use in underprivileged areas.”
The role of medical training and collaboration
McCulloch, the immediate past president of the South African Transplant Society and a former president of the International Paediatric Transplant Association, stressed the importance of education and training. “We cannot address this crisis without investing in the training of nephrologists, nurses, and technicians. By empowering local healthcare professionals, we build sustainable solutions.”
One initiative she discussed involves partnerships between universities and hospitals in high-income and low-income countries. “Through mentorship programmes and virtual training platforms, we are equipping healthcare workers with the knowledge to diagnose and manage kidney disease more effectively.”
McCulloch also spoke about her findings from “Lessons learned from a regional training programme”, which details the experiences of children’s kidney specialists trained at RCWMCH/UCT and their subsequent return to their home institutions across Africa. With a return rate of 100%, these specialists have evidently been deeply moved by their experiences and inspired to contribute to their communities and be a part of shaping their nations’ future. They are often the first such doctors in their countries to do the pioneering work of children’s kidney care.
“We have seen in Ghana over 100 young doctors and nurses support community dialysis as part of the health system. We have saved 500 patients with a 65% survival rate.”
The results of their efforts are remarkable: “We’ve put together some international guidelines ... both for adults and children. We’ve run the ‘saving young lives’ course, not just in one day but for five days. We have seen in Ghana over 100 young doctors and nurses support community dialysis as part of the health system. We have saved 500 patients with a 65% survival rate.”
Pointing to the map which shows their work extends to various regions, including South America, Southeast Asia, and Fiji, where there were no paediatric kidney centres. “You can see how far our reach has extended. We’ve literally gone all over the world. We taught them how to do dialysis under water conditions, and now they are meeting patient needs independently.”
Innovative solutions and resilience
McCulloch shared inspiring stories of resilience and innovation in dialysis treatment. “During a severe water crisis, many hospitals in Cape Town had to ration dialysis sessions. Instead of giving up, doctors and engineers at RCWMCH devised a water recycling system by sinking a borehole to sustain treatment.”
Her talk emphasised innovation in paediatric dialysis, particularly when traditional supplies are unavailable: “These companies have stopped making children’s catheters worldwide ... so we had to think of alternative solutions.” She recounted improvising with adult catheters for small children, stating, “It works just as well as the PD catheter.”
Discussing the role of technology in expanding access, McCulloch noted: “Telemedicine has allowed us to monitor kidney patients remotely, providing them with expert advice without requiring costly travel. This is a game-changer.”
Advocacy and policy changes
McCulloch concluded her talk with a call to action for policy makers and the global community, stressing the need for public awareness campaigns. “Kidney disease must become a public health priority. Governments must invest in preventive care, subsidise dialysis treatments, and promote organ donation. Many people do not realise that simple lifestyle changes, such as reducing salt intake, staying hydrated, and controlling blood pressure can significantly lower the risk of CKD.”
She strongly believes in teamwork, and expressed gratitude for her support system, from family members to the hundreds of young patients and their families as well as colleagues and collaborators around the world. “I’m grateful to everyone who has my back as we are trying to build something long-term, and it’s amazing what we can achieve together.”
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The UCT Inaugural Lecture Series
Inaugural lectures are a central part of university academic life. These events are held to commemorate the inaugural lecturer’s appointment to full professorship. They provide a platform for the academic to present the body of research that they have been focusing on during their career, while also giving UCT the opportunity to showcase its academics and share its research with members of the wider university community and the general public in an accessible way.
In April 2023, Interim Vice-Chancellor Emeritus Professor Daya Reddy announced that the Vice-Chancellor’s Inaugural Lecture Series would be held in abeyance in the coming months, to accommodate a resumption of inaugural lectures under a reconfigured UCT Inaugural Lecture Series – where the UCT extended executive has resolved that for the foreseeable future, all inaugural lectures will be resumed at faculty level.
Recent executive communications
2025
2024
Professor Susan Cleary delivered her inaugural lecture on 14 March.
14 Mar 2024 - 5 min read
2023
Prof Lydia Cairncross’s inaugural lecture provided a snapshot of the career path of a surgeon and community activist whose commitment to social justice means her work doesn’t end in the operating theatre.
02 Nov 2023 - 8 min read
2022
Professor Linda Ronnie is in UCT’s Faculty of Commerce.
28 Sep 2022 - 6 min read
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2021
2020
2019
2018
2017
2016 and 2015
No inaugural lectures took place during 2015 and 2016.