British Journal of Renal Medicine - 2012

Comment: Unwanted transmissions
John Bradley
pp 3-3
Cancer is common and, often, fatal. How often, however, may be less clear than we think. In 2010, 493,242 deaths were registered in England and Wales. Circulatory diseases were the most common registered cause of death, contributing to 32% of all deaths, but cancer accounted for 29%. There were 2,029 deaths due to cancer per million population (pmp) for males, and 1,477 pmp for females.
Asymptomatic bacteriuria and urinary tract infection in renal transplantation
Mark Harber, James Malone-Lee and Scott Wildman
pp 4-7
Urinary tract infection (UTI) is the most common bacterial infection and cause of septicaemia after transplant, accounting for 40–50% of all infectious complications after transplant. On an individual basis, the risk of a UTI after transplant is very high; in the ELITESymphony study, 25% of renal transplant patients had symptomatic UTIs within the first year, but it is likely that many others had asymptomatic infections, and rates as high as 86% have been reported.
Shared decision-making in renal care: a call to action
Steven Laitner, Charles Tomson, Robert Elias, Fiona Loud, Ashley Brooks, Elizabeth Carter and Donal J O’Donoghue
pp 8-8
‘Please address my real needs, not my clinical needs’ – so says a man with end-stage renal failure and far-reaching personal experience of kidney care in the NHS. One of the best ways to identify and address ‘real’ (as opposed to ‘clinical’) needs is to share decisions about every aspect of a person’s treatment with that person. Yet, despite our best efforts, we do not always succeed.
Residual renal clearance in predicting dialysis adequacy
Michaela C Brown, Siobhan K McManus and Robert A Mactier
pp 9-13
Adequate peritoneal dialysis (PD) is difficult to define, and its relationship to patient outcome is controversial. Adequate PD may be defined as appropriate fluid balance, acceptable serum biochemistry and the absence of uraemic symptoms. However, the major guidelines all include measurement of small solute clearance with recommended minimum targets as part of PD adequacy assessment. All guidelines recommend a lower acceptable limit for weekly small solute clearance, but no upper target.
What I tell my patients about magnetic resonance imaging
Rizna Cader
pp 15-18
In an era of developing technology and noninvasive investigations, there is more and more reliance on radiological investigations. Magnetic resonance imaging (MRI) is a relatively new technology that was first developed at the University of Nottingham. Increasingly, MRI is being used to establish a diagnosis. Within the field of renal medicine, there is growing use of MRI in the diagnosis of renovascular disease, renal transplantation work-up and response to treatment in autosomal dominant polycystic kidney disease.
Payment by Results in renal medicine – a guide
Donal J O'Donoghue and John Bradley
pp 19-21
‘Payment by Results’ is the hospital payment system used in England. Commissioners (clinical commissioning groups, primary care trusts or specialised commissioning groups) pay providers (NHS trusts, NHS foundation trusts, private healthcare organisations) a tariff for most procedures, based on the number of patients treated or seen.
Provision of renal care for children through networks
Mary E McGraw
pp 22-25
Paediatric renal disease is rare. Care for children with renal problems in the UK is provided through a system of care combining one of the nation’s 13 tertiary units with the individual child’s local team. The geographical area covered by each of these units, the populations that are served and the number of hospitals from which the centre receives referrals varies. Therefore, the model of service is different for each region.
Idiopathic nodular glomerulosclerosis in non-diabetic patients
Karl Walsh and Julian Wright
pp 26-28
Kimmelstiel–Wilson nodules, first described in 1936, occur in approximately 25% of the renal biopsies of patients with diabetic nephropathy and have been generally thought to be pathognomonic of diabetic nephropathy. In a few reported cases, Kimmelstiel–Wilson nodules have been present on kidney biopsy specimens in non-diabetic patients.
Donor-transmitted malignancy following transplantation
Christopher JE Watson
pp 29-31
Recipient survival after successful kidney transplantation is better than after continued dialysis, although the shortage of donor organs inevitably means a period of dialysis for most patients. By the end of March 2011, there were 6,871 patients waiting for a kidney, but only 957 deceased organ donors in the preceding 12 months. In the same period, 288 patients died while waiting for a kidney transplant, and a further 468 were removed from the national transplant waiting list – mostly because their health had declined, making transplantation inadvisable.

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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