Publications
113 results found
Gulati K, McAdoo S, Galliford J, et al., 2018, PLASMAPHERESIS, RITUXIMAB AND LOW-DOSE CYCLOPHOSPHAMIDE FOR REMISSION INDUCTION THERAPY IN SEVERE ANCA-ASSOCIATED VASCULITIS, 55th Congress of the European-Renal-Association (ERA) and European-Dialysis-and-Transplantation-Association (EDTA), Publisher: OXFORD UNIV PRESS, ISSN: 0931-0509
Rashid T, Perinpathasan K, Casley C, et al., 2018, The use of alternative renal monitoring in people living with HIV (PLWH) over the age of 50 to predict renal disease, European AIDS conference, Publisher: WILEY, Pages: S87-S87, ISSN: 1464-2662
Wernig F, Hatfield E, Smith C, et al., 2018, Early Treatment With Rituximab Can Improve Clinical Outcomes In Isolated IgG4- related Hypophysitis, The Endocrine Society Annual Meeting, Publisher: Oxford University Press (OUP), ISSN: 0163-769X
McAdoo SP, Medjeral-Thomas N, Gopaluni S, et al., 2017, Long-term Follow-up of a Combined Rituximab and Cyclophosphamide Regimen in Renal ANCA-associated Vasculitis, Nephrology Dialysis Transplantation, ISSN: 0931-0509
Aydin SZ, Direskeneli H, Merkel PA, 2017, Assessment of Disease Activity in Large-vessel Vasculitis: Results of an International Delphi Exercise, JOURNAL OF RHEUMATOLOGY, Vol: 44, Pages: 1928-1932, ISSN: 0315-162X
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- Citations: 22
McAdoo SP, Tanna A, Hrušková Z, et al., 2017, Patients double-seropositive for ANCA and anti-GBM antibodies have varied renal survival, frequency of relapse, and outcomes compared to single-seropositive patients., Kidney International, Vol: 92, Pages: 693-702, ISSN: 1523-1755
Co-presentation with both ANCA and anti-GBM antibodies is thought to be relatively rare. Current studies of such 'double-positive' cases report small numbers and variable outcomes. To study this further we retrospectively analyzed clinical features and long-term outcomes of a large cohort of 568 contemporary patients with ANCA-associated vasculitis, 41 patients with anti-GBM disease, and 37 double-positive patients with ANCA and anti-GBM disease from four European centers. Double-positive patients shared characteristics of ANCA-associated vasculitis (AAV), such as older age distribution and longer symptom duration before diagnosis, and features of anti-GBM disease, such as severe renal disease and high frequency of lung hemorrhage at presentation. Despite having more evidence of chronic injury on renal biopsy compared to patients with anti-GBM disease, double-positive patients had a greater tendency to recover from being dialysis-dependent after treatment and had intermediate long-term renal survival compared to the single-positive patients. However, overall patient survival was similar in all three groups. Predictors of poor patient survival included advanced age, severe renal failure, and lung hemorrhage at presentation. No single-positive anti-GBM patients experienced disease relapse, whereas approximately half of surviving patients with AAV and double-positive patients had recurrent disease during a median follow-up of 4.8 years. Thus, double-positive patients have a truly hybrid disease phenotype, requiring aggressive early treatment for anti-GBM disease, and careful long-term follow-up and consideration for maintenance immunosuppression for AAV. Since double-positivity appears common, further work is required to define the underlying mechanisms of this association and define optimum treatment strategies.
McAdoo SP, Gopaluni S, Medjeral-Thomas N, et al., 2017, Long-term follow-up of a combined rituximab and low-dose cyclophosphamide regimen for remission induction in renal anca-associated vasculitis, Rheumatology, Vol: 56, Pages: 153-153, ISSN: 1462-0324
Khajuria A, Cheng K, Levy J, 2017, Effect of a national focused course on academic medicine for UK candidates applying for a Clinical Academic Programme, JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH, Vol: 47, Pages: 65-69, ISSN: 1478-2715
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- Citations: 11
Milburn J, Jones R, Levy JB, 2017, Renal effects of novel antiretroviral drugs, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 32, Pages: 434-439, ISSN: 0931-0509
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- Citations: 53
Hamzah L, Jose S, Booth JW, et al., 2017, Treatment-limiting renal tubulopathy in patients treated with tenofovir disoproxil fumarate., Journal of Infection, Vol: 74, Pages: 492-500, ISSN: 1532-2742
OBJECTIVES: Tenofovir disoproxil fumarate (TDF) is widely used in the treatment or prevention of HIV and hepatitis B infection. TDF may cause renal tubulopathy in a small proportion of recipients. We aimed to study the risk factors for developing severe renal tubulopathy. METHODS: We conducted an observational cohort study with retrospective identification of cases of treatment-limiting tubulopathy during TDF exposure. We used multivariate Poisson regression analysis to identify risk factors for tubulopathy, and mixed effects models to analyse adjusted estimated glomerular filtration rate (eGFR) slopes. RESULTS: Between October 2002 and June 2013, 60 (0.4%) of 15,983 patients who had received TDF developed tubulopathy after a median exposure of 44.1 (IQR 20.4, 64.4) months. Tubulopathy cases were predominantly male (92%), of white ethnicity (93%), and exposed to antiretroviral regimens that contained boosted protease inhibitors (PI, 90%). In multivariate analysis, age, ethnicity, CD4 cell count and use of didanosine or PI were significantly associated with tubulopathy. Tubulopathy cases experienced significantly greater eGFR decline while receiving TDF than the comparator group (-6.60 [-7.70, -5.50] vs. -0.34 [-0.43, -0.26] mL/min/1.73 m(2)/year, p < 0.0001). CONCLUSIONS: Older age, white ethnicity, immunodeficiency and co-administration of ddI and PI were risk factors for tubulopathy in patients who received TDF-containing antiretroviral therapy. The presence of rapid eGFR decline identified TDF recipients at increased risk of tubulopathy.
Beckwith H, Medjeral-Thomas N, Galliford J, et al., 2017, Mycophenolate mofetil therapy in immunoglobulin A nephropathy: histological changes after treatment, Nephrology Dialysis Transplantation, Vol: 32, Pages: i123-i128, ISSN: 0931-0509
BackgroundEndocapillary hypercellularity independently predicts renal outcome in immunoglobulin A nephropathy (IgAN). Mycophenolate mofetil (MMF) treatment is offered to patients presenting to the Imperial College Renal and Transplant Centre with IgAN and histological evidence of endocapillary hypercellularity. Clinical trials of MMF in IgAN have been inconclusive and have been limited by a lack of specific histological inclusion and exclusion criteria when recruiting patients. Evidence of histological improvement following MMF treatment would support its therapeutic use. We therefore reviewed histological changes after MMF therapy in a cohort of IgAN patients.MethodEighteen IgAN patients with native renal biopsies before and after repeated MMF treatment were identified. Patients were excluded if they had received any other immunosuppressive therapy, including corticosteroids. On the basis of the Oxford Classification of IgAN, we reviewed histological changes after MMF treatment.ResultsNine patients (50%) were male. At diagnostic renal biopsy, the median age was 35 years [interquartile range (IQR) 30–41], serum creatinine was 97 µmol/L (IQR 79–153) and urine protein creatinine ratio (UPCR) was 146 mg/mmol (IQR 98–212). The median time between biopsies was 24 months (range 9–41). Following MMF treatment, repeat biopsy demonstrated statistically significant improvement in the mean percentage of glomeruli showing endocapillary hypercellularity and cellular/fibrocellular crescents. There was no change in mesangial hypercellularity, segmental sclerosis or tubular atrophy scores. Mesangial IgA deposition was also significantly reduced. Histopathological improvement persisted after the cessation of MMF therapy, suggesting that 2 years of treatment is adequate for benefit. The median serum creatinine remained stable at 3 years follow-up at 104 µmol/L (IQR 79–147).ConclusionMMF treatment is associated with histopathological improveme
Booth JW, Hamzah L, Jose S, et al., 2016, Clinical characteristics and outcomes of HIV-associated immune complex kidney disease, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 31, Pages: 2099-2107, ISSN: 0931-0509
Girometti N, Jones R, Levy J, et al., 2016, Risks and benefits HIV preexposure prophylaxis with tenofovir/emtricitabine in an older male with comorbidities, AIDS, Vol: 30, Pages: 2131-2133, ISSN: 0269-9370
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- Citations: 1
Gathogo E, Harber M, Bhagani S, et al., 2016, Impact of Tacrolimus Compared With Cyclosporin on the Incidence of Acute Allograft Rejection in Human Immunodeficiency Virus-Positive Kidney Transplant Recipients, TRANSPLANTATION, Vol: 100, Pages: 871-878, ISSN: 0041-1337
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- Citations: 26
McAdoo SP, Tanna A, Randone O, et al., 2015, Necrotizing and crescentic glomerulonephritis presenting with preserved renal function in patients with underlying multisystem autoimmune disease: a retrospective case series, RHEUMATOLOGY, Vol: 54, Pages: 1025-1032, ISSN: 1462-0324
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- Citations: 11
Levy J, Connor T, Basu S, 2015, THE REAL-WORLD WORKLOAD AND HEALTH ECONOMIC CONSIDERATIONS OF INITIATING A TREATMENT FOR ADULT POLYCYSTIC KIDNEY DISEASE, 52nd Congress of the European-Renal-Association-European-Dialysis-and-Transplant-Assocation, Publisher: OXFORD UNIV PRESS, ISSN: 0931-0509
Spanos G, Singh S, Charif R, et al., 2015, LOWDOSE UROKINASE INFUSION TO RESTORE THE PATENCY OF TUNNELED CENTRAL VEIN HAEMODIALYSIS CATHETERS, 52nd Congress of the European-Renal-Association-European-Dialysis-and-Transplant-Assocation, Publisher: OXFORD UNIV PRESS, ISSN: 0931-0509
Gathogo E, Davies G, Harber M, et al., 2015, Risk factors for acute allograft rejection in HIV-positive kidney transplant recipients, HIV MEDICINE, Vol: 16, Pages: 8-9, ISSN: 1464-2662
Gathogo E, Jose S, Jones R, et al., 2014, End-Stage Kidney Disease and Kidney Transplantation in HIV-Positive Patients: An Observational Cohort Study, JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, Vol: 67, Pages: 177-180, ISSN: 1525-4135
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- Citations: 16
Tanna A, Guarino L, Tam FWK, et al., 2014, Long-term outcome of anti-neutrophil cytoplasm antibody-associated glomerulonephritis: evaluation of the international histological classification and other prognostic factors, Nephrology Dialysis Transplantation, Vol: 30, Pages: 1185-1192, ISSN: 1460-2385
Background Anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis with renal involvement requires treatment with potentially toxic drugs to reduce morbidity and mortality, and there is a major challenge to determine clinical and histological features predictive of renal prognosis. The aim of our study was to evaluate the use of the 2010 international histological classification for ANCA-associated glomerulonephritis (AAGN) as a predictor of renal outcome when used in conjunction with other prognostic factors.Methods One hundred and four patients with AAGN treated at our centre were included: 23 were classified as focal, 26 as crescentic, 48 as mixed and 7 as sclerotic. Renal outcomes were based on estimated glomerular filtration rate (eGFR) at 1 and 5 years, and on renal survival.Results By univariate analysis, patients in the focal class had the best renal outcome, those in the sclerotic class the worst outcome, and those in the mixed and crescentic classes had intermediate renal survival. There was no significant difference in outcome between the mixed and crescentic classes. In multivariate models, histological class did not improve model fit or associate with renal outcome after adjusting for established prognostic factors. Lower percentage of normal glomeruli, greater degree of tubular atrophy (TA), MPO-ANCA positivity, increasing age and lower starting eGFR, all correlated with poorer renal outcomes.Conclusions We conclude that, in our cohort of patients, the international histological classification is predictive of renal outcome in AAGN, but did not appear to be additionally informative over other established prognostic factors in multivariate analysis. However, it may be of value to combine the current histological classification with other established parameters, such as TA and percentage normal glomeruli.
Beckwith H, Medjeral-Thomas N, Galliford J, et al., 2014, Mycophenolate mofetil therapy in IgA nephropathy: histological changes after treatment, SCOTTISH MEDICAL JOURNAL, Vol: 59, Pages: E26-E26, ISSN: 0036-9330
Yombi JC, Pozniak A, Boffito M, et al., 2014, Antiretrovirals and the kidney in current clinical practice: renal pharmacokinetics, alterations of renal function and renal toxicity, AIDS, Vol: 28, Pages: 621-632, ISSN: 0269-9370
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- Citations: 82
Medjeral-Thomas N, Ziaj S, Condon M, et al., 2014, Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol: 9, Pages: 478-483, ISSN: 1555-9041
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- Citations: 38
Gathogo EN, Hamzah L, Hilton R, et al., 2014, Kidney transplantation in HIV-positive adults: the UK experience, INTERNATIONAL JOURNAL OF STD & AIDS, Vol: 25, Pages: 57-66, ISSN: 0956-4624
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- Citations: 39
Condon MB, Ashby D, Pepper RJ, et al., 2013, Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids, ANNALS OF THE RHEUMATIC DISEASES, Vol: 72, Pages: 1280-1286, ISSN: 0003-4967
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- Citations: 284
Tanna A, Mcadoo S, Tam F, et al., 2013, Long-term outcome in patients with both ANCA and GBM positivity, PRESSE MEDICALE, Vol: 42, Pages: 667-668, ISSN: 0755-4982
Tanna A, Laura G, Tam F, et al., 2013, Factors predictive of prognosis in renal AAV - A study of 104 patients in a single UK centre, PRESSE MEDICALE, Vol: 42, Pages: 670-671, ISSN: 0755-4982
Mcadoo SP, Tanna A, Randone O, et al., 2013, Focal necrotizing and crescentic glomerulonephritis in patients with normal serum creatinine, PRESSE MEDICALE, Vol: 42, Pages: 753-753, ISSN: 0755-4982
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- Citations: 1
Gathogo E, Hamzah L, Hilton R, et al., 2013, Outcomes of kidney transplantation in HIV-positive patients: the UK experience, Spring Meeting for Clinician Scientists in Training, Publisher: ELSEVIER SCIENCE INC, Pages: 43-43, ISSN: 0140-6736
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- Citations: 1
McClure M, Singh GJ, Rayment M, et al., 2012, Clinical outcomes of a combined HIV and renal clinic, Clinical Kidney Journal, Vol: 5, Pages: 530-534, ISSN: 2048-8505
BACKGROUND: Renal disease is an emerging problem in patients living with human immunodeficiency virus (HIV), as illustrated by an increased incidence of acute kidney injury and chronic kidney disease (CKD) from HIV, its associated treatment and comorbidities such as diabetes and vascular disease. We have established a combined HIV-renal clinic to manage such patients, enhance their treatment and minimize outpatient visits. METHODS: We have analysed the outcomes of the first 99 patients seen in the clinic using electronic patient records. These ninety-nine patients were referred to the service from HIV physicians in West London and all the patients were seen jointly by an HIV and a renal consultant. RESULTS: Sixty-five percent of the patients were referred with reduced renal function or proteinuria [mean creatinine at presentation 136 mcmol/L, estimated glomerular filtration rate (eGFR) 57 mL/min/1.73 m(2)]. The majority (53%) had risk factors predisposing to vascular disease including diabetes, hypertension, previous stroke or myocardial infarction. Overall, 27% of patients had a renal diagnosis directly associated with HIV (HIVAN, immune complex nephritis, tenofovir toxicity, Fanconi syndrome), 73% had an alternative possible cause. Twenty-seven percent of patients had low-level proteinuria (urine protein:creatinine ratio abnormal but <100 mg/mmol) or mildly reduced eGFR (40-66 mL/min/1.73 m(2)) without a clear underlying cause. Ten percent of patients were thought to have tenofovir-induced renal damage all of whom improved on cessation of this agent. Following the review in the combined clinic, 64% of patients had a change in treatment or management, with 50% improving their renal parameters as a result. Most patients were discharged back to their main HIV teams for ongoing follow-up. CONCLUSIONS: A combined HIV-renal clinic can enhance patient care with reduced outpatient visits.
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