British Journal of Renal Medicine - 2007

Comment: A new paradigm for chronic renal failure
Dominic de Takats
pp 3-3
When estimated glomerular filtration rate (eGFR) was introduced across the UK last year, we gained more than just a formula for transforming serum creatinine into a best guess GFR: it heralded a new paradigm for managing chronic renal failure – and with it, the name chronic kidney disease (CKD).
Renal biopsy criteria and the apparent prevalence of IgA nephropathy
Clive L Hall, Phillip J Rushton, Robin K Fackrell, Rachael J Bradley and Daniel S Peat
pp 4-6
IgA nephropathy (IgAN) is the most common type of glomerulonephritis (GN) worldwide and a major cause of end-stage renal failure (ESRF), accounting for up to 44% of all biopsyconfirmed ESRF due to primary GN. Current reviews indicate that the prevalence of IgAN as a percentage of biopsy-proven GN is some 30–40% in Japan and south-east Asia and 23–35% in Australia, northern Europe and southern Europe. The same reviews indicate that the prevalence of IgAN is lower in the UK, Canada and the USA, at 4–20% of all primary GN.
The 'expert' renal patient: a CKD support programme
Jean Jenkins, Ann Jones, Nerys Thomas and Alison Prichard
pp 7-8
This article outlines how an ‘expert patient’ programme can be implemented and evaluated as part of a multidisciplinary approach to education in chronic kidney disease (CKD).
Screening for malnutrition in HD patients – are objective measures effective?
George H Hartley
pp 9-11
Malnutrition occurs where there is a mismatch between nutritional requirements and nutrient provision. The term can be used for both over and under-nutrition, but for the purposes of this article it is used to refer to protein-energy malnutrition (PEM). Screening is taken to mean the systematic review of patients’ nutrition, with the aim of identifying those individuals who are malnourished, or who are likely to become so.
Retroperitoneal fibrosis: a retrospective case series
Sathish Kallankara and Sunil Bhandari
pp 12-14
Retroperitoneal fibrosis (RPF), first described by the French urologist Albarran in 1905, did not become a clinical entity until Ormond published two cases in 1948.1 It is an uncommon disease, characterised by fibrosis and chronic inflammation of the retroperitoneal area, which is defined as the region bounded anteriorly by the posterior peritoneum, posteriorly by the transversalis fascia, superiorly by the diaphragm and extending down to the pelvic brim. Chronic fibrosis in this area may thus result in compression or obstruction of the pelvicalyceal systems, ureters, neurovascular bundles and lymphatic circulation.
What I tell my patients about renal diets
Debbie Sutton
pp 15-18
What do patients need to know about food and diet when they are progressing through the various stages of renal failure? Asking people to change the eating habits of a lifetime is far from easy. It is hard to learn new behaviour and habits around food, especially when food plays such an integral role in our social and family life and one cannot ‘give up’ eating in the same way as one can potentially give up smoking or alcohol.
Double-filtration plasmapheresis: what the nephrologist needs to know
Muhammad Imran and Matthew Howse
pp 19-22
Plasmapheresis is a well-established treatment for a number of immune-mediated and other medical disorders. There are a number of proposed mechanisms for its action; for example, removal of the culprit antibody, replacement of a missing factor or removal of inflammatory cytokines. The kidneys are involved in many of these autoimmune disorders. Traditionally, centrifugation or single-filter methods of plasma exchange (PE) are used in most renal units. These involve separation of plasma from the cellular components of blood and replacement of the plasma with an equal volume of albumin or fresh frozen plasma (FFP).
New developments in phosphate control
Rosemary L Donne and Alastair J Hutchison
pp 23-25
Hyperphosphataemia remains a difficult problem for patients with renal failure despite advances in drug and dialysis therapies. It is now recognised to have far-reaching consequences for patient morbidity and recent clinical studies have isolated it as an independent risk factor for mortality. In addition, the treatment of hyperphosphataemia often leads to new problems of calcium imbalance, vascular calcification and increased pill burden.
Renal transport - recommendations for a patient-centred service
Jennifer A Scott
pp 26-27
Transport is a fundamental part of the care a renal patient receives, but it is frequently not developed in synergy with the clinical aspects of care. Years of separate planning and service delivery have resulted in disconnected commissioning, often with little focused emphasis on quality and cost-effectiveness. The Department of Health (DH) wanted to address transport issues as part of the implementation of the National Service Framework (NSF) for Renal Services and established two action learning sets, in Cheshire and Merseyside and County Durham and Tees Valley, to take this work forward and to make recommendations which could be considered at a national level.
Effect of co-morbidity on arteriovenous fistula outcome
Baldwin Yeung, Robert Mactier, Paul Leiberman, Douglas Gilmour, Douglas Orr and Paul Teenan
pp 28-31
A native arteriovenous (AV) fistula is the preferred form of vascular access in the great majority of haemodialysis (HD) patients as it produces higher blood flow rates than central venous catheters, minimises sepsis and has the greatest longevity. Increasing the use of fistulas instead of central venous catheters for vascular access would reduce the high rates of hospital-acquired infections observed in renal units and improve HD patient survival rates. Rayner et al highlighted the predicted increase in life expectancy of UK HD patients who have had a fistula. However, the Dialysis Outcomes and Practice Patterns Study (DOPPS) shows that only 67% of prevalent patients in the UK have functioning fistulas, compared with the European average of 80%.

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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