British Journal of Renal Medicine - 2020

Bed occupancy in the NHS normally runs at around 90%. Between April and June 2019 the daily average number of overnight beds available in England was 128,621, of which 101,762 were in the acute and general sector (NHS Digital, 2020). Of these acute and general beds 90.1% were occupied.

As the COVID-19 pandemic affects healthcare delivery worldwide, nephrologists and their patients face difficult decisions regarding the management options for glomerular diseases. Dexamethasone has been shown to reduce mortality in individuals with severe COVID-19 infection, however the impact of immunosuppression in mild or asymptomatic cases is unknown. Indeed, high-dose steroids and immunosuppression are thought to be associated with poorer prognosis and prolonged viral shedding . These issues pose a significant challenge for managing patients with kidney disease and coinfection with COVID-19. How may we handle the immunosuppression appropriately, balancing the risk-benefit considerations in the current climate? And how may our practice be altered to minimise the risks to a renal patient with COVID co-infection, in the face of the little knowledge we have of this disease?

At the British Transplant Society’s Annual Congress, held at the ICC Belfast 4 – 6 March 2020, clinicians heard presentations on topics regarding challenges in equity of access in kidney allocation systems, particularly for highly sensitised patients.

The delivery of healthcare has been dramatically altered since the advent of coronavirus disease (COVID-19), the recently discovered contagious disease caused by severe acute respiratory syndrome (SARS) coronavirus (CoV)-2. The rapidly spreading outbreak, declared a global pandemic, primarily manifests as an acute respiratory illness with interstitial and alveolar pneumonia, but can affect multiple organs including kidney, heart, digestive tract, blood and nervous system.

Regenerative medicine typically implants cells to directly replace damaged tissues or to indirectly enhance the tendency of our organs to repair themselves. This cell transfer approach can be complemented with tissue engineering where implanted scaffolds provide physical and molecular cues to enhance healing. Moreover, stem cell technology promises to provide unlimited numbers of cells for regenerative medicine therapies. As recently reviewed, researchers are beginning to explore this exciting yet still unfamiliar field with respect to kidney disease.

De novo thrombotic microangiopathy (TMA) is a rare but serious complication of renal transplantation, which can result in poor patient and graft outcomes. Microangiopathic haemolytic anaemia occurs in the setting of endothelial injury and dysfunction, which in turn can result from a variety of causes. Most cases of de novo TMA after transplantation are usually related to Calcineurin inhibitor (CNI), mammalian target of rapamycin inhibitors (mTOR I), or antibody mediated rejection. Cases of complement induced atypical haemolytic uremic syndrome have also been described. Here we describe a case of de novo TMA post transplantation caused by peri and post-operative severe allograft ischaemia reperfusion injury. We highlight how finding and establishing the chronological sequence of events leading up to the onset of symptoms helped in arriving at an etiologic diagnosis.

Frailty is a state of health where seemingly minor insults can result in a dramatic decline in physical or mental wellbeing. Incidence of frailty increases as the glomerular filtration rate (GFR) decreases and prevalence of frailty in patients with end stage renal disease (ESRD) is high irrespective of age.1 In the ESRD population frailty is associated with early mortality, increased hospitalisations, and significant symptom burden. Despite this it is not routinely measured. A recent study identified that clinicians rely on instinct to identify frailty and acknowledge uncertainty determining frailty status in the absence of clear tools.

Young adults with chronic renal disease face the rigours of adolescence alongside the responsibility of safeguarding their own health. They have poorer renal transplant outcomes than other age groups presumed due to non-adherence with medication and clinic attendance. We had set up a Young Adult Service and aimed to understand whether this had reduced distress in young adults and impacted positively on renal transplant survival.

The great Vince Lombardi, the legendary head coach of the Green Bay Packers during the 1960s, said: “Individual commitment to a group effort – that is what makes a team work, a company work, a society work, a civilisation work”, and people often say “There is no I in team”, attributing the saying to management gurus such as Peter Drucker or sports personalities like Michael Jordan. Somebody at the back of the room usually pipes up with – “But there is a me in team!”.