Volume 14, Number 4

Donal O’Donoghue BSc MB ChB FRCP National Clinical Director for Kidney Care, Salford Royal Hospital, Salford

As we enter the next phase of the National Service Framework for Renal Services, we need to accelerate the pace and scale of quality improvement for people with kidney disease. Kidney disease now has visibility, and we have a platform for making a substantial difference to the experience and outcomes of our patients.

Chris J Callaghan PhD MRCS Clinical Lecturer and Honorary Specialist Registrar; Christopher JE Watson MD FRCS Reader and Honorary Consultant Surgeon, Department of Surgery, Addenbrooke’s Hospital, Cambridge

Kidney transplantation has become the preferred method of renal replacement therapy for the majority of patients with end-stage renal disease (ESRD). Transplantation provides a survival advantage when compared with dialysis, facilitates a better quality of life (QoL) than haemodialysis (HD) or peritoneal dialysis, and is the most cost-effective treatment for ESRD.

John Bradley, Editor

The gap between supply and demand in organ transplantation underlines the need to make the best use of a scarce resource. An allocation system that is both equitable and utilitarian balances the need to get the best from each donated organ against the need for patients at risk of a less favourable outcome to have a reasonable chance of receiving a transplant.

Nora Kerigan RGN BSC(Hons) Adequacy Nurse Specialist, Royal Preston Hospital, Lancashire; Heather Hill BSC(Hons) SRD Advanced Specialist Renal Dietitian, Westmorland General Hospital, Kendal; Nicola O’Connell BA(Hons) Qualitative Researcher, London

The management of blood phosphorus in renal patients is challenging, as its success largely relies on a good healthcare professional–patient partnership. Here, we speak to staff from a department of renal medicine about the principles of management and the ways they achieve results, following a bone chemistry management protocol developed by the trust’s bone chemistry team. Adequacy Nurse Specialist Nora Kerigan is qualified as a non-medical prescriber, and is based at the Royal Preston Hospital, in the Lancashire Teaching Hospitals NHS Foundation Trust, while Advanced Specialist Renal Dietitian Heather Hill is based in Westmorland General Hospital, Kendal, a satellite unit and part of University Hospitals of Morecambe Bay NHS Trust. Both follow bone chemistry protocols that have been adapted to their environments.

John Tuckett BM BCh F1 Doctor; Emma Vaux FRCP DPhil Consultant Nephrologist; Lindsey Barker FRCP Consultant Nephrologist; Mobin Mohteshamzadeh MRCP MD Consultant Nephrologist; Ramesh Naik FRCP Consultant Nephrologist, Renal Unit, Royal Berkshire Hospital, Reading

The Department of Health (DH) has recommended that people in certain at-risk groups have vaccinations against Streptococcus pneumoniae. The most recent recommendations advise vaccination in infants; those over 65 years of age; asplenic patients; patients with respiratory disease, chronic liver disease, chronic heart disease, or chronic kidney disease (CKD) – including those patients who have received renal transplantation; diabetics; immunosuppressed patients; and those with cochlear implants or with cerebrospinal fluid leaks.

Paul Roderick MBBS MSc MD FRCP FFPH Professor of Public Health, University of Southampton School of Medicine, Southampton

The old adage ‘prevention is better than cure’, attributed to the Dutch thinker Erasmus, is highly relevant to the treatment of chronic kidney disease (CKD).

Andrew Connor MBBS BSc MRCP Specialist Registrar in Renal and General Medicine, Dorset County Hospital, Dorchester; Green Nephrology Fellow, The Campaign for Greener Healthcare; Charles Tomson MA BM BCh DM FRCP Consultant Nephrologist, Southmead Hospital, Bristol. President-elect of the Renal Association; Frances Mortimer MBBS BA MRCP Medical Director, The Campaign for Greener Healthcare

The decision by The Lancet to commission a 40-page report into the health effects of global warming should be taken as an indication that the medical profession can no longer ignore the implications of climate change. Renal medicine is among the first specialties to begin to pursue the changes in infrastructure and practice that will be required to tackle this impending public health catastrophe.

Vishal Madan MBBS(Hons) MD MRCP(UK) MRCP(London) Honorary Consultant Dermatologist, Salford Royal NHS Foundation Trust and Central Manchester Dermatology Centre, Manchester Royal Infirmary; Sheila Russell RGN BSc MSc Advanced Nurse Practitioner, Renal Transplant Unit, Manchester Royal Infirmary; John T Lear MD FRCP Consultant Dermatologist, Salford Royal NHS Foundation Trust and Central Manchester Dermatology Centre, Manchester Royal Infirmary

Since publication of the first report highlighting the high incidence of skin cancers in renal transplant recipients, there has been a surge in studies confirming an association of iatrogenic immunosuppression with skin cancers. Skin cancers, including melanoma and non-melanoma skin cancers (basal and squamous cell carcinomas), constitute 37–50% of all de novo cancers in renal transplant recipients, and this skin cancer risk is directly related to the total duration of immunosuppressive therapy.

Clare Beard BSc(Hons) MSC FFPH Programme Lead, NHS Kidney Care, Newcastle-upon-Tyne; Paul Harden FRCP Consultant Nephrologist and Transplant Physician, Oxford Radcliffe Hospitals; David V Milford BM DM FRCP FRCPCH Consultant Nephrologist, Birmingham Children’s Hospital

What is it like to grow up with kidney disease? How does it affect what you do as a young adult? What support does a young adult need (and not need) from services so they can lead a full life – in work, education or training; when forming new relationships or leaving home? NHS Kidney Care is starting a new project examining how best to support young adults with complex health needs such as chronic kidney disease (CKD).

Mohamed Wazeer Buhary MBBS MRCP Specialist Registrar in Renal Medicine; Paul Scott MB BCh FRCR Consultant Vascular Radiologist; Helen Collinson MBBS BSc(Hons) FRCP Consultant Renal Physician; Sunil Bhandari MB BCh FRCP PhD MClinEdu Consultant Renal Physician, Hull and East Yorkshire Hospitals NHS Trust

Renal artery stenosis is a condition characterised by a narrowing of one or both of the arteries supplying blood to the kidneys. It may cause future kidney damage and high blood pressure. It is a progressive condition and, when not diagnosed early and treated appropriately, could lead to complete blockage of the kidney arteries, leading to kidney failure and very high blood pressure. When it is diagnosed and acted on early, treatment can improve kidney function and reduce high blood pressure or the number of medications needed to treat it.