British Journal of Renal Medicine - 2005


Comment: Celebrating publication of Part Two of the renal NSF
Donal O’Donoghue
pp 4-4
Part Two of the National Service Framework for Renal Services (renal NSF) was published on 3 February 2005. It covers prevention, early identification and management of chronic kidney disease (CKD), as well as aspects of acute renal failure and end-of-life care for people with renal disease. Together with Part One, it covers the entire patient pathway for people with CKD.
Non-dialysis management of end-stage renal failure
Jenny Altschuler
pp 6-9
There are several issues pertinent to adopting a palliative care approach to end-stage renal failure (ESRF), when conservative management is considered. These include the importance of creating a voice for the voiceless; of considering the cultural constructs of health, illness and appropriate care; the fluidity of family–healthcare professional boundaries and the potential psychological implications of this work for all healthcare professionals.
Managing primary amyloid with a tertiary care centre
Peter McClelland
pp 10-11
Rare medical problems with relentless and rapid progression sometimes present many problems for the attendant physician. I present such a case to illustrate the considerable morbidity associated with these patients and to demonstrate the shared-care approach with a tertiary care centre.
Treatment of calciphylaxis – from past to present
Janet Hegarty
pp 12-14
Calcific uraemic arteriolopathy or calciphylaxis, as it is frequently called, is a syndrome of medial calcification of the small arteries, leading to painful ischaemia, usually of the skin. It is almost exclusively found in patients with chronic kidney disease (CKD). While fortunately rare, it is profoundly distressing for patients and their families, and is frequently fatal. It poses a major challenge to the renal multiprofessional team to provide the best possible supportive medical, physical, social and psychological care in the face of often relentless disease.
What I tell my patients about sex and renal failure
Robert Higgins, Hemali Kanji, Anne Bakewell and Lilian Cerasoli
pp 15-18
Sexual problems are common for men and women who suffer from kidney disease. Not only are emotional problems likely to occur as a result of the stress of the disease, but there are also a number of medical conditions that can affect sexual function and fertility, both in men and women. Research has shown that people of all ages may have sexual problems, but these become more frequent in middle-aged people with kidney diseases.
Explaining the complexities of glomerulonephritis
Clive L Hall and Judith SL Partridge
pp 19-22
Glomerulonephritis (GN) is one of the most complex and extensive topics in renal medicine. It is perceived by junior doctors, nephrology nurses and medical students as being difficult to learn and even more difficult to understand. However, GN can be approached relatively easily using a simple classification based on the appearance – mainly by light microscopy – of the glomerular mesangial, endothelial and epithelial cells and of the glomerular basement membrane. By integrating the glomerular histology with the clinical manifestations, laboratory data and treatment options, the classification of GN becomes relevant to daily practice in renal medicine. This classification provides a practical basis on which more detailed knowledge can be added step by step.
Pure red cell aplasia (PRCA) – unravelling the mystery
Iain C Macdougall
pp 23-25
The development of epoetin-induced pure red cell aplasia (PRCA) at the turn of the century was one of the most startling revelations to hit modern-day medicine.
Spotlight on national policies
Angela Lumsdon and Geraldine Flavell
pp 26-26
The National Kidney Research Fund’s Annual Conference 2004 was held on 18 November 2004 at the Royal Geographical Society in London. The conference gave The National Kidney Research Fund (the Fund) an opportunity to present its work and reinforce its role and collaborative stance while linking to topical issues of the day. The theme was the analysis of national policies and initiatives, and the potential implications for, and impact on, the renal community.
Identifying a mismatch of perceptions in shared care
Rachel A Elliott, Judith Cantrill, Anne-Marie Bowron, Anowara Ali, Kathryn Challinor, David Graham, Gareth Price and Neil R Parrott
pp 26-29
Shared care may be defined as, ‘the joint participation of hospital consultants and general practitioners (GPs) in the planned delivery of care for patients with a chronic condition, informed by an enhanced information exchange over and above routine discharge and referral letters’.Shared care is employed widely for management of patients post-renal transplant because immunosuppressive therapy is complex, expensive and requires close monitoring. Research suggests that, in general, shared care is not always effectively executed, leading to suboptimal care and poorer outcomes for patients.Patients and GPs hold negative attitudes, reporting poor relationships, as well as a poor exchange of information, communication and delineation of responsibility.2,3 Some GPs feel uncomfortable managing complex therapies, and patients want more communication at both primary and secondary care levels.

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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ISSN 1365-5604 (Print)  ISSN 2045-7839 (Online)

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