I specialise in the treatment of chronic kidney disease and associated heart and blood vessel diseases in kidney patients. I have an interest in diabetes and how it affects the kidney, as well as kidney diseases secondary to raised blood pressure or as a result of other renal conditions. In addition I also consult on hyperparathyroidism, calcification syndromes, and calciphylaxis. For information on my specialist clinical and research interests, please click here.
Chronic kidney disease (CKD) is a long-term condition where the kidneys cannot excrete toxins and excess water as efficiently as they should. It is much commoner with advancing age, and is driven mainly by elevated blood pressure, diabetes, overweight and other metabolic and physical factors. Kidney disease is usually acquired, but, of course, can be hereditary, or congenital.
CKD does not usually cause symptoms until it reaches a reasonably advanced stage. It is usually detected at earlier stages by blood and urine tests.
Diabetes is a chronic condition where the amount of glucose in the bloodstream is too high because the body cannot use and regulate it properly. 95% of diabetes in the modern era is type II (insulin-resistant) diabetes, driven by poor diet and excessive weight.
It can be extremely damaging to the kidneys over time; the earliest manifestations of such long-term progressive damage being leakage of albumin from the blood into the urine (micro-albuminuria).
If you have high blood pressure, this higher pressure puts extra strain on your heart and blood vessels. Over time, this extra strain increases your risk of a heart attack or stroke.
High blood pressure can also cause heart and kidney disease.
Hyperparathyroidism results when there is excessive secretion of parathyroid hormone (PTH). PTH is secreted by the four parathyroid glands, located in the neck behind the thyroid gland. PTH is one of the key regulators of blood levels of calcium and phosphate. There is interplay also with vitamin D.
Calcification is usually a response to chronic injury; it can be simply a marker of a problem, or, itself, can become associated with poor outcomes over time (e.g. arteriosclerosis, or "hardening of the arteries"). These systems are usually significantly deranged in CKD.
Welcome, I am David Goldsmith, MA MB BChir FRCP(Lond) FRCP(Edin) FASN FERA.
In May 2015 I was very honoured to be the Congress President of the 52nd ERA-EDTA Congress in London, where we had 2496 abstracts submitted (a record), and 8190 attendees (4th highest attendance since 1964).
My current positions include Consultant Nephrologist at Guy’s & St Thomas’ NHS Foundation Trust Hospital.
In addition to my clinical duties I have, or have held, several honorary academic positions, including Cardio-Renal Medicine, King’s College London, Visiting Professor at St George's University of London, and G.I. Popa School of Medicine and Pharmacy, Iasi, Romania.
I have both undertaken teaching duties, and performed research, at these institutions, often in fruitful collaborations with very many others, around the World, helping to drive and shape clinical excellence through research collaborations. As a passionate research-driven clinician I am determined and committed to harnessing ever more successful approaches to improving the treatment of renal conditions. I have published extremely widely in my field covering clinical scientific and medico-political topics, as I seek to ensure that we can continue to move renal treatments ever further forward. For a full list of publications, please click here.
Within this site I would like to take the opportunity to present you with information about my training, career, general medical and kidney medicine experience, research and publications, my role in teaching and management, and my interests outside of medicine and how may I be of help to you.