British Journal of Renal Medicine - 2002

Comment: Fit for a king
John Bradley
pp 4-4
Herod killed by kidney disease … The story concerning the demise of Herod the Great (circa 74–73 BC) broke not at the time of his death, but in AD 2002. Although concerns over delays in the delivery of healthcare are currently widespread, no criticism was made of the fact that it took over 2000 years to reach this diagnosis.
The control of calcium and phosphate in renal failure
Paul Altmann
pp 6-9
The management of calcium, phosphate and parathyroid hormone disorders requires a clear understanding of the underlying disease mechanisms, as reviewed in part I of this article (British Journal of Renal Medicine, Winter 2001). The benefits of very careful calcium and phosphate management are not only the avoidance of renal bone disease but, more importantly, the reduction of a major cardiovascular risk factor in chronic renal failure. Parathyroidectomy may be necessary if the approaches outlined below fail.
Evaluating renal function
Sue Carr
pp 10-12
The incidence of end-stage renal disease (ESRD) and acceptance onto dialysis programmes continues to increase in a linear fashion. It is recognised that early identification and appropriate nephrology referral provides an important opportunity to delay the progression of renal impairment1 and to address cardiovascular risk factors. The incidence of ESRD is especially high in the elderly, certain ethnic groups and in patients with diabetes.
What I tell my patients about a kidney biopsy
Liz Taylor, Iain Wittwer and Christopher G Winearls
pp 13-14
A kidney, or renal, biopsy is a minor but very important procedure to take a sample of kidney tissue, about the size of half a matchstick, which can be examined under the microscope by a specialist pathologist. This procedure will be outlined over the next four pages: the first two pages examine how and why a biopsy is carried out in adults and the second two pages look at the approach taken with children.
What I tell my patients about a kidney biopsy in children
Alan R Watson
pp 15-16
We can obtain much of the information about how the kidneys are working by examining your child for signs such as water in the tissues (oedema) and measuring their blood pressure (high blood pressure is called hypertension). Examination of the urine using a dipstick and microscope will also tell us whether there are blood cells, protein or white cells present. This information is combined with the results from blood tests to tell us how well the kidneys are working and possibly how severe the inflammation is in the kidneys.
Membranous nephropathy
Peter Mathieson
pp 17-19
Membranous nephropathy (MN) is an important cause of the nephrotic syndrome, especially in adults, and accounts for at least a third of cases attributed to glomerulonephritis. It is also a significant cause of end-stage renal disease (ESRD). In Australia and New Zealand, where registry information has been available for many years, glomerular disease has accounted for over 30% of patients requiring renal replacement therapy and MN is one of the common morphological types. MN is diagnosed by renal biopsy and the appearances are the same regardless of whether the condition is considered to be primary, or secondary to a known underlying cause.
Health-related quality of life in elderly people on dialysis
Donna L Lamping
pp 21-24
The demand for renal replacement therapy for elderly people is increasing, both in the UK and worldwide. This is as a result of population aging, the liberalisation of acceptance criteria for dialysis, and the age-related increase in the incidence of chronic renal failure. Given limited healthcare resources and the pressure to contain costs, dialysis – both in general and in elderly people in particular – has become a frequent target in the more general debate about the rationing of healthcare by age.
The advent of advanced nursing in renal medicine
Jonathan Casey
pp 25-27
Renal nursing presents many challenges for nurses seeking to work at advanced level. The ever-changing political climate and increasing service demands make it vital for nurses to grasp the opportunities that advanced practice offers. Theorists have suggested that the overspecialisation of nursing could lead to a fragmented service and undervalue the status of the registered nurse. In September 1999, two advanced nurse practitioners were appointed within our renal unit. A review of the first 12 months of this advanced nurse practitioner service suggests that the role of the ANP has a lot to offer in a renal setting.

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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