Salford Royal NHS Foundation Trust
Salford Royal NHS Foundation Trust is one of the major sites in the UK for renal care and research.
The group has an international reputation for its work in atherosclerotic renovascular disease, cardio-renal disease and chronic kidney disease. We have one of the largest peritoneal dialysis patient populations and consequently support research in this area as well as haemodialysis. Salford Royal is also the principle centre for the UK Calciphylaxis Study, which is part of an international collaboration that aims to learn more about this rare condition.
Salford Royal is the home of the CRISIS (Chronic Renal Insufficiency Standards Implementation Study) project, which has one of the largest patient chronic kidney disease cohorts in the world. The study, which started in 2002, highlights the risk factors associated with more rapid progression of chronic kidney disease and so helps target people at greater risk for higher level care. Around 300 patients a year join the study, which has its own biobank containing 35,000 separate samples to help researchers carry out their work.
As part of the Vascular Research Group, we are fortunate to be able to work with our diabetes and endocrinology colleagues in supporting clinical trials across different specialties which are relevant to many of our patients. We have developed collaborations with our colleagues at the University of Manchester which will enable us to study some of the mechanisms behind diseases at a basic science level. As part of GMANN we have strengthened out links with our adult and paediatric colleagues at Central Manchester.
Royal Manchester Children’s Hospital
Children’s Renal Research – from Bench to Bedside
Institute Human Development, University of Manchester and the Royal Manchester Children’s Hospital, CMFT.
In the UK, about 1000 children have such severe kidney failure that they can only survive by having regular dialysis or a kidney transplant. Of these, about half were born with abnormally formed kidneys and most others have early onset disease of glomeruli inside the kidney. Moreover, of the 50,000 UK adults who currently require long term renal replacement therapy, several thousand had kidney disease dating from childhood. There is increasing evidence that such individuals carry mutations of genes normally encoding molecules which are essential for formation, growth and maturation of the kidneys and renal tract.
In the University of Manchester and CMFT, we are at the forefront of translational research into children’s and familial kidney disease. Accordingly, our research vision for the next decade incorporates the following sequence: a. definition of the genetic causes of disease in our cohorts with kidney and bladder disease; b. discovery of predictive biomarkers in children with kidney and renal tract disease; c. definition in preclinical trials of the efficacy and safety of novel therapies (e.g. precursor cells and growth factors) to delay the need for dialysis; d. the testing of novel therapies in children with renal disease, and the refinement of existing therapies via randomised prospective national trials.
In the Paediatric Nephrology Department at the Royal Manchester Children’s Hospital, 2000 patients are reviewed annually including 120 with severe renal failure. Our clinical resources include two renal genetics clinics (one for affected children and the other for adult relatives) and the Urology department features one of the only two UK treatment centres for bladder exstrophy. Our principal investigators include international experts in kidney malformations and renal stem cells (Professor Adrian Woolf, Chair of Paediatric Science), renal cell biology (Dr Rachel Lennon, Wellcome Trust Intermediate Fellow) and clinical trials in glomerular disease, renal transplantation and bladder dysfunction (Professor Nick Webb, Director of the Manchester NIHR / Wellcome Trust Children's Clinical Research Facility). They are currently funded by the MRC, NIHR, the Wellcome Trust and the major kidney research charities. They also have strong existing research links locally (e.g. Genomic Medicine in CMFT/FMHS and the Wellcome Trust Centre for Cell Matrix Research and the Manchester Tissue Regeneration and Stem Cell Network) and nationally (e.g. the UK Regenerative Medicine Platform, the Medicines for Children Research Network, the UK Registry for Rare Kidney Diseases, the UK Vesicoureteric reflux DNA Collections).
Manchester Royal Infirmary
Improving Renal Outcomes through Research, Education and Service Innovation at Manchester Royal Infirmary
Kidney disease and its treatment modalities such as dialysis impose a huge inflammatory and metabolic burden which is strongly linked to poor clinical outcomes. The renal research team at MRI focus on understanding disease mechanisms in CKD, dialysis and transplantation, explore novel diagnostics & therapeutic interventions and promote health technology innovation as part of the Inflammation and Repair theme of Manchester Area Health Science Centre (MAHSC; a collaboration involving all the universities and academic teaching hospitals across Greater Manchester). The MRI renal research program will contribute to developing MAHSC as a world class research and innovation centre for patients with kidney problems resulting in improved patient outcomes and service delivery. The MRI team collaborate on research programs with clinical colleagues at Salford Royal and RMCH and have significant joint research projects across University of Manchester Faculties of Medicine and Health Science, Life Sciences and Engineering and Physical Sciences.
We are pursuing a number of strategies for reducing vascular inflammation, dysfunction and mortality in Kidney Disease and Renal replacement therapy (dialysis and transplantation) in the following areas:
- Chronic Kidney Disease, Vascular Access Biology, Cannulation injury and repair
Involves Sandip Mitra, Alastair Hutchison, Anand Vardhan, Ramya Bhargava.
Understanding AV fistula maturation MANVAS: 2012-2014
Controlling Phosphate levels in CKD: SPIRIT study RfPB ,NIHR Portfolio Study
Novel cannulation devices in vascular access (SAVE-2 trial UK and Europe)
- Dialysis Medicine to develop safer systems and sustainable patient empowered models of dialysis care to achieve optimal clinical outcomes
Involves Sandip Mitra, Alastair Hutchison Leonard Ebah, Anu Jayanti
Home Dialysis therapies and improved clinical outcomes. BASIC multicentre study NIHR Portfolio study. 2012-2014
- Understanding mechanisms of inflammation in native and transplanted kidney
Involves Paul Brenchley, Durga Kanigicherla, Mike Venning, Mike Picton, Muir Morton, Nina Brown, Patrick Hamilton, Beatrice Coupes, Rachael Barber, Shelley Harris, Steve Roberts, Rachel Lennon, Tom Jowitt, Maryline Fresquet, Jennet Gummadova, Eddie McKenzie, Kay Poulton.
In native kidneys, inflammation (glomerulonephritis) accounts for at least 25% of cases of CKD5. We are actively researching the pathological mechanisms causing Membranous nephropathy "Autoimmunity in membranous nephropathy". MRC project grant 2013-2015 NIHR Portfolio study. EU FP7 Programme “EurenOmics Rare Kidney Disease across Europe:” Membranous Nephropathy 2012-2017. KRUK project grant "Pathogenicity of anti-PLA2R" 2013-2014. Lead for UK MN RADAR Rare Disease Group.
ANCA vasculitis; Member of UK Vasculitis Consortium; Identify and compare the microRNA expression pattern of renal AAV in plasma & urine samples in disease and remission. KfL, 2014-15.
SLE nephritis; Understanding the immune pathology of SLE membranous nephritis. KfL. Existing collaboration with Rheumatology (I Bruce) in ANCA Vasculitis and SLE IgA nephropathy. Identifying the genes controlling recurrence of IgA nephropathy in transplants. KfL, UHSM, 2013-2015.
Acute Kidney Injury (AKI); Involves Beatrice Coupes, Rachel Lennon, Rachael Barber
Improving outcomes in AKI in Paediatric Intensive Care Patients. KfL 2012-2014.
- Improving outcomes in Renal Transplantation
Involves Mike Picton, Muir Morton, Beatrice Coupes, P Klapper
Understanding EBV infection in transplant patients
Many of the studies listed above make use of the Manchester Renal BioBank, an ethically approved BioBank for Renal Research supported by KfL and UHSM.