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Kremser J.,Friedrich - Schiller University of Jena | Kleemann F.,John Walls Renal Unit | Reinhart K.,Friedrich - Schiller University of Jena | Schummer W.,Friedrich - Schiller University of Jena
British Journal of Anaesthesia | Year: 2011

Background Central venous catheter (CVC) placement under ECG guidance in the left thoracocervical area can lead to catheter misplacement. The aim of this study was to identify the cause and quantify the magnitude of this error. Methods CVCs were sited in either the left or right internal jugular (IJ), subclavian (SC), or innominate (brachiocephalic) vein using the Seldinger technique and a total of 227 insertions were studied. The position of the catheter tip was confirmed with two different intra-atrial ECG monitoring methods (Seldingers wire vs 10 saline solution). Measurements were compared between the two methods and correlated to the different access sites. Results All right-sided CVC had the line tip in the optimal position and both intra-atrial ECG recording by Seldingers wire or 10 saline delivered correct results. For left-sided lines, however, the two methods gave significantly different results regarding the position of the line tip for each insertion site. When using the Seldinger wire as intravascular ECG lead, the results differed from the saline method by a mean of 21 mm for the IJ and 10 mm for the SC. Conclusions CVC placement under ECG guidance is a reliable method to site the line tip at the optimal position. However, when using a left-sided thoracocervical access point, the Seldinger wire-conducted ECG delivered a constant error. This could be adjusted for by advancing the CVC 20 mm in addition to the wire-based measurement of the insertion depth at the left IJ vein and 10 mm at the left SC vein. © 2011 The Author. Source

Clapp E.L.,University of Leicester | Bevington A.,University of Leicester | Smith A.C.,John Walls Renal Unit
Pediatric Nephrology | Year: 2012

It is well known that adults suffering from chronic kidney disease (CKD) experience muscle wasting and excessive fatigue, which results in a reduced exercise capacity and muscle weakness compared to their healthy counterparts, but research suggests that this can be improved through exercise. There is very limited data available regarding exercise tolerance in children with CKD and even less on the effects of exercise training programs. However, the available evidence does suggest that like adults, children also suffer from poor exercise capacity and reduced muscle strength, although the reasons for these limitations remain unclear. Studies that have attempted to implement exercise training programs in pediatric CKD populations have experienced high dropout rates, suggesting that the approach used to implement such programs in children needs to be different from the approach used for adults. This review summarizes the current knowledge regarding exercise capacity and muscle strength in children with CKD, the methods used to perform these assessments, and the possible causes of physical limitations. The results of exercise training studies, and the potential reasons as to why training programs have proved relatively unsuccessful are also discussed. © IPNA 2011. Source

Hall M.,Nottingham Transplant and Renal Unit | Brunskill N.J.,John Walls Renal Unit
Obstetrics, Gynaecology and Reproductive Medicine | Year: 2013

Pregnancy in women with chronic kidney disease (CKD) is associated with risks of accelerated decline in renal function in the mother and adverse outcomes for the infant, including prematurity and growth restriction. Managing these risks requires collaboration between patient, nephrologist, neonatologist and obstetrician. In this review we will discuss approaches to managing pregnancy in women with CKD. © 2012. Source

Floege J.,RWTH Aachen | Feehally J.,John Walls Renal Unit
Nature Reviews Nephrology | Year: 2016

Links between IgA nephropathy (IgAN) and the mucosa have been recognized since the 1970s. In particular, the observation of visible haematuria induced by respiratory infections in patients with IgAN and the association of IgAN with diseases in which the mucosa plays a part, especially coeliac disease, have been taken as evidence of a mucosa-kidney axis. Here, we review current evidence that links the mucosa, in particular the gastrointestinal mucosa, and IgA produced by the bone marrow with IgAN. Genome-wide association studies in patients with IgAN have identified risk loci in genes involved in the intestinal mucosal integrity and immune network. Furthermore, the systemic immune response to mucosal antigens in IgAN is increased. Moreover, patients with IgAN have an increased reactivity to dietary proteins associated with subclinical intestinal mucosal inflammation. Associations between IgAN and gastrointestinal diseases have also been reported in a small number of patients, but whether these diseases share a common pathogenesis or whether gastrointestinal inflammation exacerbates IgAN is uncertain. Indeed, mucosal alterations such as infections could activate the innate immune system, aggravate a pre-existing IgAN and promote disease manifestations such as macrohaematuria. Various clinical interventions and trials targeting the mucosa or presumed mucosa-associated mechanisms have so far not yielded consistent findings and the results of ongoing trials are eagerly awaited. © 2016 Macmillan Publishers Limited. Source

Pawluczyk I.Z.A.,University of Leicester | Pawluczyk I.Z.A.,John Walls Renal Unit | Harris K.P.G.,University of Leicester | Harris K.P.G.,John Walls Renal Unit
JRAAS - Journal of the Renin-Angiotensin-Aldosterone System | Year: 2012

Background and aim: The protective role of angiotensin type 2 receptors (AT2-Rs) is still controversial. As AT2-Rs are minimally expressed in adult tissues the aim of the current study was to over-express AT2-Rs in rat mesangial cells in order to ascertain their potential role in modulating renal scarring. Methods: Male and female mesangial cells were transiently transfected with AT2-R or control vector then 'injured' with macrophage-conditioned medium (MCM). Culture supernatants and extracted RNA were analysed for evidence of an anti-fibrotic phenotype.Results: Supernatant fibronectin levels in female mesangial cells treated with MCM were reduced in AT2-R transfected cells (p < 0.001) compared to controls. AT2-R transfected male cells showed a trend towards lower constitutive fibronectin levels. There was no effect of AT2-R transfection on TGF-β or TNF-α secretion; however, IL-Iβ levels were reduced in male cells treated with MCM. RT-PCR demonstrated that constitutive kallikrein mRNA levels were suppressed in both male and female AT2-R transfected cells. Bradykinin receptors (BkB2-R and BkB1-R) were unaffected in female cells although the BkB1-R was upregulated in male cells treated with MCM.Conclusion: This data provides a case for AT2 receptors playing a protective role in rat mesangial cells independent of the effects of blood pressure control. © 2012 The Author(s). Source

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