Publications by authors named "Alexander Woywodt"

86 Publications

Time to press the reset button-can we use the COVID-19 pandemic to rethink the process of transplant assessment?

Clin Kidney J 2021 Oct 6;14(10):2137-2141. Epub 2021 Jul 6.

Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

Coronavirus disease 2019 has taken a severe toll on the transplant community, with significant morbidity and mortality not just among transplant patients and those on the waiting list, but also among colleagues. It is therefore not surprising that clinicians in this field have viewed the events of the last 18 months as predominantly negative. As the pandemic is gradually ebbing away, we argue that this is also a unique opportunity to rethink transplant assessment. First, we have witnessed a step-change in the use of technology and virtual assessments. Another effect of the pandemic is that we have had to make do with what was available-which has often worked surprisingly well. Finally, we have learned to think the unthinkable: maybe things do not have to continue the way they have always been. As we emerge on the other side of the pandemic, we should rethink which parts of the transplant assessment process are necessary and evidence-based. We emphasize the need to involve patients in the redesign of pathways and we argue that the assessment process could be made more transparent to patients. We describe a possible roadmap towards transplant assessment pathways that are truly fit for the 21st century.
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http://dx.doi.org/10.1093/ckj/sfab118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344542PMC
October 2021

From quail to earthquakes and human conflict: a historical perspective of rhabdomyolysis.

Clin Kidney J 2021 Apr 22;14(4):1088-1096. Epub 2020 May 22.

Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

Rhabdomyolysis is a common cause of acute kidney injury, featuring muscle pain, weakness and dark urine and concurrent laboratory evidence of elevated muscle enzymes and myoglobinuria. Rhabdomyolysis is often seen in elderly and frail patients following prolonged immobilization, for example after a fall, but a variety of other causes are also well-described. What is unknown to most physicians dealing with such patients is the fascinating history of rhabdomyolysis. Cases of probable rhabdomyolysis have been reported since biblical times and during antiquity, often in the context of poisoning. Equally interesting is the link between rhabdomyolysis and armed conflict during the 20th century. Salient discoveries regarding the pathophysiology, diagnosis and treatment were made during the two world wars and in their aftermath. 'Haff disease', a form of rhabdomyolysis first described in 1920, has fascinated scientists and physicians alike, but the marine toxin causing it remains enigmatic even today. As a specialty, we have also learned a lot about the disease from 20th-century earthquakes, and networks of international help and cooperation have emerged. Finally, rhabdomyolysis has been described as a sequel to torture and similar forms of violence. Clinicians should be aware that rhabdomyolysis and the development of renal medicine are deeply intertwined with human history.
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http://dx.doi.org/10.1093/ckj/sfaa075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023192PMC
April 2021

Opportunities in the cloud or pie in the sky? Current status and future perspectives of telemedicine in nephrology.

Clin Kidney J 2021 Feb 14;14(2):492-506. Epub 2020 Aug 14.

Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

The use of telehealth to support, enhance or substitute traditional methods of delivering healthcare is becoming increasingly common in many specialties, such as stroke care, radiology and oncology. There is reason to believe that this approach remains underutilized within nephrology, which is somewhat surprising given the fact that nephrologists have always driven technological change in developing dialysis technology. Despite the obvious benefits that telehealth may provide, robust evidence remains lacking and many of the studies are anecdotal, limited to small numbers or without conclusive proof of benefit. More worryingly, quite a few studies report unexpected obstacles, pitfalls or patient dissatisfaction. However, with increasing global threats such as climate change and infectious disease, a change in approach to delivery of healthcare is needed. The current pandemic with coronavirus disease 2019 (COVID-19) has prompted the renal community to embrace telehealth to an unprecedented extent and at speed. In that sense the pandemic has already served as a disruptor, changed clinical practice and shown immense transformative potential. Here, we provide an update on current evidence and use of telehealth within various areas of nephrology globally, including the fields of dialysis, inpatient care, virtual consultation and patient empowerment. We also provide a brief primer on the use of artificial intelligence in this context and speculate about future implications. We also highlight legal aspects and pitfalls and discuss the 'digital divide' as a key concept that healthcare providers need to be mindful of when providing telemedicine-based approaches. Finally, we briefly discuss the immediate use of telenephrology at the onset of the COVID-19 pandemic. We hope to provide clinical nephrologists with an overview of what is currently available, as well as a glimpse into what may be expected in the future.
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http://dx.doi.org/10.1093/ckj/sfaa103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454484PMC
February 2021

The use of health information technology in renal transplantation: A systematic review.

Transplant Rev (Orlando) 2021 04 10;35(2):100607. Epub 2021 Feb 10.

Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK.

Renal transplantation is a complex, multi-disciplinary and cross-center service. Clinical pathways naturally traverse specialty and organizational boundaries as patients transition from chronic kidney disease to renal failure and ultimately transplantation. Health information technology (IT) has the potential to support transplant care by improving access to data, information sharing and communication. This novel review aimed to identify and characterize health IT solutions in renal transplantation, and where possible evaluate any intended benefits. A systematic literature review was conducted of studies covering any part of the clinical pathway, with end-users being clinical staff or patients. Interventions were characterized and evaluated for achieved benefits using the World Health Organization (WHO) Classification of Digital Health Interventions and the mixed methods assessment tool (MMAT) was used to determine the quality of experimental studies. Of 4498 articles, 12 descriptive and 6 experimental studies met the inclusion criteria. Median MMAT percentage score of experimental studies was 64 (i.q.r. 57 to 74.8). The most frequent functionality of technology involved overcoming communication roadblocks and improving access to data. Intended benefits included improving information management and supporting workflow, however only one study reported evaluated results. Six patient-facing applications that primarily addressed adherence-to-treatment were identified, five of which were evaluated for intended benefits, showing overall positive results. Overall, despite transplantation being well suited to health IT interventions, this review demonstrates a scarcity of literature in this field. A small number of clinician- and patient-facing IT solutions have been reported, albeit mostly in non-experimental studies. Due to this lack of formal evaluation, the effectiveness of solutions remains unclear. High-quality evaluative studies are required to develop effective IT solutions that improve clinical care.
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http://dx.doi.org/10.1016/j.trre.2021.100607DOI Listing
April 2021

[Digital nephrology].

Nephrologe 2021 Jan 5:1-5. Epub 2021 Jan 5.

Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Deutschland.

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http://dx.doi.org/10.1007/s11560-020-00478-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784214PMC
January 2021

Bedside teaching during the COVID-19 pandemic.

Clin Teach 2021 Aug 15;18(4):367-369. Epub 2020 Dec 15.

Department of Undergraduate Medical Education, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

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http://dx.doi.org/10.1111/tct.13322DOI Listing
August 2021

Paper-based signatures for attendance verification.

Clin Teach 2020 10 29;17(5):560-562. Epub 2020 Jan 29.

Undergraduate Medical Education, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

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http://dx.doi.org/10.1111/tct.13139DOI Listing
October 2020

Frailty and chronic kidney disease: current evidence and continuing uncertainties.

Clin Kidney J 2018 Apr 2;11(2):236-245. Epub 2017 Dec 2.

Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization. In recent years there have been efforts to create an operationalized definition of frailty to aid its diagnosis and to categorize its severity. Two principal concepts are described, namely the Fried Phenotype Model of Physical Frailty and the Cumulative Deficit Model of Frailty. There is no agreement on which frailty assessment approach is superior, therefore, for the time being, emphasis should be placed on any efforts to identify frailty. Recognizing frailty should prompt a holistic assessment of the patient to address risk factors that may exacerbate its progression and to ensure that the patient has appropriate psychological and social support. Adequate nutritional intake is essential and individualized exercise programmes should be offered. The acknowledgement of frailty should prompt discussions that explore the future care wishes of these vulnerable patients. With further study, nephrologists may be able to use frailty assessments to inform discussions with patients about the initiation of renal replacement therapy.
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http://dx.doi.org/10.1093/ckj/sfx134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5888002PMC
April 2018

Obesity and listing for renal transplantation: weighing the evidence for a growing problem.

Clin Kidney J 2017 Oct 22;10(5):703-708. Epub 2017 Apr 22.

Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.

A 56-year-old female patient was referred to the transplant assessment clinic in July 2016. She started haemodialysis in 2012 for renal failure due to urinary tract infections. She is doing very well on dialysis and has an excellent exercise tolerance without shortness of breath or angina. She has had no infections since starting dialysis and no other comorbidity, except well-controlled hypertension and hyperparathyroidism requiring treatment with cinacalcet. Clinical examination is essentially normal except for truncal obesity with height 167 cm and weight 121 kg, giving her a body mass index of 43.4. Can she be listed for a renal transplant? If not, which target weight should be given to the patient before she can be transplant listed? Which interventions, if any, should be recommended to achieve weight loss?
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http://dx.doi.org/10.1093/ckj/sfx022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622900PMC
October 2017

Infectious complications of rituximab therapy in renal disease.

Clin Kidney J 2017 Aug 6;10(4):455-460. Epub 2017 Jul 6.

Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

Rituximab, an anti-CD20 monoclonal antibody, was originally used to treat B-cell malignancies. Its use has significantly increased in recent years, as it is now also used to treat a variety of autoimmune diseases including rheumatoid arthritis and ANCA-associated vasculitis (AAV). Initial studies suggested that the adverse effects of rituximab were minimal. Though the risk of malignancy with rituximab-based immunosuppressive regimens appears similar to that of the general population, there are now concerns regarding the risk of infectious complications. Rituximab has been associated with serious infections, including pneumonia (PJP) and the reactivation of hepatitis B virus (HBV) and tuberculosis (TB). The risk of infection appears to be the result of a variety of mechanisms, including prolonged B-cell depletion, B-cell-T-cell crosstalk, panhypogammaglobulinaemia, late-onset neutropenia and blunting of the immune response after vaccination. Importantly, the risk of infectious complications is also related to individual patient characteristics and the indication for rituximab. Individualization of treatment is, therefore, crucial. Particular attention should be given to strategies to minimize the risk of infectious complications, including vaccinating against bacterial and viral pathogens, monitoring white cell count and immunoglobulin levels, prophylaxis against PJP and screening for HBV and TB.
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http://dx.doi.org/10.1093/ckj/sfx038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5570071PMC
August 2017

Twelve tips on how to establish a new undergraduate firm on a critical care unit.

Med Teach 2017 Mar 26;39(3):244-249. Epub 2016 Dec 26.

b Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK.

Background: Little is known about undergraduate teaching in critical care unit (CrCU) and many undergraduate curricula lack placements in CrCU.

Aims: To describe how our CrCU succeeded in developing a novel placement for Year 3 undergraduate medical students.

Methods: Particular emphasis was placed on a robust timetable incorporating a variety of activities, a dedicated and thorough induction, and a mix of teaching methods such as formal and informal, consultant-led, and skills. Services allied to CrCU were also utilized.

Results: Our new firm has exceeded all expectations and, based on student feedback, received the "Firm of the Year" award for several years in succession. It now serves as a model of undergraduate teaching in our hospital.

Conclusions: Educationalists and intensivists should work together to unlock the full potential of this rich learning environment. Professional societies in critical care medicine should take the opportunity to develop more interest in undergraduate medical education.
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http://dx.doi.org/10.1080/0142159X.2017.1266314DOI Listing
March 2017

Twelve tips for turning quality assurance data into undergraduate teaching awards: A quality improvement and student engagement initiative.

Med Teach 2017 Feb 10;39(2):141-146. Epub 2016 Nov 10.

a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK.

Data on teaching awards in undergraduate medical education are sparse. The benefits of an awards system may seem obvious at first glance. However, there are also potential problems relating to fairness, avoidance of bias, and alignment of the awards system with a wider strategy for quality improvement and curriculum development. Here, we report five- year single center experience with establishing undergraduate teaching awards in a large academic teaching hospital. Due to lack of additional funding we based our awards not on peer review but mainly on existing and very comprehensive quality assurance (QA) data. Our 12 tips describe practical points but also pitfalls with awards categories and criteria, advertising and disseminating the awards, the actual awards ceremony and finally embedding the awards in the hospital's wider strategy. To be truly successful, teaching awards and prizes need to be carefully considered, designed and aligned with a wider institutional strategy of rewarding enthusiastic educators.
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http://dx.doi.org/10.1080/0142159X.2016.1248912DOI Listing
February 2017

Granulomatous interstitial nephritis: a chameleon in a globalized world.

Clin Kidney J 2015 Oct 24;8(5):511-5. Epub 2015 Sep 24.

Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK.

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http://dx.doi.org/10.1093/ckj/sfv092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581397PMC
October 2015

A day in the zoo.

Clin Kidney J 2014 Jun 18;7(3):318-9. Epub 2014 Mar 18.

Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK.

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http://dx.doi.org/10.1093/ckj/sfu023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377745PMC
June 2014

Twelve tips to revitalise problem-based learning.

Med Teach 2015 Aug 17;37(8):723-729. Epub 2014 Nov 17.

b Lancashire Teaching Hospitals NHS Foundation Trust , UK.

The role of the problem-based learning (PBL) facilitator has seen different interpretations ever since PBL first gained widespread use. What has remained unchanged is the challenge for facilitators to use their knowledge and expertise sparingly and to use their interpersonal skills to improve group dynamics. Medical undergraduates attending PBL sessions have also changed in their skill sets, expectations and the use of technology. Based on the published literature and a recent faculty workshop, we provide PBL facilitators and institutions with 12 tips on how to make PBL more vibrant and interesting. We discuss our tips with reference to published literature and International Academy of Medical Education (AMEE) guidance. Our tips help students to engage with PBL, avoid monotony and make this teaching format more vibrant and fun for all involved. Introducing greater variety to the PBL process may also help with group dynamics by catering for a broader audience with different learning styles.
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http://dx.doi.org/10.3109/0142159X.2014.975192DOI Listing
August 2015

How we established a new undergraduate firm on a Medical Admissions Unit.

Med Teach 2014 Nov 4;36(11):940-4. Epub 2014 Mar 4.

Lancashire Teaching Hospitals NHS Foundation Trust , UK.

Medical Admission Units (MAUs) were introduced in the UK in the 1980s primarily driven by a governance and service improvement agenda. In the UK this has led to the development of Acute Medicine as a specialty in its own right, together with a strong role of this specialty in postgraduate teaching. In contrast, the role of MAUs, if any, in undergraduate medical education is currently unclear. Prompted by an expansion of our undergraduate student numbers, our aim was to establish a Year 3 undergraduate firm on a 33-bedded MAU in a large academic teaching hospital in the National Health Service (NHS). Despite initial scepticism from clinicians, managers, and educators, the new firm placement on MAU became an instant success and continues to attract excellent feedback from our Year 3 undergraduate students. Students enjoy the bedside teaching with a high percentage of consultant-delivered teaching and also liked the involvement of Foundation Doctors. Here, we report our experience on how to make such a firm work, based on student feedback and the tutors' experience. We provide an overview and a step-by-step guide of how to construct a successful new undergraduate firm on a busy MAU. We also discuss opportunities and challenges and discuss the relevant literature. We conclude that undergraduate teaching is feasible and rewarding in an extremely busy MAU setting. We note that identifying enthusiastic educators within the MAU team, utilisation of peripheral learning opportunities, structured timetables and induction, and a robust framework for quality assurance are all crucial to success.
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http://dx.doi.org/10.3109/0142159X.2014.886769DOI Listing
November 2014

Single-centre experience with Renal PatientView, a web-based system that provides patients with access to their laboratory results.

J Nephrol 2014 Oct 15;27(5):521-7. Epub 2014 Feb 15.

Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, Lancashire, PR2 9HT, UK,

Background: Renal PatientView (RPV) is a novel, web-based system in the UK that provides patients with access to their laboratory results, in conjunction with patient information.

Aim: To study how renal patients within our centre access and use RPV.

Methods: We sent out questionnaires in December 2011 to all 651 RPV users under our care. We collected information on aspects such as the frequency and timing of RPV usage, the parameters viewed by users, and the impact of RPV on their care.

Results: A total of 295 (45 %) questionnaires were returned. The predominant users of RPV were transplant patients (42 %) followed by pre-dialysis chronic kidney disease patients (37 %). Forty-two percent of RPV users accessed their results after their clinic appointments, 38 % prior to visiting the clinic. The majority of patients (76 %) had used the system to discuss treatment with their renal physician, while 20 % of patients gave permission to other members of their family to use RPV to monitor results on their behalf. Most users (78 %) reported accessing RPV on average 1-5 times/month. Most patients used RPV to monitor their kidney function, 81 % to check creatinine levels, 57 % to check potassium results. Ninety-two percent of patients found RPV easy to use and 93 % felt that overall the system helps them in taking care of their condition; 53 % of patients reported high satisfaction with RPV.

Conclusion: Our results provide interesting insight into use of a system that gives patients web-based access to laboratory results. The fact that 20 % of patients delegate access to relatives also warrants further study. We propose that online access to laboratory results should be offered to all renal patients, although clinicians need to be mindful of the 'digital divide', i.e. part of the population that is not amenable to IT-based strategies for patient empowerment.
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http://dx.doi.org/10.1007/s40620-014-0060-5DOI Listing
October 2014

Donating in good faith or getting into trouble Religion and organ donation revisited.

World J Transplant 2012 Oct;2(5):69-73

Mike Oliver, Aimun Ahmed, Alexander Woywodt, Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR29HT, United Kingdom.

There is worldwide shortage of organs for solid-organ transplantation. Many obstacles to deceased and live donation have been described and addressed, such as lack of understanding of the medical process, the issue of the definition of brain death, public awareness of the need for transplants, and many others. However, it is clear that the striking differences in deceased and live donation rates between different countries are only partly explained by these factors and many cultural and social reasons have been invoked to explain these observations. We believe that one obstacle to both deceased and live donation that is less well appreciated is that of religious concerns. Looking at the major faiths and religions worldwide, it is reassuring to see that most of them encourage donation. However, there is also scepticism amongst some of them, often relating to the concept of brain death and/or the processes surrounding death itself. It is worthwhile for transplant teams to be broadly aware of the issues and also to be mindful of resources for counselling. We believe that increased awareness of these issues within the transplant community will enable us to discuss these openly with patients, if they so wish.
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http://dx.doi.org/10.5500/wjt.v2.i5.69DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782236PMC
October 2012

Muir-Torre syndrome in a haemodialysis patient.

Clin Kidney J 2013 Aug;6(4):414-7

Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK.

Muir-Torre syndrome (MTS) is a rare inherited cancer syndrome with variable penetrance. MTS follows an autosomal-dominant pattern of inheritance, and is a subtype of Lynch syndrome [formally known as hereditary non-polyposis colorectal cancer (HNPCC)]. MTS is caused by mutations in one of several mismatch repair genes. Patients typically present with sebaceous neoplasms (sebaceous adenoma, sebaceous epithelioma, or sebaceous carcinoma) or with multiple keratoacanthomas. These patients also have an increased lifetime risk of visceral malignancies, typically affecting the colon, ovary, endometrium, genitourinary tract and small bowel. We describe a case of MTS in a haemodialysis patient and implications for transplant listing.
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http://dx.doi.org/10.1093/ckj/sft068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898341PMC
August 2013

Of mites and men: scabies in patients with kidney disease.

Clin Kidney J 2013 Apr;6(2):125-7

Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , Lancashire , UK.

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http://dx.doi.org/10.1093/ckj/sft024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432458PMC
April 2013

A purpose-built simulator for percutaneous ultrasound-guided renal biopsy.

Clin Nephrol 2013 Mar;79(3):241-5

Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

Aims: To construct a simple and affordable simulator for ultrasoundguided percutaneous renal biopsy.

Material And Methods: The kidney biopsy phantom was constructed by embedding a porcine kidney in gelatine. Silicon carbide and aluminium oxide were used as scattering particles in order to mimic the ultrasound appearance of human tissues. Two porcine ribs were also embedded. A latex sheet was placed over the top of the gel layer to resemble skin. The simulator was used and feedback from participants obtained during a renal ultrasound course with an international audience of middle-grade trainees from adult and pediatric nephrology, many of whom had never done a renal biopsy. Biopsy was carried out a single-use biopsy gun.

Results: All participants were able to perform a biopsy and obtain a satisfactory sample. All trainees felt that our simulator was very realistic. 94% of participants agreed that the simulator would help to allay their fears in relation to renal biopsy The total cost of the simulator was around £ 50,- for consumables per simulator.

Conclusions: We describe a purpose-built and affordable simulator for percutaneous ultrasound-guided renal biopsy. We suggest that others evaluate our simulator used as part of a structured approach to teach this important procedure.
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http://dx.doi.org/10.5414/cn107236DOI Listing
March 2013

What's in a name? Bence Jones protein.

Clin Kidney J 2012 Oct;5(5):478-83

Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK.

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http://dx.doi.org/10.1093/ckj/sfs127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432430PMC
October 2012

Tuberculosis, acute kidney injury and pancreatitis--what is the underlying cause?

Clin Kidney J 2012 Aug;5(4):364-5

Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire , UK.

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http://dx.doi.org/10.1093/ckj/sfs084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393487PMC
August 2012

A day at the pool.

Clin Kidney J 2012 Jun 14;5(3):265-8. Epub 2012 Mar 14.

Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

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http://dx.doi.org/10.1093/ckj/sfr180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400497PMC
June 2012

Intermittent peritoneal dialysis: just enough for some or inadequate altogether?

Perit Dial Int 2012 Mar-Apr;32(2):134-6

Division of Nephrology Lancashire Teaching Hospitals NHS Foundation Trust Preston, UK.

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http://dx.doi.org/10.3747/pdi.2011.00228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525394PMC
June 2012

Rhabdomyolysis and elevated liver function tests-what's the underlying cause?

NDT Plus 2011 Dec;4(6):447-8

Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK.

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http://dx.doi.org/10.1093/ndtplus/sfr154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421666PMC
December 2011

Circulating endothelial cells and stroke: influence of stroke subtypes and changes during the course of disease.

J Stroke Cerebrovasc Dis 2012 Aug;21(6):452-8

Department of Nephrology, Hannover Medical School, Hannover, Germany.

Background: Circulating endothelial cells (CECs) are a novel and valuable marker of endothelial damage in a variety of vascular disorders. There is limited information as to CEC counts and the time course of CECs in subtypes of stroke.

Methods: We studied 49 patients with stroke (18 with atherothrombotic infarction in the territory of the middle cerebral artery, 16 with cardioembolic stroke, and 15 with lacunar stroke). We also included 16 healthy controls and 64 disease controls. CECs were isolated and enumerated with lectin-augmented CD146-driven immunomagnetic isolation. Neurologic deficit was assessed with the European Stroke Scale (ESS) and the National Institutes of Health Stroke Scale (NIHSS). Recovery was assessed with the modified Rankin scale (mRS).

Results: Healthy controls had low numbers of CECs (median, 8 cells/mL; mean, 9 cells/mL; range, 0-16 cells/mL; n = 16). Patients with stroke had markedly elevated numbers of CECs at presentation. Patients with atherothrombotic infarction had 32 cells per milliliter (mean, 42 cells/mL; range, 24-116 cells/mL; n = 18; P < .001 when compared to controls). Patients with lacunar stroke had 68 cells per milliliter (mean, 68 cells/mL; range, 8-144 cells/mL; n = 15; P < .001 when compared to controls). Patients with cardioembolic stroke had 46 cells per milliter (mean, 54 cells/mL; range, 24-116 cells/mL; n = 16; P < .001 when compared to healthy controls). There was a tendency towards higher numbers of CECs in lacunar stroke. The number of CECs peaked at day 7 in patients with atherothrombotic infarction and came back to normal at day 90. In contrast, CECs in patients with acute lacunar stroke and cardioembolic stroke decreased progressively until day 90.

Conclusions: CECs are markers of endothelial damage and/or repair in stroke. Differences during the course of disease are likely to reflect different pathophysiology.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2010.11.003DOI Listing
August 2012

tHe USual Suspects.

NDT Plus 2011 Aug 31;4(4):260-3. Epub 2011 Mar 31.

Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK.

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http://dx.doi.org/10.1093/ndtplus/sfr031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421445PMC
August 2011

Routine and emergency management guidelines for the dental patient with renal disease and kidney transplant. Part 2.

Dent Update 2011 May;38(4):245-8, 250-1

Plymouth Hospitals NHS Trust, UK.

Unlabelled: Aimed at the practitioner in Special Care Dentistry, this is the second article in a two-part series providing guidelines on the dental management of renal patients. Dentists working in Special Care Dentistry will frequently be called upon to manage dialysis patients, whether pre- or post-transplant. The following paper deals with guidance as to the assessment, work-up and management of such patients when undergoing specialist dental treatment. The key to safe treatment is careful assessment, discussion and planning with the relevant team members.

Clinical Relevance: This paper provides guidance to the special care dentist for the dental management of patients with renal disease, and highlights issues in patients who are either on dialysis or have a kidney transplant.
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http://dx.doi.org/10.12968/denu.2011.38.4.245DOI Listing
May 2011

SPECT MIBI imaging for cardiac output and index in end stage renal disease.

Hemodial Int 2011 Jul 27;15(3):320-5. Epub 2011 Jun 27.

Department of Nuclear Medicine, Royal Preston Hospital, Fulwood, Preston, UK.

To compare cardiac output (CO) and cardiac index (CI) and left ventricular ejection fraction (LVEF) in end-stage renal disease (ESRD) with a control group using gated single photon emission computed tomography (SPECT)/computed tomography (CT) imaging. Altered cardiovascular function with increased CO secondary to arterio-venous fistulas (AVF) for dialysis has been reported in patients with ESRD. Thirty-two patients (18 with AVF or graft) referred for pre-renal transplant cardiac assessment using SPECT/CT were studied with 2 comparison groups, 42 normal weight (body mass index<30) and 46 obese (body mass index>30) patients. End-stage renal disease patients had overall reduced mean hemoglobin 11.6 mg/dL and elevated mean parathyroid hormone of 396 pg/mL. Gated SPECT using MIBI was performed after Bruce protocol apart from 4 renal patients who underwent cardiac stressing with adenosine. Cardiac output was calculated by product of stroke volume and resting heart rate and CI determined. Mean CI was 2.6 L/min/m(2) for renal disease group compared with 2.2 and 2.3 L/min/m(2) for the normal weight and obese groups, P=0.005 and 0.005 respectively (Wilcoxon's rank test). Cardiac output was increased for the renal group; 4.9 L/min, equal to the obese group but greater than normal weight group at 4.3 L/min. No significant difference in LVEF was seen between the 3 patient groups. No significant difference in CI or output was seen between the renal disease patients with AVF and those without fistulas. Cardiac ouput and CI, assessed using SPECT/CT, are increased in patients with ESRD. This may be independent of the presence of AVF or grafts and other factors such as anemia and hyperparathyroidism may contribute to this high output cardiac function. As LVEF is not increased for these patients, increased heart rate, may also contribute to elevated CO.
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http://dx.doi.org/10.1111/j.1542-4758.2011.00565.xDOI Listing
July 2011
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