Paul Carmichael

Assessment of quality of life in a single centre dialysis population using the KDQOL-SFTm questionnaire

Health-related quality of life (HRQOL) is a valid marker of outcome for chronic dialysis therapy. A wide range of questionnaires are now available which assess different aspects of an individuals health. Appreciation of those factors that contribute to explaining HRQOL items remains poorly defined. The development of disease-specific questionnaires such as KDQOL-SFTm, should allow for such questions to be better answered. A cross-sectional analysis of our chronic dialysis population was made using the KDQOL-SFTm questionnaire. By multiple linear regression analysis demographic, clinical and dialysis-related factors were assessed for their contribution to the HRQOL in this population. The HRQOL of these patients was also compared against a general population sample. From a total of 190 chronic dialysis patients, 146 completed the KDQOL-SFTm questionnaire. The haemodialysis (HD) and peritoneal dialysis (PD) patients were similar with respect to most demographic, clinical and dialysis variables except for haemoglobin and albumin which were significantly (p < 0.05) greater in the peritoneal and haemodialysis populations respectively. Compared to the general population, the HRQOL of dialysis patients was impaired for all SF-36 subscales. Use of the disease-specific components of KDQOL-SFTm discriminated between dialysis modality for our dialysis population. Multiple linear regression analysis demonstrated that 27.5 to 42.7% of the variance in the SF-36 subscales could be explained. Satisfactory sleep, dialysis related symptoms, effect of kidney disease on lifestyle and burden of kidney disease were found to be the most important determinants of HRQOL for this population.

Acute renal failure in the surgical setting

Acute renal failure (ARF) is an unwelcome complication of major surgical procedures that contributes to surgical morbidity and mortality. Acute renal failure associated with surgery may account for 18−47% of all cases of hospital‐acquired ARF. The overall incidence of ARF in surgical patients has been estimated at 1.2%, although is higher in at‐risk groups. Mortality of patients with ARF remains disturbingly high, ranging from 25% to 90%, despite advances in dialysis and intensive care support. Appreciation of at‐risk surgical populations coupled with intensive perioperative care has the capacity to reduce the incidence of ARF and by implication mortality. Developments in understanding the pathophysiology of ARF may eventually result in newer therapeutic strategies to either prevent or accelerate recovery from ARF. At present the best form of treatment is prevention. In this review the epidemiology, pathophysiology, diagnosis, treatment and possible prevention of ARF will be discussed.

Late onset interstitial nephritis associated with mesalazine treatment

Patients taking mesalazine should have renal function monitored regularly to avoid nephrotoxicity Mesalazine is widely prescribed for the treatment of inflammatory bowel disease. It is a single molecule of 5-aminosalicylic acid (5-ASA), and is structurally similar to phenacetin and aspirin. Occasionally, treatment with mesalazine may lead to a severe indolent interstitial nephritis causing appreciable morbidity. Unless detected and treated early this may progress to end stage renal failure despite withdrawal of the drug.1 It is obvious from the increasing number of reports of nephritis and renal failure occurring after treatment with mesalazine that the premise that “there is no need for routine monitoring of renal function”2 needs to be reviewed; the need for a review has been suggested by a number of recent reports. 1 3–9 We report two cases of late onset interstitial nephritis induced by mesalazine (Asacol); the first presented after at least 5 years of continuous treatment with the drug and the second after 1 year. ### Case 1 A 38 year old laboratory technician began taking mesalazine for ulcerative colitis. After 2 years of continuous treatment he remained well with normal renal function (serum creatinine concentration 76 μmol/l; normal range 71-133 μmol/l) and negative results on urinalysis. He had an exacerbation of his colitis during the third and fourth years of treatment. On each occasion he responded to a combination of oral prednisolone treatment and an increase in the dose of mesalazine to 1.2 g twice a day. Each time, steroid treatment lasted for 3 months and began with 40 mg a day of prednisolone which was rapidly tapered down to a maintenance dose of 10 mg a day. Repeat serum creatinine concentration measured after 3 years of mesalazine treatment was 79 μmol/l. Thereafter the dose of mesalazine fluctuated between 800 …

Wegener's Granulomatosis of the Breast

Abstract:  A 60‐year‐old woman presented with a painless self‐detected breast lump. After wide local excision, the histology of this radiologically suspicious lump turned out to be an inflammatory lesion with granulomatous foci, suggesting a diagnosis of granulomatous mastitis. Prior to the excision biopsy, this woman had suffered from and been treated for anterior uveitis, secretory otitis media, and proximal myopathy. Four weeks later, a skin biopsy of a rapidly developing widespread petechial rash, mainly affecting the lower limbs, confirmed the diagnosis as Wegeners granulomatosis. Treatment with intravenous steroids and later cyclophosphamide produced rapid remission.

Atherosclerotic renal artery stenosis: from diagnosis to treatment.

Renovascular hypertension represents a form of correctable hypertension and preventable renal failure. Such patients need to be identified early so that specific therapy can be instigated. Patient identification requires a high index of suspicion in patients with certain clinical features. Subsequent non-invasive imaging may result in angiography which is required for diagnostic purposes and for planning intervention. Correctable therapy takes one of two forms, namely percutaneous transluminal renal angioplasty, with or without stenting, or surgical revascularisation, together with modification of underlying risk factors.