Well I hope that
people with atypical haemolytic uraemic syndrome (aHUS ) count. Largely
genetic in origin, aHUS is a rare, progressive, life-threatening and incurable
complement disorder which affects mainly the kidneys. It occurs when
a faulty gene, known as a mutation, is triggered, often by an external factor,
which causes uncontrolled over-activation of the complement system. Complement
is a normally well controlled feature of the body’s immune system whereby
certain proteins actively counter bacterial and viral infections in the blood
by restoring damaged cells and clearing debris. But when the complement system
acts in an uncontrolled fashion, it damages rather than restores the red blood
cells. This restricts their ability to pass through the small blood vessels in
the kidneys which causes blockage and inflammation. Unchecked, this may lead to
kidney failure.
I am not sure the
public or indeed our policy makers appreciate the impact of kidney failure on
individuals and families . A year or two ago I found myself chatting to a
single mum about the same age as my daughter. She had never been on holiday
with her 8 year old daughter! NEVER! The young lady had developed aHUS
shortly after her pregnancy and was on dialysis. She had a sister who
wanted to donate a kidney but she couldn’t be transplanted because of the
high risk that the aHUS would recur in the transplant . Being “stuck” on hospital
dialysis as she put it meant she was unable to get away for a break – ever! Her
sister did take her niece, the daughter, away with her own family
and the patient explained that seeing the photos gave her great enjoyment.
The story just came out in conversation as we were queuing for lunch .
The young lady didn’t make a big deal of it but I was left feeling very sad
that she hadn’t yet experienced that fun part of being a parent and seeing your
children paddle in the sea or race you along the sand . I was also in two minds
whether or not to speak about eculizumab a new drug that has been recently
found to practically “work miracles” in aHUS by restoring the balance of
complement in the kidney and preventing kidney damage occurring because it
wasn’t yet generally available on the NHS and was still awaiting some final
trials before gaining approval as a first line treatment for aHUS. It
crossed my mind at the lunch counter that I didn’t want to raise hopes
unnecessarily but we did have that conversation because I felt the data that
the Newcastle research team, who have been researching aHUS for quite some
time, had presented at the Renal Association meeting some weeks before
was so completing and was pretty sure that the FDA in the USA and the European
Medicines agency would soon approve the treatment.
Well the authorities
have now approved the drug but unfortunately we do seem to be dragging our feet
in making it available to the few patients and families who could benefit.
The disease is ultra-rare, at the last count in 2010 affecting about 170
people in UK, of whom 140 are thought to be in England. Some 10-15 new cases
present each year in UK. There are about 50 patients like the lady I was
chatting to, people who are locked into lifelong dialysis who will never
receive a transplant until eculizumab can be used to protect their new kidney .
The aHUS patient
support group and the wider kidney community had been hoping the drug would be
available from January this year but the Department of Health ducked
the issue deciding instead to defer national funding and refer the case
to NICE for further consideration of the affordability before reporting to the
new commissioning board that is now called NHS England. Well I hope that
NHS England does not let the kidney community “get left behind “ to
quote the new planning guidance . The evidence for benefit is clear, yes the
costs are high but the benefits are truly life changing for people and
families with aHUS . If we, the system, get our act together its quite a
reasonable aspiration to expect a successful live donor transplant for the lady
I met and a holiday in the sun (wearing sun block of course) shortly
thereafter. One could also wonder “how come she hasn’t been able to get away
for a break or a holiday while on dialysis“ but that’s another even
longer running story that for now I will leave for another day .