Study objective -The study aimed to determine the relative risk of being accepted for renal replacement treatment of black and Asian populations compared with whites in relation to age, sex, and underlying cause. The implications for population need for renal replacement therapy in these populations and for the development of renal services were also considered. crude relative acceptance rates compared with whites were 3 5 and 3-2 respectively. Age sex specific relative acceptance ratios increased with age in both ethnic populations and were greater in females. Age standardised acceptance ratios were increased 4-2 and 3-7 times in Asian and black people respectively. The most common underlaying cause in both these populations was diabetes; relative rates of acceptance for diabetic end-stage renal failure were 5 8 and 6 5 respectively. The European Dialysis and Transplant Association coding system was inaccurate for disaggregating non-insulin and insulin dependent forms. "Unknown causes" were an important category in Asians with a relative acceptance ofrate 5 7. The relative rates were reduced only slightly when the comparison was confined to the district health authorities with large ethnic minority populations, suggesting that geographical access was not a major factor in the high rates for ethnic minorities. Conclusion -Acceptance rates for renal replacement treatment are increased significantly in Asian and black populations. Although data inaccuracies and access factors may contribute to these findings, the main reason is probably the higher incidence of end-stage renal failure. This in turn is due to the greater prevalence of underlying diseases such as non-insulin dependent diabetes but possibly also increased susceptibility of developing nethropathy. The main implication is that these populations age demand for renal replacement treatment will increase. This will have an impact nationally but will be particularly apparent in areas with large ethnic minority populations. Future planning must take these factors into account and should include strategies for preventing chronic renal failure, especially that due to non-insulin dependent diabetes and hypertension. The data could not determine the extent to which population need was being met; further studies are required to estimate the incidence of endstage renal failue in ethnic minority populations. (J7 Epidemiol Community Health 1996;50:334-339) Although end-stage renal failure is relatively uncommon, treatment by renal replacement therapy (dialysis or transplantation) is complex, costly, and has to be given lifelong. Without treatment patients die. Provision in the UK has expanded significantly in the past decade. We present data from the national review of renal services in England, the first time a national dataset on ethnicity and uptake of health 334 on 29 April 2019 by guest. Protected by copyright.

Twenty-three cases of IgM associated primary diffuse mesangial proliferative glomerulonephritis are presented. In 18, IgM was the sole localising host immunoglobulin, and it was the predominant globulin in five; C3 was also present in 18. Light microscopy revealed variable diffuse and global mesangial proliferation in all cases, with additional focal global sclerosis in 16, focal segmental sclerosis in 15, and small capsular crescents in seven. Material for electron microscopy was available from 19 patients; in 13, occasional intramesangial electron dense deposits were identified, and in 18 there were irregular, rather ill defined areas of increased electron density in mesangial regions. Clinically, 14 patients presented with the nephrotic syndrome, and nine had asymptomatic proteinuria. During follow-up, only 10 patients showed no change in renal function or improved; the remainder showed increasing hypertension and/or renal function deterioration and four developed end stage renal failure. It is suggested that IgM associated mesangial proliferative glomerulonephritis should be considered as a distinct clinicoimmunopathological entity.

Objective-To determine the age related incidence of advanced chronic renal failure in two areas of England. Design-Prospective study of patients newly identified as having advanced chronic renal failure within a two year period; subsequent monitoring of patients' clinical course for a further 26 months. patients Setting-Devon and Blackburn. tion) accepted Subjects-Those patients in a population of ir in 708 997 who developed advanced chronic renal failure (serum creatinine concentration >500 [tmol/l) 1982 1988 for the first time during a two year period. Main outcome measures and results-210 Patients 38-1 957 (148 per million population per year) developed 5382 850 advanced chronic renal failure, 117 (51%) of whom were over 70. The age related incidence rose from 58 44 0 77°per million per year in those aged 20-49 to 588 per 27-4 65-3 pemilo 41-3 64-3 million per year in those aged 80 or over. Only 54% 4485 61 8 (113) of patients were referred to a nephrologist; 120 18-8 59-2 32-7 57.1 patients (57%) needed dialysis or died within three 30 9 56-3 months of presenting without receiving dialysis, and 3318 5457 187 (89%) died or needed dialysis within three years. 37-3 52-7 After those unsuitable for further treatment had 26-9 52-5 been excluded, 78 patients per million population per year aged under 80 needed to start long term renal replacement treatment. Conclusions-Many patients suitable for renal replacement treatment are still not referred for nephrological opinion and are denied treatment. If the treatment rate in the United Kingdom rose from the 1988 rate of 55-1 per million per year to 78 per million per year then the number ofpatients receiving treatment would rise to about 800 per million. This is double the present number and has considerable but predictable resource implications for the NHS.

Black and Asian people receive and have a greater need for renal replacement therapy, and the need will increase as these populations age. These findings have important implications for the provision of renal services in districts with a high proportion of ethnic minorities and for the management of diabetes mellitus and hypertension, two important causes of end stage renal failure in these populations.