Comment: Moving on up – preparing for adult healthcare
John Bradley
pp 59-59
Precision medicine aims to combine both individual and population-based data to understand a patient's disease more precisely, and so select treatments with more predictable, safer and cost-effective outcomes. Genomic medicine provides an important platform and exemplar for the development of treatments that are both personalised and precise, but in this issue of the British Journal of Renal Medicine, Donal O’Donoghue makes it clear that personalised medicine needs to be applied to all aspects of healthcare (see page 80).
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An innovative model for young adult renal care
Constantina Chrysochou, James Ritchie, Julie Gorton, Kathryn Lloyd-Williams, Lisa Hobson & Samuel Armstrong
pp 60-63
Transition from paediatric to adult services is a challenging time for young adults. While there is increasing appreciation for the benefit of dedicated clinics and young people-friendly criteria, this ‘heightened profile is yet to translate into action across many hospitals in the UK’, where service development to address young people’s specific developmental and health needs has lagged behind. Many young people still feel disengaged from the system and outcomes for this group remain sub-optimal.
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Development of nephrogenic systemic fibrosis in a patient with chronic kidney disease
Angel I Martin, Elizabeth J Haynes, Leah Clark, Claude Bassil
pp 66-68
Nephrogenic systemic fibrosis (NSF), formerly known as nephrogenic fibrosing dermopathy, is characterised by fibrosis of the skin as well as – in its more severe form – internal organs such as the lungs, heart and kidneys. Nor- mally, thickening and hardening of the skin occurs in the extremities and, in some cases, the trunk. Although the pathogenesis of NSF is not fully understood, it has been linked with exposure to gadolinium-containing contrast agents. Almost all known cases of NSF following gadolin ium exposure have been reported in patients on dialysis or with advanced chronic kidney disease, whose estimated glomerular filtration rate (eGFR) is <30 ml/min/1.73m2. Rare cases of NSF have also been reported in patients with an eGFR of 30–60 ml/min/1.73m2, and, even more rarely, an eGFR of >60 ml/min/1.73m2. Gadolinium can also be found in tissue samples of these patients.
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British Renal Society
Maarten Taal
pp 68-68
In my first column as president of the British Renal Society (BRS) I would like to start by thanking Dr Simon Ball for his superb leadership as president over the past three years. Simon has ably led the BRS through three very successful conferences – two in conjunction with the Renal Association (RA) – as well as the important transition of the secretariat to Executive Business Support. In addition, he has strengthened the leadership by expanding the number of vice presidents, which has allowed the BRS to increase its contribution to important projects like the Kidney Quality Improvement Partnership and the National Renal Research Strategy. The leadership will soon be expanded further by the appointment of four deputy vice presidents, so there will be ample opportunity for more people to make an active contribution to the BRS. Simon can look back on three very successful years that have left the BRS in robust health. I am delighted that he will remain on the BRS Council as immediate past president so that the BRS can continue to benefit from his many talents and wisdom.
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A new option for the treatment of hepatitis C in patients with chronic kidney disease
Andrew Tran
pp 70-71
Hepatitis C virus (HCV) is one of the most common blood-borne infections globally and in the UK it is estimated that 214,000 individuals are chronically infected. HCV is classified into six genotypes, with genotypes 1 and 3 ac- counting for approximately 90% of infections in the UK. Patients with HCV infection face a higher risk of developing hepatic complications, such as cirrhosis, hepatocellular carcinoma and extra-hepatic complications, such as glomerulonephritis.
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NKF: So, now we know – Britain is to leave the EU
Timothy F Statham
pp 72-72
Whatever view you take about Brexit, there can be no denying that, for renal patients it creates more uncertainty about their future and the treatment they can expect to receive. Who is brave enough to predict whether this will mean more or less money for the NHS? Who can say whether the All Party Parliamentary Kidney Group (APPKG), which represents kidney patients in parliament, will emerge from the meltdown of the main political parties strengthened or weakened. Which of the members voted to remain and which voted to leave, which MPs will become Ministers and leave the APPKG, and which MPs will form breakaway political groupings? Will there be another general election, meaning that the APPKG has to be rebuilt again?
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Association of elevated N-terminal pro-B-type natriuretic peptide with chronic kidney disease severity
Jamal Golbahar, Helen Melville, Louise Messinger, Timothy Watts, John O'Connor
pp 75-78
Elevated levels of N-terminal pro–B-type natriuretic peptide (NT-proBNP) are associated with heart failure, major cardiovascular events and mortality. Since their discovery in the last two decades, brain natriuretic peptides (BNPs) have emerged as important biomarkers with an established role in the diagnosis of heart failure. Natriuretic peptides are synthesised by cardiomyocytes and secreted in the heart muscle in response to increased tension or stretching. These peptides are synthesised as pre-proBNP, which splits to form a signal peptide and NT-proBNP. The physiological functions of these natriuretic peptides include natriuresis, vasodilation, inhibition of the renin–angiotensin system and adrenergic activity. NT-proBNP levels have been reported to be elevated in patients with reduced kidney function resulting from multiple physiologic stresses, including extracellular volume expansion and reduced renal clearance. To date, most studies have primarily focused on the association between NT-proBNP and cardiovascular disease, particularly heart failure. However, kidney outcomes are also important in management of high-risk patients because decreased kidney function is a well-established risk factor for cardiovascular disease and mortality.
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The Renal Association
Donal J Donoghue
pp 79-79
The Renal Association (RA) is delighted to have this opportunity to contribute to the British Journal of Renal Medicine, and we hope you will find these regular updates on RA activity useful. Having succeeded Bruce Hendry as President, I am continuing efforts to improve the RA’s communication with the whole renal community. The renal national clinical director post was scrapped this year, so we must all work together to ensure renal issues retain a high national profile. In this update, however, I want to highlight progress with two innovations that put patients at the centre of care planning and research.
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Precision or personalised medicine?
Donal J O’Donoghue
pp 80-80
The short answer is that this is the wrong question – it's not either or, it’s both. The longer answer is that everybody should always have personalised care, which is shaped by patients’ personal preferences and values, and addresses their particular needs. Precision medicine, operating within that holistic care paradigm, should also be the cornerstone of the care plan, when possible.
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Acute kidney injury: the business of risk
Miles D Witham, Helen Hobbs, Christopher K Farmer, Lui G Forni & Andrew J P Lewington.
pp 81-85
Acute kidney injury (AKI) is a medical emergency that commonly occurs in primary and secondary care. The National Confidential Enquiry into Perioperative Deaths report found that AKI was avoidable in 30% of patients who died from AKI in hospitals. The cost of caring for patients with AKI has been estimated to be £1.02 billion in England. NHS England has prioritised AKI as an area for quality improvement and has positioned AKI in the Patient Safety workstream, establishing the Think Kidneys AKI Programme.
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Supporting careers in kidney research
Kidney Research UK
pp 85-85
At the start of the new academic year, the Kidney Research UK fellowship grants round opens for researchers from across the UK to apply for funding. A variety of awards are on offer, designed to support clinical and non-clinical researchers at different career stages.
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Resources: Care for young adult kidney patients
Fiona Loud
pp 86-86
At this year’s UK Kidney Week conference, the British Kidney Patient Association held a session on caring for young adult kidney patients, reflecting our support in this area since the day we were founded some 40 years ago by Elizabeth Ward, mother of young kidney patient Timbo Ward. In the past year alone, the charity has invested over £800,000 in projects and staff to address the extra challenges of kidney disease for young patients and their families. Posts funded include dietetic and young adult support workers, with the long-term aim of encouraging trusts to fund these posts themselves as core staffing.
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