Comment: Klotho - spinning a complex web
John Bradley
pp 3-3
In mythology, Klotho was a Greek goddess and one of the three Fates, responsible for determining a person’s destiny. Klotho was the spinner, spinning the thread of life. In the year 360 BC, Plato described how Klotho controlled the revolution of the spindle with a touch of her right hand.
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What nephrologists need to know about UTI
Steven Miller, Nauman Zafar, Thomas Swallow, Michael Bishop and Richard Parkinson
pp 4-8
Urinary tract infection is common, but in those without anatomical or functional abnormalities, it is usually a self-limiting condition. Fifteen per cent of patients, usually females, suffer from recurrent UTI.1 Uncomplicated UTIs, even when recurrent and causing symptoms of severe acute pyelonephritis, rarely cause permanent renal damage.
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Assisted automated peritoneal dialysis: setting up a new programme
Julie Hicks and Lucy Dodsworth
pp 9-11
Plymouth Dialysis Unit serves a population of 256,7001 covering patients living in Plymouth, east Cornwall and north and south Devon, incorporating both urban and rural areas. The area we serve is flanked by the Royal Cornwall Hospital to our western boundary and the Royal Devon & Exeter NHS Foundation Trust to the east.
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Focusing the renal dietitian’s time where it is most needed
Louise Wells
pp 12-14
The role of the dietitian as an integral member of the renal care team is well established. Over the years, this role has evolved and expanded in response to increased knowledge on the nutritional needs of patients with chronic kidney disease (CKD). The publication of the National Service Framework for Renal Services and subsequent guidance, has led to significant changes in the way CKD is identified and managed. This has provided another important opportunity for renal dietitians to review their role and scope of practice, and to reconsider priorities in nutrition intervention. It has also presented a number of challenges.
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What I tell my patients about kidney stones
Rachel Busuttil Leaver
pp 15-18
Kidney stone disease (urolithiasis) is a growing problem. Worldwide, around two people in 1,000 develop problems related to kidney stones each year, and up to 20% of people have had problems with kidney stones at some time. In Europe, up to 8% of the population have been affected, but this number is rising. It is estimated that at least 720,000 individuals currently have kidney stone problems in the UK.
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Don’t let them die of AKI
Donal J O'Donoghue
pp 19-19
This year’s World Kidney Day theme, acute kidney injury (AKI), marked a significant moment in raising the profile of such a common, harmful and avoidable condition. At the Renal Association and forthcoming British Renal Society meeting, AKI research is prominent, and the NICE guideline on AKI is now out for consultation. What are you doing about it?
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Vascular calcification in CKD: a report of a UK consensus group
John R Cockcroft and Christopher McIntyre
pp 20-24
Cardiovascular calcification is one of the defining features of chronic kidney disease-bone and mineral disorder (CKD-BMD), a complex syndrome also characterised by biochemical derangements and hormonal and bone abnormalities. The pathogenesis of these interrelated disease states is only partly understood and the clinical evidence available to inform their management is of uneven quality.
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How I coped with polycystic kidney disease
Andrew Moorhouse
pp 26-27
My father was born with polycystic kidney disease, a hereditary condition in which cysts are present on the kidneys and other organs. These cysts may grow over time, gradually diminishing the kidneys’ ability to process impurities. My grandmother had died from the disease in the early 1960s, when not a great deal was known about the condition, but research had led to improved treatment by the time my dad was diagnosed.
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Emerging therapies for polycystic kidney disease
Richard Sandford
pp 28-31
Estimates suggest that between 1:400 and 1:1,000 of the world population have autosomal dominant polycystic kidney disease (ADPKD), making it the most common single-gene disorder leading to end-stage renal failure (ESRF). This predicts that there are over 60,000 people in the UK with, or at risk of, developing its complications. These typically include hypertension, macroscopic haematuria, flank pain, nephrolithiasis, cyst infection and a progressive decline in renal function, leading to ESRF. Overall, about 70% of people with ADPKD will develop ESRF during their lifetime.
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