British Journal of Renal Medicine - 2007

Comment: Education, education, education
John Bradley
pp 3-3
The Medical Training Application System (MTAS) is currently unavailable and the specific placements of doctors training in renal medicine was uncertain (in many cases) just a fortnight before their scheduled start date. Alison Brown notes that the number of applicants for national training courses has been falling recently; some deaneries had fewer first choice applicants for specialty training (ST)3 posts than places available for training in the first round of interviews. Renal medicine needs to remain alert to the factors that attract students and doctors into the specialty.
Renal transplantation in the HCV-positive patient
Abeed A Pall and Kenneth Donaldson
pp 4-7
Patients with end stage renal disease (ESRD) who are anti-hepatitis C virus IgG positive have poorer survival than those who are hepatitis C virus negative. This is true for all forms of renal replacement therapy (RRT), including transplantation. Being hepatitis C virus (HCV)-positive adds to the complexity of patient management, particularly if they are being considered for renal transplantation. However, there has been an increase in our understanding of the natural history of chronic HCV infection in patients with chronic kidney disease (CKD) and the effect of immunosuppression after transplantation. Tailoring management on an individual basis, the use of antiviral treatments and a combined approach from nephrologists, hepatologists and transplant surgeons can optimise patient outcome.
Diagnosis and management of Anderson-Fabry disease
Praveen Jeevaratnam, Derralynn Hughes and Aine Burns
pp 8-11
Anderson-Fabry disease (AFD) is an X-linked inherited lysosomal storage disease. Symptoms include angiokeratomas, proteinuria and lymphoedema. AFD is caused by a mutation in the gene (Xq22.1) encoding alpha-galactosidase A (GLA). The GLA gene has been isolated and sequenced and, to date, there are 417 mutations reported in the Human Gene Mutation Database. The majority of these are missense or nonsense mutations.
Anaemia and chronic kidney disease – NICE guidance
James Fotheringham and Martin Wilkie
pp 12-14
In September 2006, the National Institute for Heath and Clinical Excellence (NICE) released its completed guidance on anaemia management in chronic kidney disease (CKD). Adding to guidance from the Renal Association, European Best Practice and the USA’s Kidney Disease Outcomes Quality Initiative (K/DOQI) groups, clinicians wondered what this would add to their existing practice. It was three years in the making and promised to encompass all elements contributing to the diagnosis, assessment and management of adults and children. But has the NICE guidance given the renal community anything it did not know already?
What I tell my patients about temporary neckline access for haemodialysis
Nicki Angell-Barrick and Alison Cornall
pp 15-18
A neckline is a special plastic tube, about the length of a pencil, which is inserted into a large vein in the neck called the internal jugular vein. The line is often placed on the right side of the neck but it can be placed on the left if the vein on that side is more suitable. The tip of the line lies in a large vein that enters the heart. A typical neckline consists of two separate tubes that join as the line enters the body, but remain two separate channels within the line, one to bring blood out of the body to the dialysis machine and one to return blood to the bloodstream.
Osteoporosis in women undergoing chronic dialysis
David V Hamilton
pp 19-21
With the introduction of new phosphate-binding agents and greater emphasis on the role of suppression of secondary hyperparathyroidism, the management of renal osteodystrophy is receiving increasing attention. Despite the advancing age of patients receiving renal replacement therapy and evidence that renal failure increases the risk of osteoporosis, this element of renal bone disease has been neglected.
Effects of a chronic kidney disease domain in the QOF
Ian Wilkinson
pp 22-23
As a result of the success of the Quality and Outcomes Framework (QOF), a concept introduced by the new General Medical Services (nGMS) contract for general practice which commenced in April 2004, the renegotiation of the nGMS contract, in respect of 2006–2007, resulted in tougher achievement thresholds for some indicators and new clinical domains within the QOF. One of these new clinical domains is chronic kidney disease (CKD).
A lack of nephrology teaching
Alison L Brown
pp 24-25
Tomorrow’s doctors, in line with General Medical Council (GMC) recommendations, are exposed to less formal teaching and didactic lectures covering traditional core facts. Instead, the emphasis is now on problem-based learning around common clinical situations. Central to the change in medical training is the reduction in directed learning – replaced by small group interactive teaching – with more emphasis on independent learning through curiosity.
Pathophysiology of diabetic nephropathy – new insights
Stephen Fava
pp 26-27
This paper reviews the wealth of literature on the complex pathophysiology of diabetic nephropathy, which is one of the more important long-term complications of diabetes. It is characterised by increased urinary albumin excretion and may progress to renal impairment, which may require renal replacement. It has become a leading cause of renal replacement and is associated with increased mortality in both major types of diabetes.
Vascular access survey – the lessons learned
Richard J Fluck
pp 28-31
The provision of good quality access has always been the cornerstone of providing high quality treatment for patients receiving renal replacement therapy (RRT). This basic fact was laid out in the renal National Service Framework (NSF) in standard three, which states, ‘All children, young people and adults with established renal failure are to have timely and appropriate surgery for permanent vascular or peritoneal dialysis (PD) access, which is monitored and maintained to achieve its maximum longevity’.

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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