David Goldsmith | St George's, University of London (original) (raw)
Papers by David Goldsmith
Nephrology Dialysis Transplantation, 2014
Journal of Nephrology, 2021
A recently published nomenclature by a "Kidney Disease Improving Global Outcomes" (KDIGO) Consens... more A recently published nomenclature by a "Kidney Disease Improving Global Outcomes" (KDIGO) Consensus Conference suggested that the word "kidney" should be used in medical writings instead of "renal" or "nephro" when referring to kidney disease and kidney health. Whereas the decade-old move to use "kidney" more frequently should be supported when communicating with the public-at-large, such as the World Kidney Day, or in English speaking countries in communications with patients, care-partners, and non-medical persons, our point of view is that "renal" or "nephro" should not be removed from scientific and technical writings. Instead, the terms can coexist and be used in their relevant contexts. Cardiologists use "heart" and "cardio" as appropriate such as "heart failure" and "cardiac care units" and have not replaced "cardiovascular" with "heartvessel", for instance. Likewise, in nephrology, we consider that "chronic kidney disease" and "continuous renal replacement therapy" should coexist. We suggest that in scientific writings and technical communications, the words "renal" and "nephro" and their derivatives are more appropriate and should be freely used without any pressure by medical journals to compel patients, care-partners, healthcare providers, researchers and other stakeholders to change their selected words and terminologies. We call to embrace the terms "kidney", "renal" and "nephro" as they are used in different contexts and ask that scientific and medical journals not impose terminology restrictions for kidney disease and kidney health. The choice should be at the discretion of the authors, in the different contexts including in scientific journals.
American Journal of Transplantation, 2014
Recent developments in our understanding of vitamin D (VitD) show that it plays a significant rol... more Recent developments in our understanding of vitamin D (VitD) show that it plays a significant role in immunological health, uniquely occupying both an anti-microbial and immunoregulatory niche. VitD deficiency is widespread among renal transplant recipients (RTRs), thus providing one patho-mechanism that may influence the achievement of a successful degree of immunosuppression. It may also influence the development of the infectious, cardiovascular and neoplastic complications seen in RTRs. This review examines the biological roles of VitD in the immune system of relevance to renal transplantation and evaluates whether VitD repletion may be relevant in determining immunologically related clinical outcomes in RTRs (including graft survival, cardiovascular disease and cancer). While there are plausible biological and epidemiological reasons to undertake VitD repletion in RTRs, there are few randomized-controlled trials in this area. Based on the available literature, we cannot at present categorically make the case for routine measurement and repletion of vitamin D in clinical practice but we do suggest that this is an area in urgent need of further randomized-controlled level evidence.
Clinical Science, 1997
1. The correction of metabolic acidosis with sodium bicarbonate remains controversial. Experiment... more 1. The correction of metabolic acidosis with sodium bicarbonate remains controversial. Experiments in vitro have suggested possible deleterious effects after alkalinization of the extracellular fluid. Disequilibrium of carbon dioxide and bicarbonate across cell membranes after alkali administration, leading to the phenomenon of ‘paradoxical’ intracellular acidosis, has been held responsible for some of these adverse effects. 2. Changes in intracellular pH in suspensions of leucocytes from healthy volunteers were monitored using a fluorescent intracellular dye. The effect in vitro of increasing extracellular pH with sodium bicarbonate was studied at different sodium bicarbonate concentrations. Lactic acid and propionic acid were added to the extracellular buffer to mimic conditions of metabolic acidosis. 3. The addition of a large bolus of sodium bicarbonate caused intracellular acidification as has been observed previously. The extent of the intracellular acidosis was dependent on s...
Kidney international, 2016
Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusion... more Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusions given to patients with end-stage renal disease caused iron overload, and the need for supplemental iron was rare. However, with the widespread introduction of ESAs, it was recognized that supplemental iron was necessary to optimize hemoglobin response and allow reduction of the ESA dose for economic reasons and recent concerns about ESA safety. Iron supplementation was also found to be more efficacious via intravenous compared to oral administration, and the use of intravenous iron has escalated in recent years. The safety of various iron compounds has been of theoretical concern due to their potential to induce iron overload, oxidative stress, hypersensitivity reactions, and a permissive environment for infectious processes. Therefore, an expert group was convened to assess the benefits and risks of parenteral iron, and to provide strategies for its optimal use while mitigating the ri...
British Journal of Cancer, 1998
Three out of four patients with primary (light chain) amyloid nephrotic syndrome treated with vin... more Three out of four patients with primary (light chain) amyloid nephrotic syndrome treated with vincristine, doxorubicin and dexamethasone (VAD) induction obtained a partial response and are alive in continuing remission at 4.1, 6.5 and 9.3 years. These preliminary results are of considerable interest and suggest that prospective evaluation of this regimen is warranted in patients with this condition.
F1000 - Post-publication peer review of the biomedical literature, 2009
Regulatory T cells (Treg) are critical regulators of immune tolerance. Both IL-2 and CD28-CD80/ C... more Regulatory T cells (Treg) are critical regulators of immune tolerance. Both IL-2 and CD28-CD80/ CD86 signaling are critical for CD4 + CD25 + FOXP3 + Treg survival in mice. Yet, both belatacept (a second-generation CTLA-4Ig) and basiliximab (an anti-CD25 monoclonal antibody) are among the arsenal of current immunotherapies being used in kidney transplant patients. In this study, we explored the direct effect of basiliximab and belatacept on the Tregs in peripheral blood both in the short term and long term and in kidney biopsies of patients with acute rejection. We report that the combined belatacept/basiliximab therapy has no long-term effect on circulating Tregs when compared to a calcineurin inhibitor (CNI)-treated group. Moreover, belatacept-treated patients had a significantly greater number of FOXP3 + T cells in graft biopsies during acute rejection as compared to CNI-treated patients. Finally, it appears that the basiliximab caused a transient loss of both FOXP3 + and FOXP3 − CD25 + T cells in the circulation in both treatment groups raising important questions about the use of this therapy in tolerance promoting therapeutic protocols.
Journal of nephrology
Patients with chronic kidney disease (CKD) have significantly increased risks of cardiovascular (... more Patients with chronic kidney disease (CKD) have significantly increased risks of cardiovascular (CV) morbidity and mortality. Dyslipidemia is a common disorder in CKD patients. CKD patients have a different lipid profile with increased atherogenic lipid fractions, and serum low-density lipoprotein cholesterol (LDL-C) levels may underestimate the atherogenic effect of LDL-C in these patients. Dyslipidemia may contribute to the increased CV morbidity and mortality, and to the progression of kidney disease in CKD patients. Currently, statins are the pharmacologic intervention of first choice, if lifestyle changes fail adequately to lower LDL-C levels in the setting of normal or moderately elevated triglycerides. Statins have been extensively studied in a large variety of patient populations and have proven efficacy in the treatment of dyslipidemia, and in reducing CV mortality. Although much evidence supports the CV benefits of statins in patients with normal renal function, there are ...
Journal of nephrology
Remarkable advances in understanding the mechanisms of immune recognition and allograft rejection... more Remarkable advances in understanding the mechanisms of immune recognition and allograft rejection have been made in the past few years, leading to the development of innovative immunosuppressive strategies in the field of renal transplantation. Monoclonal antibodies (mAbs) have emerged as a new class of immunosuppressive agents, which appear to be effective (in both the treatment and the prevention of acute rejection) and well-tolerated in renal transplant recipients. The highly specific effects of these drugs make them less toxic than the oral long-term maintenance agents such as corticosteroids and the calcineurin inhibitors. Some of these mAbs have already confirmed their efficacy in preventing acute rejection in clinical phase III studies, and are now part of the well-established immunosuppressive regimens; these are the anti-CD25 mAbs (basiliximab and daclizumab). Other recently developed mAbs, like anti-CD52 (Campath-1H), anti-CD20 (rituximab), anti-LFA-1, anti-ICAM-1 and anti...
Journal of nephrology
Ambulatory blood pressure monitoring (ABPM) has been developed to overcome recognized deficiencie... more Ambulatory blood pressure monitoring (ABPM) has been developed to overcome recognized deficiencies and inaccuracies of classic (office) BP measurements in the diagnosis and management of hypertension (HTN). Although in adults it has become a valuable tool for the diagnosis and ongoing management of HTN, and its use has been documented in over 50 studies in children, few pediatric nephrologists systematically use this approach for HTN assessment. Some of the reluctance to completely embrace the technique comes from the fact that none of the major hypertension trials has been based on ambulatory BP readings. The prognostic information from ABPM studies is slowly accumulating, but there is still relatively little information on the long-term prognostic value of ABPM-derived readings. For children there are particular problems in measuring representative BP values. It would be very helpful to know to what extent ABPM can help. However, there have been few comprehensive reviews in this p...
QJM, 1996
After serious paracetamol overdose, charcoal haemoperfusion was used to remove paracetamol from t... more After serious paracetamol overdose, charcoal haemoperfusion was used to remove paracetamol from the circulation, aiming to reduce the severity of subsequent hepatic damage. Daily long-hours high-flux dialysis was given to patients with grade 111-IV hepatic encephalopathy, and also to those at risk of developing encephalopathy. We reviewed patients treated in this manner who had not received N-acetylcysteine within the first 15 h after overdose. From January 1983 to January 1993, 73 patients with serious paracetamol overdose were seen, of whom 51 received charcoal haemoperfusion and/or high-flux dialysis. Patients who were admitted within the first 42 h after overdose and who received haemoperfusion and/or dialysis had significantly lower peak levels of prothrombin time, bilirubin and creatinine than those who were admitted after 42 h. Mortality was also lower amongst patients admitted before 42 h, at 2/18 (11%) vs. 15/33 (45%), p < 0. 0 5 .
Postgraduate Medical Journal, 1997
Summary A 56-year-old man who received a live-related renal transplant in 1988 was started in 199... more Summary A 56-year-old man who received a live-related renal transplant in 1988 was started in 1995 on the selective angiotensin II antagonist losartan (Dupont-Merke) to treat worsening hypertension. Two months later because of pulmonary oedema, loop diuretics were started. Within two weeks, serum creatinine had increased from 245 to 571 mumol/l, and the patient became oliguric. A systolic bruit was noted over the graft. Renal angiography showed a 90% stenosis of the transplant renal artery. Losartan was withdrawn, with prompt improvement in renal function. A successful percutaneous transluminal angioplasty performed a few days later resulted in further improvement in renal function accompanied by a significant diuresis.
Postgraduate Medical Journal, 1996
The proportion of patients with vasculitis and rapidly progressive nephritis aged 70 years or ove... more The proportion of patients with vasculitis and rapidly progressive nephritis aged 70 years or over has risen from about 10% in the 1980s to over 30% in series reported in the 1990s. This study was undertaken to examine the presentation and outcome of such older patients. Seventeen of 56 patients (30%) who presented at two renal units were aged 70 years or over. Mean creatinine level at presentation was 530 mumol/l, and five patients received dialysis at presentation. Outcome was dependent on three factors, namely comorbid pathology, response to immunosuppressive therapy, and the occurrence in three cases of temporary spontaneous partial remission. Overall patient survival at one and two years was 62.5% and 50%, respectively, and 90% and 100% of surviving patients were independent of dialysis at one and two years, respectively. Response to chemotherapy was excellent, with full rehabilitation in many cases and no deaths directly attributable to adverse effects of immunosuppressive the...
Nephrology Dialysis Transplantation, 1997
phenomenon is not modulated by successful renal transplantation. Background. Ambulatory blood pre... more phenomenon is not modulated by successful renal transplantation. Background. Ambulatory blood pressure recordings have been shown to correlate better with target organ Key words: ambulatory blood pressure; dipper; antidamage than have isolated clinic blood pressure readhypertensives; uraemia ings. There have been some small studies demonstrating that abnormal blood pressure diurnal rhythm is common in uraemia and in patients on renal replacement therapy. Abnormal blood pressure diurnal
... Original Article Urea kinetic modelling—are any of the &amp;amp;#x27;bedside&... more ... Original Article Urea kinetic modelling—are any of the &amp;amp;#x27;bedside&amp;amp;#x27; Kt/V formulae reliable enough?Adrian Covic1, David JA Goldsmith2, Ken Hill3, Michael C. Venning3 and Peter Ackrill3 ... ASAIO Trans 1987; G, Giacchino F. Single pool urea kinetic model (UKM) and 33: 286–288 ...
... Find all citations by this author (default). Or filter your current search. Covic A, Find all... more ... Find all citations by this author (default). Or filter your current search. Covic A, Find all citations by this author (default). Or filter your current search. Goldsmith DJ, Find all citations by this author (default). Or filter your current search. ...
&lt; i&gt; Background and Aim:&lt;/i&gt; Due to increasing eviden... more &lt; i&gt; Background and Aim:&lt;/i&gt; Due to increasing evidence suggesting a link between hyperphosphatemia and cardiovascular disease (CVD), mediated through vascular calcification in patients on dialysis, the following question arises: At what stage of chronic ...
QJM, 1999
Two hundred and eighty-six patients (190 males and alive at 1 January 1996: 44 continuing on HD w... more Two hundred and eighty-six patients (190 males and alive at 1 January 1996: 44 continuing on HD while the other ten had been successfully transplanted. In 96 females) with end-stage renal failure (ESRD) started haemodialysis (HD) at Withington Hospital these 54 patients, mean 24-h ambulatory blood pressure recorded at the date of the study was between 1 January 1968 and 31 December 1986. Of these, 152 (53.1%) were successfully trans-117.6/68.9 mmHg; mean BP for the last 5 years on HD was 136.4/81.2 mmHg. Only four (7.4%) were planted, while 134 had only HD or one transplant lasting <3 months (i.e. total HD interruption <3 regularly taking antihypertensive medication. Left ventricular hypertrophy (LVH) (by ECG) was present months). For the whole group, the probabilities of being alive on long-hours home HD at 10 and 20 in 64.8% of the 54 patients; its prevalence by echocardiography (LVM index >130 g/m2 for men and years were 58.7% and 33.2%, respectively. Mean gross mortality 1968-1986 was 6.5±3.2% per year. >110 g/m2 for women) was 77.5%. Only 10 (18.5%) had symptoms or clinical signs of ischaemic The main causes of death were cardiovascular (36.6%), infection-related (19.2%) and malignancy heart disease and/or peripheral vascular disease. None had cardiac failure symptoms NYHA class (9.6%). Males and younger cohorts had a significantly (p<0.05) higher probability of being alive on 3-4. Our data show a low incidence of all-cause and cardiovascular mortality, confirming those from long-hours home HD than did females and older cohorts. Eighty-two patients (29% of the total group) the Tassin unit in France, and make a medical case for extended haemodialysis treatment hours.
F1000 - Post-publication peer review of the biomedical literature, 2011
BACKGROUND & AIMS-Interleukin (IL)-17-producing CD4 + helper T cells (Th17) mediate mucosal immun... more BACKGROUND & AIMS-Interleukin (IL)-17-producing CD4 + helper T cells (Th17) mediate mucosal immunity and are involved in the pathogenesis of inflammatory bowel disease (IBD). They are believed to arise from the same precursor population as regulatory T (Treg) cells, but little is known about how these T-cell subsets interact under chronic inflammatory conditions. We studied Th17 cells and Treg cells isolated from intestinal lamina propria of patients with inflammatory bowel disease (IBD) to investigate their role in pathogenesis. METHODS-FoxP3 expression (a marker of Treg cells) and IL-17 production were assessed in CD4 + lamina propria lymphocytes (LPLs) isolated from IBD patients and healthy subjects. IL17 + FoxP3 + and IL-17 + CD4 + T-cell clones were generated by limiting dilution. An in vitro suppression assay was performed to assess the functional capacity of derived T-cell clones. RESULTS-IL17 + FoxP3 + T cells were identified in inflamed intestinal mucosa of patients with Crohn's disease (CD), but not in patients with ulcerative colitis (UC) or healthy controls. These cells shared phenotypic characteristics of Th17 and Treg cells, and showed potent suppressor activity in vitro. Transforming growth factor-® was necessary and sufficient to induce development of a IL17 + FoxP3 + cell population in CD4 + LPLs derived from patients with UC. CONCLUSIONS-The inflammatory environment in the intestinal mucosa of patients with CD contributes to the generation of a distinct population of Treg cells that are FoxP3 + and produce IL-17. These cells are likely to arise during differentiation of Th17 and Treg cells. Specific microenvironmental cues from tissues are likely to determine their commitment to either lineage and affect the balance between regulation and inflammation in the intestine.
Nephrology Dialysis Transplantation, 2014
Journal of Nephrology, 2021
A recently published nomenclature by a "Kidney Disease Improving Global Outcomes" (KDIGO) Consens... more A recently published nomenclature by a "Kidney Disease Improving Global Outcomes" (KDIGO) Consensus Conference suggested that the word "kidney" should be used in medical writings instead of "renal" or "nephro" when referring to kidney disease and kidney health. Whereas the decade-old move to use "kidney" more frequently should be supported when communicating with the public-at-large, such as the World Kidney Day, or in English speaking countries in communications with patients, care-partners, and non-medical persons, our point of view is that "renal" or "nephro" should not be removed from scientific and technical writings. Instead, the terms can coexist and be used in their relevant contexts. Cardiologists use "heart" and "cardio" as appropriate such as "heart failure" and "cardiac care units" and have not replaced "cardiovascular" with "heartvessel", for instance. Likewise, in nephrology, we consider that "chronic kidney disease" and "continuous renal replacement therapy" should coexist. We suggest that in scientific writings and technical communications, the words "renal" and "nephro" and their derivatives are more appropriate and should be freely used without any pressure by medical journals to compel patients, care-partners, healthcare providers, researchers and other stakeholders to change their selected words and terminologies. We call to embrace the terms "kidney", "renal" and "nephro" as they are used in different contexts and ask that scientific and medical journals not impose terminology restrictions for kidney disease and kidney health. The choice should be at the discretion of the authors, in the different contexts including in scientific journals.
American Journal of Transplantation, 2014
Recent developments in our understanding of vitamin D (VitD) show that it plays a significant rol... more Recent developments in our understanding of vitamin D (VitD) show that it plays a significant role in immunological health, uniquely occupying both an anti-microbial and immunoregulatory niche. VitD deficiency is widespread among renal transplant recipients (RTRs), thus providing one patho-mechanism that may influence the achievement of a successful degree of immunosuppression. It may also influence the development of the infectious, cardiovascular and neoplastic complications seen in RTRs. This review examines the biological roles of VitD in the immune system of relevance to renal transplantation and evaluates whether VitD repletion may be relevant in determining immunologically related clinical outcomes in RTRs (including graft survival, cardiovascular disease and cancer). While there are plausible biological and epidemiological reasons to undertake VitD repletion in RTRs, there are few randomized-controlled trials in this area. Based on the available literature, we cannot at present categorically make the case for routine measurement and repletion of vitamin D in clinical practice but we do suggest that this is an area in urgent need of further randomized-controlled level evidence.
Clinical Science, 1997
1. The correction of metabolic acidosis with sodium bicarbonate remains controversial. Experiment... more 1. The correction of metabolic acidosis with sodium bicarbonate remains controversial. Experiments in vitro have suggested possible deleterious effects after alkalinization of the extracellular fluid. Disequilibrium of carbon dioxide and bicarbonate across cell membranes after alkali administration, leading to the phenomenon of ‘paradoxical’ intracellular acidosis, has been held responsible for some of these adverse effects. 2. Changes in intracellular pH in suspensions of leucocytes from healthy volunteers were monitored using a fluorescent intracellular dye. The effect in vitro of increasing extracellular pH with sodium bicarbonate was studied at different sodium bicarbonate concentrations. Lactic acid and propionic acid were added to the extracellular buffer to mimic conditions of metabolic acidosis. 3. The addition of a large bolus of sodium bicarbonate caused intracellular acidification as has been observed previously. The extent of the intracellular acidosis was dependent on s...
Kidney international, 2016
Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusion... more Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusions given to patients with end-stage renal disease caused iron overload, and the need for supplemental iron was rare. However, with the widespread introduction of ESAs, it was recognized that supplemental iron was necessary to optimize hemoglobin response and allow reduction of the ESA dose for economic reasons and recent concerns about ESA safety. Iron supplementation was also found to be more efficacious via intravenous compared to oral administration, and the use of intravenous iron has escalated in recent years. The safety of various iron compounds has been of theoretical concern due to their potential to induce iron overload, oxidative stress, hypersensitivity reactions, and a permissive environment for infectious processes. Therefore, an expert group was convened to assess the benefits and risks of parenteral iron, and to provide strategies for its optimal use while mitigating the ri...
British Journal of Cancer, 1998
Three out of four patients with primary (light chain) amyloid nephrotic syndrome treated with vin... more Three out of four patients with primary (light chain) amyloid nephrotic syndrome treated with vincristine, doxorubicin and dexamethasone (VAD) induction obtained a partial response and are alive in continuing remission at 4.1, 6.5 and 9.3 years. These preliminary results are of considerable interest and suggest that prospective evaluation of this regimen is warranted in patients with this condition.
F1000 - Post-publication peer review of the biomedical literature, 2009
Regulatory T cells (Treg) are critical regulators of immune tolerance. Both IL-2 and CD28-CD80/ C... more Regulatory T cells (Treg) are critical regulators of immune tolerance. Both IL-2 and CD28-CD80/ CD86 signaling are critical for CD4 + CD25 + FOXP3 + Treg survival in mice. Yet, both belatacept (a second-generation CTLA-4Ig) and basiliximab (an anti-CD25 monoclonal antibody) are among the arsenal of current immunotherapies being used in kidney transplant patients. In this study, we explored the direct effect of basiliximab and belatacept on the Tregs in peripheral blood both in the short term and long term and in kidney biopsies of patients with acute rejection. We report that the combined belatacept/basiliximab therapy has no long-term effect on circulating Tregs when compared to a calcineurin inhibitor (CNI)-treated group. Moreover, belatacept-treated patients had a significantly greater number of FOXP3 + T cells in graft biopsies during acute rejection as compared to CNI-treated patients. Finally, it appears that the basiliximab caused a transient loss of both FOXP3 + and FOXP3 − CD25 + T cells in the circulation in both treatment groups raising important questions about the use of this therapy in tolerance promoting therapeutic protocols.
Journal of nephrology
Patients with chronic kidney disease (CKD) have significantly increased risks of cardiovascular (... more Patients with chronic kidney disease (CKD) have significantly increased risks of cardiovascular (CV) morbidity and mortality. Dyslipidemia is a common disorder in CKD patients. CKD patients have a different lipid profile with increased atherogenic lipid fractions, and serum low-density lipoprotein cholesterol (LDL-C) levels may underestimate the atherogenic effect of LDL-C in these patients. Dyslipidemia may contribute to the increased CV morbidity and mortality, and to the progression of kidney disease in CKD patients. Currently, statins are the pharmacologic intervention of first choice, if lifestyle changes fail adequately to lower LDL-C levels in the setting of normal or moderately elevated triglycerides. Statins have been extensively studied in a large variety of patient populations and have proven efficacy in the treatment of dyslipidemia, and in reducing CV mortality. Although much evidence supports the CV benefits of statins in patients with normal renal function, there are ...
Journal of nephrology
Remarkable advances in understanding the mechanisms of immune recognition and allograft rejection... more Remarkable advances in understanding the mechanisms of immune recognition and allograft rejection have been made in the past few years, leading to the development of innovative immunosuppressive strategies in the field of renal transplantation. Monoclonal antibodies (mAbs) have emerged as a new class of immunosuppressive agents, which appear to be effective (in both the treatment and the prevention of acute rejection) and well-tolerated in renal transplant recipients. The highly specific effects of these drugs make them less toxic than the oral long-term maintenance agents such as corticosteroids and the calcineurin inhibitors. Some of these mAbs have already confirmed their efficacy in preventing acute rejection in clinical phase III studies, and are now part of the well-established immunosuppressive regimens; these are the anti-CD25 mAbs (basiliximab and daclizumab). Other recently developed mAbs, like anti-CD52 (Campath-1H), anti-CD20 (rituximab), anti-LFA-1, anti-ICAM-1 and anti...
Journal of nephrology
Ambulatory blood pressure monitoring (ABPM) has been developed to overcome recognized deficiencie... more Ambulatory blood pressure monitoring (ABPM) has been developed to overcome recognized deficiencies and inaccuracies of classic (office) BP measurements in the diagnosis and management of hypertension (HTN). Although in adults it has become a valuable tool for the diagnosis and ongoing management of HTN, and its use has been documented in over 50 studies in children, few pediatric nephrologists systematically use this approach for HTN assessment. Some of the reluctance to completely embrace the technique comes from the fact that none of the major hypertension trials has been based on ambulatory BP readings. The prognostic information from ABPM studies is slowly accumulating, but there is still relatively little information on the long-term prognostic value of ABPM-derived readings. For children there are particular problems in measuring representative BP values. It would be very helpful to know to what extent ABPM can help. However, there have been few comprehensive reviews in this p...
QJM, 1996
After serious paracetamol overdose, charcoal haemoperfusion was used to remove paracetamol from t... more After serious paracetamol overdose, charcoal haemoperfusion was used to remove paracetamol from the circulation, aiming to reduce the severity of subsequent hepatic damage. Daily long-hours high-flux dialysis was given to patients with grade 111-IV hepatic encephalopathy, and also to those at risk of developing encephalopathy. We reviewed patients treated in this manner who had not received N-acetylcysteine within the first 15 h after overdose. From January 1983 to January 1993, 73 patients with serious paracetamol overdose were seen, of whom 51 received charcoal haemoperfusion and/or high-flux dialysis. Patients who were admitted within the first 42 h after overdose and who received haemoperfusion and/or dialysis had significantly lower peak levels of prothrombin time, bilirubin and creatinine than those who were admitted after 42 h. Mortality was also lower amongst patients admitted before 42 h, at 2/18 (11%) vs. 15/33 (45%), p < 0. 0 5 .
Postgraduate Medical Journal, 1997
Summary A 56-year-old man who received a live-related renal transplant in 1988 was started in 199... more Summary A 56-year-old man who received a live-related renal transplant in 1988 was started in 1995 on the selective angiotensin II antagonist losartan (Dupont-Merke) to treat worsening hypertension. Two months later because of pulmonary oedema, loop diuretics were started. Within two weeks, serum creatinine had increased from 245 to 571 mumol/l, and the patient became oliguric. A systolic bruit was noted over the graft. Renal angiography showed a 90% stenosis of the transplant renal artery. Losartan was withdrawn, with prompt improvement in renal function. A successful percutaneous transluminal angioplasty performed a few days later resulted in further improvement in renal function accompanied by a significant diuresis.
Postgraduate Medical Journal, 1996
The proportion of patients with vasculitis and rapidly progressive nephritis aged 70 years or ove... more The proportion of patients with vasculitis and rapidly progressive nephritis aged 70 years or over has risen from about 10% in the 1980s to over 30% in series reported in the 1990s. This study was undertaken to examine the presentation and outcome of such older patients. Seventeen of 56 patients (30%) who presented at two renal units were aged 70 years or over. Mean creatinine level at presentation was 530 mumol/l, and five patients received dialysis at presentation. Outcome was dependent on three factors, namely comorbid pathology, response to immunosuppressive therapy, and the occurrence in three cases of temporary spontaneous partial remission. Overall patient survival at one and two years was 62.5% and 50%, respectively, and 90% and 100% of surviving patients were independent of dialysis at one and two years, respectively. Response to chemotherapy was excellent, with full rehabilitation in many cases and no deaths directly attributable to adverse effects of immunosuppressive the...
Nephrology Dialysis Transplantation, 1997
phenomenon is not modulated by successful renal transplantation. Background. Ambulatory blood pre... more phenomenon is not modulated by successful renal transplantation. Background. Ambulatory blood pressure recordings have been shown to correlate better with target organ Key words: ambulatory blood pressure; dipper; antidamage than have isolated clinic blood pressure readhypertensives; uraemia ings. There have been some small studies demonstrating that abnormal blood pressure diurnal rhythm is common in uraemia and in patients on renal replacement therapy. Abnormal blood pressure diurnal
... Original Article Urea kinetic modelling—are any of the &amp;amp;#x27;bedside&... more ... Original Article Urea kinetic modelling—are any of the &amp;amp;#x27;bedside&amp;amp;#x27; Kt/V formulae reliable enough?Adrian Covic1, David JA Goldsmith2, Ken Hill3, Michael C. Venning3 and Peter Ackrill3 ... ASAIO Trans 1987; G, Giacchino F. Single pool urea kinetic model (UKM) and 33: 286–288 ...
... Find all citations by this author (default). Or filter your current search. Covic A, Find all... more ... Find all citations by this author (default). Or filter your current search. Covic A, Find all citations by this author (default). Or filter your current search. Goldsmith DJ, Find all citations by this author (default). Or filter your current search. ...
&lt; i&gt; Background and Aim:&lt;/i&gt; Due to increasing eviden... more &lt; i&gt; Background and Aim:&lt;/i&gt; Due to increasing evidence suggesting a link between hyperphosphatemia and cardiovascular disease (CVD), mediated through vascular calcification in patients on dialysis, the following question arises: At what stage of chronic ...
QJM, 1999
Two hundred and eighty-six patients (190 males and alive at 1 January 1996: 44 continuing on HD w... more Two hundred and eighty-six patients (190 males and alive at 1 January 1996: 44 continuing on HD while the other ten had been successfully transplanted. In 96 females) with end-stage renal failure (ESRD) started haemodialysis (HD) at Withington Hospital these 54 patients, mean 24-h ambulatory blood pressure recorded at the date of the study was between 1 January 1968 and 31 December 1986. Of these, 152 (53.1%) were successfully trans-117.6/68.9 mmHg; mean BP for the last 5 years on HD was 136.4/81.2 mmHg. Only four (7.4%) were planted, while 134 had only HD or one transplant lasting <3 months (i.e. total HD interruption <3 regularly taking antihypertensive medication. Left ventricular hypertrophy (LVH) (by ECG) was present months). For the whole group, the probabilities of being alive on long-hours home HD at 10 and 20 in 64.8% of the 54 patients; its prevalence by echocardiography (LVM index >130 g/m2 for men and years were 58.7% and 33.2%, respectively. Mean gross mortality 1968-1986 was 6.5±3.2% per year. >110 g/m2 for women) was 77.5%. Only 10 (18.5%) had symptoms or clinical signs of ischaemic The main causes of death were cardiovascular (36.6%), infection-related (19.2%) and malignancy heart disease and/or peripheral vascular disease. None had cardiac failure symptoms NYHA class (9.6%). Males and younger cohorts had a significantly (p<0.05) higher probability of being alive on 3-4. Our data show a low incidence of all-cause and cardiovascular mortality, confirming those from long-hours home HD than did females and older cohorts. Eighty-two patients (29% of the total group) the Tassin unit in France, and make a medical case for extended haemodialysis treatment hours.
F1000 - Post-publication peer review of the biomedical literature, 2011
BACKGROUND & AIMS-Interleukin (IL)-17-producing CD4 + helper T cells (Th17) mediate mucosal immun... more BACKGROUND & AIMS-Interleukin (IL)-17-producing CD4 + helper T cells (Th17) mediate mucosal immunity and are involved in the pathogenesis of inflammatory bowel disease (IBD). They are believed to arise from the same precursor population as regulatory T (Treg) cells, but little is known about how these T-cell subsets interact under chronic inflammatory conditions. We studied Th17 cells and Treg cells isolated from intestinal lamina propria of patients with inflammatory bowel disease (IBD) to investigate their role in pathogenesis. METHODS-FoxP3 expression (a marker of Treg cells) and IL-17 production were assessed in CD4 + lamina propria lymphocytes (LPLs) isolated from IBD patients and healthy subjects. IL17 + FoxP3 + and IL-17 + CD4 + T-cell clones were generated by limiting dilution. An in vitro suppression assay was performed to assess the functional capacity of derived T-cell clones. RESULTS-IL17 + FoxP3 + T cells were identified in inflamed intestinal mucosa of patients with Crohn's disease (CD), but not in patients with ulcerative colitis (UC) or healthy controls. These cells shared phenotypic characteristics of Th17 and Treg cells, and showed potent suppressor activity in vitro. Transforming growth factor-® was necessary and sufficient to induce development of a IL17 + FoxP3 + cell population in CD4 + LPLs derived from patients with UC. CONCLUSIONS-The inflammatory environment in the intestinal mucosa of patients with CD contributes to the generation of a distinct population of Treg cells that are FoxP3 + and produce IL-17. These cells are likely to arise during differentiation of Th17 and Treg cells. Specific microenvironmental cues from tissues are likely to determine their commitment to either lineage and affect the balance between regulation and inflammation in the intestine.