British Journal of Renal Medicine - 2015

Comment: Self-preservation
John Bradley
pp 31-31
Between one third and a half of all arteriovenous fistulas created for haemodialysis fail to mature. Considerable attention has been paid to the factors associated with the failure of fistulae to become established. Diabetes, increasing age and female sex have been variably reported to reduce the chance of fistula maturation in some, but not all, studies. In contrast, treatment with calcium-channel blockers and low haemoglobin levels have been associated with successful functional fistula maturation. At a local level, the importance of shear stress and flow-mediated dilatation have been defined, and biological factors that might contribute to luminal narrowing have been identified. While neointimal hyperplasia has been implicated as a key factor in stenosis, pre-existing venous intimal hyperplasia does not appear to predispose to postoperative arteriovenous fistula stenosis.
A multidisciplinary approach to control severe mineral bone disorder in haemodialysis patients
Ann Dougan, Sandra Francis-Love and Neil Ashman
pp 32-34
Mineral bone disorder is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD), particularly in the latter stages. It is a multi-factorial disease, which can occur at all stages of CKD, becoming progressively worse as renal function declines. Without treatment it can result in osteomalacia, with accompanying risk of bone fractures and extra-osseous calcium deposition and calciphylaxis, which carries a high risk of mortality. Mineral bone disorder is associated with abnormalities in vitamin D metabolism, deranged calcium and phosphate balance, and hyperparathyroidism.
Solving the mystery of a rare kidney disease
Rachel Lennon and Paul Brenchley
pp 35-36
Researchers at Manchester University and Central Manchester Healthcare NHS Trust have made a significant breakthrough in the fight against membranous nephropathy, a rare kidney disease that often leads to kidney failure. Here we report how fundamental scientific research can support clinical investigation, ultimately leading to the development of new treatment strategies.
Eculizumab therapy for complement-mediated atypical haemolyticuraemic syndrome
Dalia Mudawi, David Kavanagh, John Sayer, Katrina Wood, Kate Armitage, Martin Rynne and Laura Baines
pp 38-41
Atypical haemolytic-uraemic syndrome (aHUS) is a rare, life-threatening systemic thrombotic microangiopathy. Abnormalities in complement family genes lead to hyperactivation of the complement system, causing endothelial cell injury and thrombi formation in the microvasculature of the kidney. Mutations in genes encoding complement regulating proteins, including complement factor H (CFH), CD46:membrane cofactor protein, complement factor I (CFI), the complement components complement factor B and complement component 3, and autoantibodies to CFH and CFI have been identified in aHUS patients. In addition to complement-mediated aHUS, recessive mutations in diacylglycerol kinase epsilon (DGKE) have been shown to cause a distinctive Mendelian disease. Individuals with recessive DGKE mutations present with aHUS before one year of age, have persistent hypertension, haematuria and proteinuria, and recurrent aHUS.
What I tell my patients about membranous nephropathy
Sanjana Gupta and Neil Ashman
pp 43-46
Membranous nephropathy (MEM-bruh-nus nuh-FROP-uh-thee) is a condition in which protein leaks into the urine from the kidneys. This can lead to low protein levels in the blood, water retention and sometimes even kidney failure. Sanjana Gupta and Neil Ashman describe this rare condition and its treatment
Vein preservation using wristbands in patients with chronic kidney disease
Nina Hjelde, Dean Thomas Williams, Anna Monteiro and Ives Ntambwe
pp 47-50
The gold standard vascular access for haemodialysis is an arteriovenous fistula (AVF). Early referral to the vascular team is encouraged, as the process of counselling and creation of an effective fistula can be time consuming. Vein preservation in patients with end-stage chronic kidney disease is threatened by the need for careful monitoring of blood biochemistry and intravenous access for concurrent conditions. Cannulation can be particularly disruptive to vein integrity, and it is recognised that protection from unnecessary venepuncture in the upper limb identified for AVF creation is important. The most useful veins for AVF creation are the cephalic vein, in the forearm and wrist, and the veins of the antecubital fossa; the same veins favoured for venepuncture and cannula placement.
Using patient ideas to inform dietetic services: patient-centred, but practical and safe?
Andrew Morris, Clive Liles and Carolyn Roskell
pp 52-53
The idea that health services should be more patient-centred is commonplace, possibly reflecting a misapprehension of the complex environment in which healthcare professionals work. Individuals strive to develop patient-centred services, but in practice this is hard to achieve. Not only do the public expect more from the NHS, there are also increased demand to develop research alongside practice, leading to increased pressure, conflicting demands and less time to devote to consultations and patient care.
Culture of care
Donal O’Donoghue
pp 54-55
The Francis report into the failings at the Mid Staffordshire NHS Foundation Trust highlighted a whole range of systemic failings, many of which can be attributed to the culture of care within organisations. The same concerns were echoed in the Kirkup report on maternity and neonatal services at the University Hospitals of Morecambe Bay NHS Foundation Trust, published earlier this year. The documentation of the devastating experiences and avoidable poor outcomes for patients, their loved ones, and the staff caring for them, makes uncomfortable reading.

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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