ETNA: Edinburgh Transient and Neurological attack: A Cohort Study
Patients frequently present with minor neurological symptoms where a diagnosis of transient ischaemic attack (TIA) or minor stroke is difficult to make positively or to exclude reasonably. For these patients, clinicians are uncertain whether they should: (a) reassure most patients that their symptoms are benign; (b) treat most patients with antiplatelet or other vascular prevention; or (c) stratify stroke risk further using clinical features or brain imaging.
This is important because clinical diagnosis is difficult. Mis-diagnosis is not infrequent and leads to harm from preventable recurrent stroke and costs to health systems from extra care and legal liabilities.
All ETNA participants will receive an MRI scan and the study aims to establish the feasibility and methods for a larger study of diagnostic utility of MR brain imaging and estimate the effects of MRI on clinician decision making.
This study has been recruiting in the Emergency Dept, inpatient wards and TIA clinics since August 2018. We aim to recruit 270 participants and have almost reached our target!
People who develop an Acute Kidney Injury (AKI) often have a poor prognosis and many go on to develop chronic kidney disease (CKD). The recognition that AKI and CKD are linked is recent and the molecular pathways that control the transition from acute injury to chronic disease are not well defined. Currently there are no specific treatments that reduce the risk of progressing to CKD after AKI.
Preliminary investigations (not yet published) suggest that AKI causes sustained activation of the endothelin (ET) system to the long-term detriment of renal and systemic haemodynamic function. These pilot data form the basis of our project that seeks to determine whether the ET system is active in patients with AKI and, thus, represents a potential target for therapeutic intervention.
KRAKIL aims to recruit altogether 100 patients from across the emergency department, acute medical unit and inpatient wards at the Royal Infirmary. 50 of which with AKI’s and 50 matched controls with normal kidney function. We will monitor their bloods and urine for 90 days and compare the data from between the two groups.