British Journal of Renal Medicine - 2008

Comment: Challenging behaviour
John Bradley
pp 3-3
Lord Darzi has set out a vision for a personalised NHS that is ‘tailored to the needs and wants of each individual, especially the most vulnerable and those in greatest need, providing access to services at the time and place of their choice’. The focus for change is on primary care, where more than 80% of patient contact takes place.
Crescentic IgA nephropathy
Naushad Junglee, Meryl Griffiths and Menna Clatworthy
pp 4-7
IgA nephropathy (IgAN) is one of the most common causes of primary glomerulonephritis (GN) and of end-stage renal failure (ESRF). Most patients with IgAN present with microscopic haematuria with or without a variable degree of renal impairment. Renal biopsy typically demonstrates glomerular mesangial hypercellularity with IgA deposition. A minority of patients with IgAN (<5%) present with acute renal failure and a rapidly progressive course.
Violence and aggression on haemodialysis units
Julia Jones, Gayle Ridge, Sarah Eales, Neil Ashman and Patrick Callaghan
pp 8-9
Disruptive, abusive and violent behaviour by patients and occasionally their family members is becoming a significant problem in some haemodialysis (HD) units, with literature suggesting that this is an emerging problem both nationally and internationally. Aggressive behaviour by a small but significant minority of dialysis patients towards staff and fellow patients consumes disproportionately large amounts of clinical time and resources.
What to look for in vascular access catheters
Nicki Angell-Barrick and Janson CH Leung
pp 10-12
It is widely accepted that an arteriovenous fistula (AVF) is the ‘gold standard’ in vascular access in haemodialysis (HD) patients as they have fewer associated infections, fewer issues with morbidity and mortality, fewer complications, and are generally more acceptable to patients than vascular access catheters (VACs). However, there will be times throughout a patient’s dialysis life when they will need to rely on a VAC for access to their bloodstream to allow HD.
My 30 years on home dialysis – one patient’s story
Robert Hinson
pp 13-14
On 5 October 1977 I started my very first dialysis session at Douglas House in Trumpington Road, Cambridge, which was then the dialysis centre for Addenbrooke’s Hospital. Thirty years, 10,000 needles and approximately 20,000 hours, or three years spent on a machine later, I find myself writing this article.
What I tell my patients about glomerulonephritis
Heather Kerr and Neil Turner
pp 15-18
Glomeruli are the filters of our kidneys. They clear the blood of unwanted waste products, allowing these to be excreted in the urine. We should have approximately one million glomeruli in each kidney. They are incredibly tiny – you could fit ten side by side on the head of a pin. A tube (tubule) leading out of each glomerulus is actually a processing device from which 99% of the filtered fluid is reprocessed back into the blood, leaving waste products, excess salt and so on, to flow out into the urine.
Nephrotic syndrome secondary to shunt nephritis in a 37-year-old female
Ramaswamy Diwakar and Peter A Andrews
pp 19-21
A 37-year-old lady presented with a six-week history of ankle and facial swelling. There was no history of upper respiratory tract infection, joint pain or skin rash. Two weeks earlier, she had developed cellulitis of the lower leg, for which she had been prescribed erythromycin. Her past history included spina bifida and childhood hydrocephalus, for which she was initially treated with a ventriculopleural shunt, which had been converted to a ventriculoatrial (VA) shunt ten years earlier.
Heparins in renal failure
Madeleine A Vernon
pp 22-24
Heparin is a widely used anticoagulant that has a range of clinical applications. Different preparations vary in their pharmacokinetic and pharmacodynamic profile. The low molecular weight heparins (LMWHs) introduced in the 1990s undergo renal elimination and their role and safety in patients with impaired renal function remains unclear and controversial.
Symptom control for patients dying with advanced CKD
Claire Douglas, Fliss Murtagh and John Ellershaw
pp 25-27
Despite the common belief that uraemic death is relatively symptom-free, the evidence does not support this. A recent systematic review of literature has shown that symptom prevalence is high in dialysis patients, and that patients managed conservatively (without dialysis) also have a high symptom burden. Common symptoms include pain, fatigue, dyspnoea and anxiety.
Practicalities of implementing online haemodiafiltration
Mark S MacGregor, Nestor Velasco, Andrew Innes, Ann Dunlop, John Wright and Ian G Mackay
pp 28-31
Only 43% of patients are alive five years after starting renal replacement therapy. For haemodialysis (HD) patients, further increases in urea clearance seem to offer limited opportunities for improvements in mortality rate. Increased dialysis frequency, longer dialysis hours or a combination of the two may improve survival, but are challenging to implement for the majority of patients. Recently, two large observational studies showed that haemodiafiltration (HDF) was associated with a 35–37% reduction in mortality.

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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