Alex M. Davison

Renal Disease in the Elderly

There are structural and functional changes which take place in the kidney with age. These changes have an impact on patient management, particularly with respect to drug therapy. It is unlikely that glomerulonephritis is less common in the elderly, and any apparent difference with respect to younger patients most likely reflects clinical practice rather than any inherent difference in the aged kidney. Tubulointerstitial nephritis may be more common and is most likely linked to drug therapy. The management of end-stage renal failure in the elderly should not be significantly different from that in younger patients and should be based on the capacity for rehabilitation rather than any arbitrary age.

CHANGES IN HUMAN NATURAL KILLER ACTIVITY EARLY AND LATE AFTER RENAL TRANSPLANTATION USING CONVENTIONAL IMMUNOSUPPRESSION

The natural killer (NK) cell activity of human peripheral blood lymphocytes falls following major surgical procedures including renal transplantation but in non-immunosuppressed individuals returns to normal levels within the first 72 hr after operation. In renal allograft recipients, if this early postoperative fall is excluded from the analysis, NK cell function appears to follow changes in allograft function, suggesting that in vivo, as has been reported in vitro, NK activity is generated during activation of the alloreactive process. In an additional group of patients whose grafts were functioning for between 3 and 102 months after cadaveric renal transplantation using conventional immunosuppression, NK function was depressed in comparison with that of control subjects. However, some patients who were more than 48 months post-transplant had normal NK cell activity. Collectively, these results suggest that NK cell function may recover despite the continued administration of conventional immunosuppressive agents.

The nephrotic syndrome in the elderly: clinico-pathological correlations in 317 patients

We have used the Medical Research Councils Glomerulonephritis (GN) registry to review the clinicopathological findings in a large group (317) of patients over 60 years of age and presenting with the nephrotic syndrome. A wide variety of histological appearances were seen to underlie this clinical diagnosis with the most frequent being membranous nephropathy (36.6%), minimal change nephrotic syndrome (11.0%) and renal amyloid (10.7%). Clinical parameters measured at the time of biopsy were unhelpful in distinguishing between the individual histological groups. A secondary cause for the nephrotic syndrome was identified in 103 (32%) patients, and a malignancy was known to be present at the time of biopsy in 15 patients.

Spontaneous glomerular immunoglobulin deposition in young Sprague-Dawley rats

The frequency, age-onset and distribution of spontaneously deposited immunoglobulins (lgs) in glomeruli of Sprague-Dawley rats has been investigated. Groups of rats (n=10) were examined at 4-7 day intervals from birth (presuckling) until 30 days of age. Findings were compared with circulating immunoglobulin concentrations in each age group. Immunoglobulins were undetectable in immature kidneys of newborn rats. However, as early as 5 days, scanty IgA and IgM deposits were observed predominantly in mesangial areas of mature glomeruli, corresponding to low circulating concentrations of these immunoglobulins. By contrast, glomerular IgG deposits were not observed until 21 days, despite relatively high concentrations of circulating maternal IgG from birth. Mesangial deposition of immunoglobulins increased with age. Absence of complement C3c or electron dense deposits associated with this mesangial localization suggests that immunoglobulins were not deposited as immune complexes. Accumulation of non-phlogogenic immunoglobulins in the mesangium of normal rats supports the concept that the mesangium is constantly perfused by circulating macro-molecules and filtration residues. The results indicate problems of interpretation of the significance of endogenous immunoglobulin deposition in models of experimental glomerulonephritis, even in studies involving weanling rats.

Preparation, purification and analysis of BSA-coated latex particles for in vivo studies: non-ionic adsorbance of unbound protein ligand

A procedure for the preparation, purification and analysis of small, BSA-coated carboxylate-modified latex (CML) particles, suitable for use in in vivo studies has been developed. Following conjugation, uptake of unbound BSA by Amberlite XAD-8 non-ionic adsorbent beads has been shown to be an effective method by which unbound protein ligands may be removed from coated latex preparations.

Options in Renal Replacement Therapy

Since the introduction over forty years ago of regular dialysis therapy for the management of end stage renal failure there have been dramatic changes in the way this treatment is provided. In pioneering days only a few highly selected patients were considered for treatment and only one treatment option was available (9). Generally, patients were treated twice weekly by haemodialysis for 14 hours with equipment which was, by present day standards, rather inefficient with little or no monitoring. Research and development has resulted in significant advances in dialyser design, membrane performance, and monitoring devices with the consequence that patients are now treated with expensive sophisticated equipment utilising computer assisted controls. Unlike the previous ‘fixed’ regimen patients now have the possibility of treatment ’tailored’ to their individual requirement by using measurements of dialysis adequacy to determine the length of each dialysis session and currently patients’ haemodialysis sessions vary from 2.5 to 6 hours twice or, more commonly, thrice weekly

The five most cited NDT articles from 1985 to 1993

The five most cited NDT articles from 1985 to 1993 Raine AEG, Margreiter R, Brunner FP et al. Report on management of renal failure in Europe, XXII 1991 NDT 1992; 7 Suppl 2: 7–35 (285 citations, end 2009) Hasslacher C, Ritz E, Wahl P et al. Similar risks of nephropathy in patients with type-I or type-II diabetes-mellitus NDT 1989; 4 (10): 859–863 (176 citations, end 2009) Schillinger F, Schillinger D, Montagnac R et al. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses NDT 1991; 6 (10): 722–724 (175 citations, end 2009) Sundal E, Kaeser U Correction of anaemia of chronic renal failure with recombinant human erythropoietin: safety and efficacy of one year’s treatment in a European multicentre study of 150 haemodialysis-dependent patients NDT 1989; 4 (11): 979–987 (152 citations, end 2009) Neumayer HH, Junge W, Kufner A et al. Prevention of radiocontrast-media-induced nephrotoxicity by the calcium-channel blocker nitrendipine: a prospective randomised clinical trial NDT 1989; 4 (12): 1030–1036 (135 citations, end 2009)

Special feature on the occasion of the 25th anniversary of NDT

The first issue of NDT was published in 1986, so we are very pleased to present you this anniversary issue celebrating the 25th anniversary of our journal. Nephrology, Dialysis, Transplantation, as the journalwas called in those days, now abbreviated to NDT, is the official journal of the European Renal Association/European Dialysis Transplant Association (ERA/EDTA). Spanning these 25 years, four Editors-in-Chief have served the journal. Instead of writing a rather ‘traditional’ historical overview of the journal, we asked our publisher, Oxford University Press, to provide us with the five most cited NDT papers in each editorial period. Each editor then summarized these papers and put them in the context of later developments in the relevant areas. We also tried to explain why these papers received such a high citation number and how they may have contributed to improving the care of our patients suffering from kidney diseases. We believe that these four contributions reflect the importance of NDT not only as a leading European but also as a truly major international journal in nephrology. We hope that our readers will enjoy reading these short papers as much as we all enjoyed writing them. At this occasion, the editors also want to express their sincere thanks to all the authors, reviewers, editors and readers of NDT for their interest in the journal. We also wish to acknowledge the continuous support over all these years of the ERA/EDTA council, the collaborators in the respective editorial offices and our publisher, OUP.