British Journal of Renal Medicine - 2001

Comment: A Spanish lesson
John Bradley
pp 4-4
As the new External Reference Group embarks on its task of preparing the Renal National Service Framework (NSF), one of the four key areas it will be considering is effective delivery of transplantation. Increasing the number of kidney transplants is an area in which the Department of Health (DoH) is determined to see progress.
Calcium and phosphate in renal failure: the disease
Paul Altmann
pp 6-9
Early in the development of dialysis as a successful form of renal replacement therapy, the management of calcium and phosphate metabolism was focused on the prevention of renal osteodystrophy (ROD). Back then, this was a condition which could even lead to multiple ‘atraumatic’ rib fractures, flail chest and respiratory failure. Nephrologists have since become better at preventing severe ROD, but patients are still affected by it. Recently, attention has turned to the fatal potential of poor calcium and phosphate control.
The social needs of patients with renal failure
Richard R Dingwall
pp 10-11
In the early days following diagnosis, most patients go through a period of shock, followed by denial. There may be some guilt, anger and depression before they accept that life will never be quite the same again and that they will have to adjust to it. There is nothing unusual about this; these are all the classic signs of somebody coping with a form of loss. There is evidence to show that if patients are given some preparation for an impending change in their circumstances they will cope better in both the short and the long term.
What I tell my patients about membranous nephropathy
Michael Boulton-Jones
pp 13-16
Membranous nephropathy is quite rare among the general population but is one of the more common glomerular diseases seen in Britain. The glomeruli are the filtering units of the kidney and there are around one million in each kidney. They are carefully constructed so that the larger proteins in the blood, such as albumin, do not cross the filtering membrane of the glomerulus. The presence of albumin in the urine is a clear signal of glomerular disease. It is present in every patient with membranous nephropathy and the process affects all glomeruli in both kidneys.
Renal transplantation from non-heartbeating donors
David Talbot
pp 17-19
The shortage of normal kidney donors has prompted some transplantation units to develop non-heartbeating donor programmes. Unstable donors can only be used in centres which have experience in identifying which kidneys are viable for transplantation. The outcomes of patients receiving such kidneys are very similar to those of patients receiving kidneys from ordinary heartbeating donors. Live donors were used when the first successful renal transplants were performed in the 1950s. With improvements in immunosuppression, allografts between non-related combinations became possible. This meant that cadaveric donors could be used.
Hepatitis B vaccination in dialysis patients
Peter Gower
pp 20-21
In 1997, a survey of British renal units showed that the prevalence of hepatitis B was 0.35% among patients on haemodialysis, 0.54% in patients on peritoneal dialysis and 0.2% in patients with a functioning transplant. The perception that the risk of acquiring hepatitis B is low in Britain has contributed to the low vaccination rate against hepatitis B. Only 13% of haemodialysis patients are vaccinated, contrary to the advice given by the Department of Health.
Anaemia, chronic kidney disease and the cardiovascular system
Robert N Foley
pp 22-24
Progressive renal failure is a paradigmatic state of haemodynamic overload. Hypertension and anaemia are the most easily indentifiable, quantifiable and treatable overload parameters. National and international guidelines suggest that patients’ haemoglobin levels should be maintained above 10 or 11 g/dl. When considering survival, epidemiological studies have suggested that there is some benefit gained by achieving a level above 12 g/dl, although there is as yet no firm positive or negative evidence from controlled trials to guide our therapy.
The predialysis nurse’s role in the transition from chronic to end-stage renal disease
Sarah A Woolley
pp 25-26
Despite huge advances in medicine, end-stage renal disease (ESRD) is still inevitable for all dialysis patients. Treatment for ESRD has become more readily available to a wider population than ever before. The transition from chronic renal failure (CRF) to ESRD is often difficult and complex. Careful assessment needs to be made of the patient’s medical, social and psychological state. Preparation for dialysis in patients with CRF has changed significantly in recent years. The focus has widened to encompass areas of care which stretch beyond direct medical intervention. Multidisciplinary care and an emphasis on patient education are now encouraged.

The British Journal of Renal Medicine was previously supported by Baxter Healthcare from 2011 to 2013, by Sandoz in 2011, by Shire Pharmaceuticals from 2006 to 2011, by Ortho Biotech and Shire Pharmaceuticals in 2005, by Ortho Biotech from 2000 to 2005 and by Janssen Cilag from 1996 to 2000.

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