Publications
226 results found
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
Lightstone L, 2014, Prepregnancy counselling and risk assessment: General overview, Renal Disease in Pregnancy, Pages: 22-29, ISBN: 9781904752592
Women with kidney disease have an increased risk of adverse maternal and fetal outcomes and it is now recognised that kidney disease is much more common than previously appreciated. By using an estimation of glomerular filtration rate (eGFR) rather than serum creatinine to assess renal function, between 3% and 10% of women of childbearing age might be defined as having chronic kidney disease (CKD). Physicians in both primary and secondary care need to be alert to advising women with renal disease that they might be at risk, but they need guidelines as to who to alert and how to advise on the degree of risk. This chapter will address these issues in more detail. The aim is to advise all women who are at increased risk of that risk prior to conception — not only so that appropriate investigations and medication changes can be implemented safely well in advance but to avoid the emotional trauma of only discovering, once pregnant, that pregnancy might be associated with long-term complications. Importantly, many women with kidney disease may be entirely unaware that their condition could affect a pregnancy. Who should have prepregnancy counselling? The role of prepregnancy advice is to make a woman and her partner aware of the risks a pregnancy may pose to her health and that of the fetus, to give guidance as to the best time to contemplate pregnancy (i.e. sooner, if she has progressive renal disease, or later, if she has a relapsing condition that has recently flared), and to provide the opportunity to optimise treatment to ensure she is not on teratogenic medications at the time of conception and to focus her on the need for optimal control of risk factors such as hypertension and hyperglycaemia.
Beckwith H, Lightstone L, 2014, Rituximab in Systemic Lupus Erythematosus and Lupus Nephritis, NEPHRON CLINICAL PRACTICE, Vol: 128, Pages: 250-254, ISSN: 1660-2110
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- Citations: 29
Wilkinson E, Randhawa G, Hall M, et al., 2013, The impact of national chronic kidney disease management guidelines in the United Kingdom on referral patterns for South Asian and european patients with type 2 diabetes mellitus, Global Public Health Policy, Pages: 225-249, ISBN: 9781624177194
Background: South Asian patients with type 2 diabetes mellitus in the United Kingdom are over 10 times more likely to progress to end-stage renal disease than European patients. It is unclear whether this is due to late interaction with primary care, late referral to secondary care, suboptimal treatment with protective therapies or increased rates of progression among South Asian patients. This study investigated the demographic and clinical status of South Asian and European patients at the time of referral to renal service, before and after the introduction of national CKD management guidelines. The study also sought to understand patient experiences. Method: A mixed-methods approach was undertaken combining audit and patient interviews. The audit consisted of a retrospective, observational study comparing all South Asian and European patients with type 2 diabetes referred to 4 specialist renal services in the United Kingdom in 2004 and in 2007. Univariate and multivariate analyses were performed. For the patient interviews, newly referred South Asian and White European patients with diabetes over 16 years were recruited from nephrology outpatient clinics in three UK centres - Luton, West London and Leicester. A semi-structured qualitative interview was conducted with 48 patients and a thematic analysis of the data produced is reported. Results: The national audit shows that South Asian patients were younger than European patients at the time of referral (2004: European (E) 70.1±10.5 vs South Asian (SA) 63.0±12.1 years, p<0.001) with less advanced renal disease (2004: eGFR E 40.7±19.6 vs SA 47.3±24.8 ml/min, p=0.006). Following introduction of national CKD guidelines, patients were referred with more advanced renal disease although the decrease in mean eGFR was less pronounced for South Asian patients (2007: eGFR E 32.7±12.4 (- 8.0) vs SA 42.8±23.1 (-4.5) ml/min, p=0.001). These differences were not accounted for by pre
Arulkumaran N, Lightstone L, 2013, Severe pre-eclampsia and hypertensive crises, BEST PRACTICE & RESEARCH CLINICAL OBSTETRICS & GYNAECOLOGY, Vol: 27, Pages: 877-884, ISSN: 1521-6934
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- Citations: 63
Griffin B, Lightstone L, 2013, Renoprotective strategies in lupus nephritis: beyond immunosuppression, LUPUS, Vol: 22, Pages: 1267-1273, ISSN: 0961-2033
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- Citations: 16
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
Bertsias G, Tektonidou M, Amoura Z, et al., 2013, JOINT EULAR/ERA-EDTA RECOMMENDATIONS FOR THE MANAGEMENT OF ADULT AND PEDIATRIC LUPUS NEPHRITIS, ANNALS OF THE RHEUMATIC DISEASES, Vol: 71, Pages: 74-75, ISSN: 0003-4967
Lightstone L, 2013, Minimising steroids in lupus nephritis - will B cell depletion pave the way?, LUPUS, Vol: 22, Pages: 390-399, ISSN: 0961-2033
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- Citations: 21
Bramham K, Chusney G, Lee J, et al., 2013, Breastfeeding and Tacrolimus: Serial Monitoring in Breast-Fed and Bottle-Fed Infants, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol: 8, Pages: 563-567, ISSN: 1555-9041
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- Citations: 78
Wilkinson E, Randhawa G, Feehally J, et al., 2012, A multi-centre qualitative study exploring the experiences of UK South Asian and White Diabetic Patients referred for renal care, BMC NEPHROLOGY, Vol: 13
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- Citations: 4
Sundel R, Solomons N, Lisk L, 2012, Efficacy of mycophenolate mofetil in adolescent patients with lupus nephritis: evidence from a two-phase, prospective randomized trial, LUPUS, Vol: 21, Pages: 1433-1443, ISSN: 0961-2033
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- Citations: 34
Bertsias GK, Tektonidou M, Amoura Z, et al., 2012, Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis, ANNALS OF THE RHEUMATIC DISEASES, Vol: 71, Pages: 1771-1782, ISSN: 0003-4967
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- Citations: 701
Okada Y, Sim X, Go MJ, et al., 2012, Meta-analysis identifies multiple loci associated with kidney function-related traits in east Asian populations, NATURE GENETICS, Vol: 44, Pages: 904-+, ISSN: 1061-4036
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- Citations: 220
Lawrence C, Cook HT, Lightstone L, 2012, Seasonal relapsing minimal change disease: a novel strategy for avoiding long-term immunosuppression., Case Rep Nephrol Urol, Vol: 2, Pages: 102-107
BACKGROUND: We describe the case of a young woman with seasonal allergic rhinitis who presented with signs of a lower respiratory tract infection, acute renal impairment and the nephrotic syndrome, demonstrated on biopsy to be due to minimal change disease (MCD) with acute tubular injury. Following initiation of high-dose corticosteroids, her respiratory symptoms and renal impairment improved, and the nephrotic syndrome went rapidly into remission, but relapsed, off treatment, in a seasonal fashion. MANAGEMENT: In view of significant side effects related to corticosteroids, relapses were treated with the calcineurin inhibitor tacrolimus with excellent effect, but the patient was keen to avoid the complications of medium-term immunosuppression and so the drug was weaned early. She relapsed for the second time, whilst off tacrolimus, at the same time of year as at her initial presentation. In subsequent years we have successfully managed this patient with seasonal relapsing MCD with seasonal prophylactic tacrolimus therapy. DISCUSSION: We discuss the natural history of MCD and treatment options and demonstrate the utility of a clear understanding of the natural history of the condition in order to predict disease relapse and tailor therapy to the individual patient.
Bramham K, Lightstone L, 2012, Pre-pregnancy counseling for women with chronic kidney disease, JOURNAL OF NEPHROLOGY, Vol: 25, Pages: 450-459, ISSN: 1121-8428
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- Citations: 35
Lightstone L, 2012, The Landscape After LUNAR: Rituximab's Crater-Filled Path, ARTHRITIS AND RHEUMATISM, Vol: 64, Pages: 962-965, ISSN: 0004-3591
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- Citations: 28
Dooley MA, Jayne D, Ginzler EM, et al., 2011, Mycophenolate versus Azathioprine as Maintenance Therapy for Lupus Nephritis, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 365, Pages: 1886-1895, ISSN: 0028-4793
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- Citations: 412
Ehret GB, Munroe PB, Rice KM, et al., 2011, Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk, NATURE, Vol: 478, Pages: 103-109, ISSN: 0028-0836
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- Citations: 1509
Wain LV, Verwoert GC, O'Reilly PF, et al., 2011, Genome-wide association study identifies six new loci influencing pulse pressure and mean arterial pressure, NATURE GENETICS, Vol: 43, Pages: 1005-U122, ISSN: 1061-4036
Numerous genetic loci have been associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in Europeans1,2,3. We now report genome-wide association studies of pulse pressure (PP) and mean arterial pressure (MAP). In discovery (N = 74,064) and follow-up studies (N = 48,607), we identified at genome-wide significance (P = 2.7 × 10−8 to P = 2.3 × 10−13) four new PP loci (at 4q12 near CHIC2, 7q22.3 near PIK3CG, 8q24.12 in NOV and 11q24.3 near ADAMTS8), two new MAP loci (3p21.31 in MAP4 and 10q25.3 near ADRB1) and one locus associated with both of these traits (2q24.3 near FIGN) that has also recently been associated with SBP in east Asians. For three of the new PP loci, the estimated effect for SBP was opposite of that for DBP, in contrast to the majority of common SBP- and DBP-associated variants, which show concordant effects on both traits. These findings suggest new genetic pathways underlying blood pressure variation, some of which may differentially influence SBP and DBP.
Chusney GD, Bramham K, Nelson-Piercy C, et al., 2011, Tacrolimus monitoring during breastfeeding in neonates of transplant recipients, 12th International Congress of Therapeutic Drug Monitoring and Clinical Toxicology, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 476-476, ISSN: 0163-4356
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- Citations: 4
Chusney GD, Lightstone L, Cairns T, et al., 2011, Quantification of hydroxychloroquine in whole blood samples by LC-MS/MS, 12th International Congress of Therapeutic Drug Monitoring and Clinical Toxicology, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 500-500, ISSN: 0163-4356
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- Citations: 1
Wilkinson E, Randhawa G, Farrington K, et al., 2011, Lack of awareness of kidney complications despite familiarity with diabetes: a multi-ethnic qualitative study., J Ren Care, Vol: 37, Pages: 2-11
BACKGROUND: Comparing South Asians with White Europeans and examining the cultural context of any observed differences is a necessary step in achieving culturally competent services and in helping to reduce inequalities which exist in outcomes for South Asian patients with End Stage Renal Disease. METHODS: Newly referred South Asian and White adult patients with diabetes were recruited from nephrology outpatient clinics in three UK centres--Luton, West London and Leicester. A semi-structured qualitative interview was conducted with 48 patients and a thematic analysis of the data produced is reported. RESULTS: Access to knowledge about renal complications of diabetes, was related to referral to renal services and recent monitoring and not to previous medical encounters. South Asian patients were aware of the high prevalence of diabetes within South Asian communities and a small number reported experience of kidney problems in other family members although any connection with diabetes was not made. CONCLUSION: Ongoing renal care information should be provided to people with diabetes and the cultural context of any information exchange needs to be addressed.
Lightstone L, 2011, Renal disease and pregnancy, Medicine, Vol: 39, Pages: 497-501, ISSN: 1357-3039
Women with renal disease should be counselled about the risks pregnancy may pose to them and their fetus before they conceive. Although worse baseline function and hypertension are associated with worse outcome, all women with renal disease should be advised whether their medication needs to be modified, whether they are likely to suffer irreversible renal damage, and that they have a higher risk of pre-eclampsia with its attendant risks to the fetus. They need to consider the implications of the possibility of having a premature baby. Pregnancy-induced renal disease is less common and renal failure is rare. The commonest causes are those associated with severe pre-eclampsia and are usually managed by early delivery. Proteinuria can persist for months after pre-eclampsia. Women with renal disease who present in pregnancy need to be assessed and a diagnosis made where possible. If their disease is relatively mild, they can be managed expectantly and monitored post partum. A key issue facing women who present in pregnancy is ensuring appropriate nephrological follow-up to ensure that a diagnosis is secured and a proper management plan is in place. Women with renal disease must generally be considered as having high-risk pregnancies; they need to be aware of this and to be managed in a centre with appropriate obstetric and renal expertise. © 2011 Elsevier Ltd. All rights reserved.
Hall M, Wilkinson E, Chadna S, et al., 2010, Ethnic differences in renal referral patterns following national CKD guidelines, CLINICAL NEPHROLOGY, Vol: 74, Pages: S152-S153, ISSN: 0301-0430
Bramham K, Lightstone L, Taylor J, et al., 2010, Pregnancy in pancreas-kidney transplant recipients: report of three cases and review of the literature., Obstet Med, Vol: 3, Pages: 73-77, ISSN: 1753-495X
Seventy-three pregnancies in 43 women with SPK have now been described by the US National Transplantation Pregnancy Registry (NTPR) (established in 1991), which contains self-reported data from questionnaires and hospital records. These women have high rates of complications despite normoglycaemia and restoration of renal function. We describe the pregnancies of three SPK recipients in the UK managed in joint renal obstetric clinics and discuss the antenatal and postnatal complications specific to SPK transplants.
Chambers JC, Zhang W, Lord GM, et al., 2010, Genetic loci influencing kidney function and chronic kidney disease, NATURE GENETICS, Vol: 42, Pages: 373-375, ISSN: 1061-4036
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- Citations: 215
Lightstone L, 2010, Lupus nephritis: where are we now?, CURRENT OPINION IN RHEUMATOLOGY, Vol: 22, Pages: 252-256, ISSN: 1040-8711
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- Citations: 30
Pepper R, Griffith M, Kirwan C, et al., 2009, Rituximab is an effective treatment for lupus nephritis and allows a reduction in maintenance steroids, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 24, Pages: 3717-3723, ISSN: 0931-0509
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- Citations: 121
Doerner T, Isenberg D, Jayne D, et al., 2009, Current status on B-cell depletion therapy in autoimmune diseases other than rheumatoid arthritis, AUTOIMMUNITY REVIEWS, Vol: 9, Pages: 82-89, ISSN: 1568-9972
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- Citations: 52
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