British Journal of Renal Medicine - 2019

Renal units now offer comprehensive education and support to prepare patients with progressive chronic kidney disease for renal replacement therapy. Despite this, patients can feel that they are uninformed and have limited scope for independent decision-making, with family members or healthcare professionals often strongly influencing their decision.

The authors describe how they redesigned their renal supportive care (RSC) service for patients with advanced chronic kidney disease (CKD) managed without dialysis, to enable consultations over a wide geographical area and within the community. The redesigned service includes an RSC nurse, a renal consultant and a palliative medicine consultant. The main components of the service are continuing care of CKD without dialysis, symptom assessment and management, and advance care planning.

The UK Renal Registry will celebrate its 25th anniversary next year – here we highlight some of its achievements and future developments.

Rudolf Virchow, the 19th  century German physician who is often referred to as ‘the father of modern pathology’, identified the three factors contributing to thrombosis – Virchow’s triad; he also coined the phrase that ‘politics is nothing else but medicine on a large scale’. In a system like ours, where health service funding is provided from general taxation, that is definitely the case.

UK Kidney Week 2019, jointly hosted by the British Renal Society and the Renal Association, was located in Brighton this year. The conference was heralded as a ‘great success’, with in excess of 1,000 delegates attending from all areas of the multiprofessional team. The programme team worked tirelessly to deliver a truly varied programme, which was thoroughly enjoyed by all those who attended the conference.

A greater index of suspicion is needed for PVB19 infection in renal transplant recipients (RTRs) with erythropoietin-resistant anaemia and low reticulocyte counts. The major challenge in managing symptomatic PVB19 infection in RTRs involves balancing the reduction of immunosuppressant dose and the risk of rejection. The authors discuss the case of a 53-year old woman who presented over a year after a simultaneous pancreas-kidney transplant with fatigue and breathlessness on minimum exertion.

Muscle weakness and wasting is a known consequence of chronic kidney disease (CKD). Now, new research led by the University of Plymouth hopes to improve patients’ quality of life by establishing how mitochondria are involved in this deterioration.

Rituximab is increasingly being used as a therapy for B cell-mediated events in transplant recipients. The authors review the role of rituximab in different transplant settings, including its use in acute antibody-mediated rejection, post-transplant lymphoproliferative disorders and as an adjunct therapy in desensitisation protocols, as well as discussing the future use of B-cell-depleting agents in solid organ transplantation.

Despite paracetamol-induced nephrotoxicity being less commonly diagnosed in comparison with hepatotoxicity, acute renal injury may be more common than previously recognised. This case report presents a young patient with delayed onset of acute kidney injury (AKI) following a paracetamol overdose, which demonstrates that AKI may be missed if patients are discharged early.

Legislation to introduce an opt-out system of organ and tissue donation for Scotland was granted Royal Assent on 19th July 2019, giving formal confirmation that it will become law.

If you have kidney failure, dialysis is a vital option. Some are not able to have a transplant and others may have to wait years until they are able to receive a donated kidney.