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Symposium: Renal medicine

Renal disease: Acute pyelonephritis can have serious complications

15 Apr 2010Registered users

The incidence of acute pyelonephritis is higher in young women than in men but the incidence in men over 65 years of age is similar to that in older women. Women have up to a 10% risk of recurrent acute pyelonephritis in the year following a first acute episode, the equivalent risk in men is lower at 6%. Acute pyelonephritis may be uncomplicated and resolve without serious sequelae. However, a minority of episodes may be complicated by acute kidney injury, papillary necrosis, renal or perinephric abscess or the development of emphysematous pyelonephritis.

 

Renal disease: GPs should be vigilant for glomerulonephritis

14 Apr 2010

Across all age groups, glomerulonephritis is the second most common renal disease leading to end-stage renal disease in the UK, but is relatively more common in those requiring renal replacement therapy under the age of 65. The incidence of glomerulonephritis is reported as 73 cases per million population per year. This equates to one new presentation per GP practice in the UK approximately every other year. With an average 10-year survival of 63%, most practices are likely to have a small number of patients with chronic glomerulonephritis at any one time.
 

Early detection of CKD will reduce heart disease risk

25 Apr 2009Paid-up subscribers

In April 2008, the Department of Health announced a strategy to reduce the adverse effects of vascular disease by focusing on its earlier detection.1 By introducing 'vascular checks' targeting those aged between 40 and 75 years of age, it is estimated that at least 25,000 people a year with diabetes or kidney disease will be diagnosed earlier. With increasing evidence that early treatment of kidney disease can slow, if not prevent, progression to established renal failure, early detection is of clear benefit from a purely renal perspective.

 

Evaluating haematuria in primary care

25 Apr 2009Registered users

Haematuria is a fairly common problem in general practice with a higher incidence in patients over 40 years old. In adults the reported prevalence of microscopic haematuria varies considerably, ranging from 1 to 20% and is highest in men over 60 years old.3 In younger adults haematuria, particularly if it is transient, may have no obvious underlying cause. In contrast, persistent haematuria may herald the first presentation of serious urological or renal disease and there is an increased risk of malignancy in older patients. Nevertheless, in many patients no diagnosis for haematuria is established despite extensive investigation.

 

February 2008: Blood pressure control key in polycystic kidney disease

01 Feb 2008Paid-up subscribers

How can polycystic kidney disease present clinically? What are the criteria for diagnosing PKD? How should GPs manage patients with PKD?
 

February 2008: Identifying and managing nephrotic syndrome in adults

01 Feb 2008Paid-up subscribers

What are the main features of nephrotic syndrome? How can proteinuria be treated? How can complications be avoided?
 

February 2007: Early recognition the key to CKD

01 Feb 2007Paid-up subscribers

What is the relationship of CVD to CKD? How should you manage dipstick positive proteinuria or haematuria? Which patients need referral and when?
 

February 2007: Renal stone recurrence can be prevented

01 Feb 2007Paid-up subscribers

What are the common causes of renal stones? How should renal stones be investigated? How can recurrence be prevented?
 
 

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Clinical reviews: Urology

Urine cytology no help in assessment of non-visible haematuria

22 Jul 2010Registered users

A total of 200 patients attending a haematuria clinic in Quebec, Canada were studied. These patients were considered to be low risk for urothelial cancer as they were non-smokers, with no significant occupational risk factors, history of previous malignancies or radiotherapy or cyclophosphamide exposure. Approximately 15% of patients with atypical cytology were found to have tumours. When atypical cytology was analysed as a positive result, the sensitivity, specificity, positive predictive value and negative predictive value of the test were 50%, 90%, 17% and 98% respectively. 'The use of urine cytology in non-visible haematuria is currently recommended by the American Urological Association guidelines, but the British Association of Urological Surgeons/Renal Association guidelines in the UK do not recommend the routine use of cytology. While this study is small and can only be of limited use in determining the correct management strategy for this condition, it would appear to support the British guidelines. GPs should therefore observe these guidelines, with initial investigation in primary care of MSU to exclude infection plus measurement of renal function, albumin:creatinine ratio and blood pressure, followed by referral to secondary care for further investigation.'
 

Prostate cancer risk increases with number of affected first degree relatives

21 Jul 2010Registered users

The risk of prostate cancer increases with the number of family members with the disease, particularly brothers, and with younger age at diagnosis, a nationwide study has shown. The national Swedish family cancer database was used to estimate age-specific familial risks of being diagnosed with prostate cancer according to the number and type of affected first-degree relatives and according to paternal and fraternal age at diagnosis. The registry includes records of >11.8 million individuals and their cancers over nearly 50 years. The authors also calculated the risk of dying from prostate cancer according to family history. This is the largest family study published with more than 26,000 prostate cancer cases, of which 5,600 were familial. 'The take home message... is that the risk of prostate cancer increases with the number of affected first-degree family members, particularly brothers, and with younger age at diagnosis. Therefore, patients who fall into higher-risk groups can be identified.'

 

Watchful waiting on the increase for low-grade prostate cancer

23 Jun 2010Registered users

More men are receiving conservative management for low-grade prostate cancer, a British study has found. The authors used a longitudinal observational database, the British Association of Urological Surgeons Cancer Registry, to investigate patterns of care for low-risk, localised prostate cancer from 2000 to 2006. The database contains data from approximately 150 institutions and 400 urologists throughout the UK. 'This trend towards increasing conservative management of low-risk disease is in marked contrast to practice in the United States. If the findings of the study represent an accurate picture of patterns of care across the UK, it would indicate a significant shift in clinical practice.'

 

Does active surveillance for prostate cancer cause anxiety?

22 Jun 2010Registered users

Anxiety and distress levels do not change significantly during active surveillance for low-risk prostate cancer, the findings of a small Dutch study suggest.These results are useful to clinicians involved in helping patients in this complex decision making process. The impact of perceived physician involvement in decision making is important and emphasises the need for greater patient involvement. As well as informative literature and interactive technology, prostate cancer specialist nurses can also play a key role. These nurses have been shown to have a hugely beneficial role in helping patients arrive at a management decision.

 

Reducing hot flushes in men treated for prostate cancer

19 May 2010Registered users

'For GPs it is also useful to know, that given the common co-existence of significant depression in cancer patients, treatment with an SSRI may significantly improve hot flushes for prostate cancer patients. Initiation of the more effective hormonal treatments will, however, most likely be carried out by uro-oncologists rather than in a primary care setting.'
 

Can 5 alpha-reductase inhibitors reduce the risk of prostate cancer?

18 May 2010

'REDUCE is an important study, but it must be interpreted with caution. While it shows interesting results in terms of overall reduction of prostate cancer cases, the story is complex and there is clearly more work to be done in establishing the exact role of 5 alpha-reductase inhibitors in reducing the risk of prostate cancer.'
 

Desmopressin an effective adjunct for analgesia in renal colic

15 Apr 2010

Urology
 

Which patients with acute retention are suitable for trial without catheter?

15 Mar 2010Registered users

Urology
 

Nocturia more than once a night impairs quality of life

15 Mar 2010Registered users

Urology
 

Improving compliance in overactive bladder syndrome

16 Feb 2010Registered users

Urology
 

Combined therapy effective in high-risk men with BPH

15 Dec 2009Registered users

 

Anticholinergics can help improve bothersome overactive bladder symptoms

01 Oct 2009Registered users

This study is directly applicable to patients seen in primary care. It would suggest a safe strategy of initiating an alpha-blocker in patients with mixed storage and voiding symptoms, reviewing at 4-6 weeks, and adding an anticholinergic for those patients whose storage symptoms remain bothersome. It is always possible to trial removing the anticholinergic after a few months of bladder retraining, particularly to see if a placebo effect had a significant role, with therapy reintroduced if storage symptoms relapse.
 

Are alpha blockers effective for expulsion of renal stones?

01 Oct 2009Registered users

Although expulsion rate was not improved by tamsulosin, patients may benefit from an analgesic effect and hence a reduced requirement for analgesics until stone expulsion.

 

LUTS a risk factor for falls in older men

27 Aug 2009Paid-up subscribers

Urology
 

Weigh up the risks and benefits of IAD in prostate cancer

01 Jun 2009Paid-up subscribers

 

Is screening for prostate cancer worthwhile?

21 May 2009Paid-up subscribers

 

Weight loss improves incontinence in women

29 Mar 2009Paid-up subscribers

Urology
 

Cranberry extract an option in recurrent UTI

01 Jan 2009Paid-up subscribers

Urology
 

‘Normal’ sex is the metabolic equivalent of light housework

17 Dec 2008Paid-up subscribers

 

Penile length not associated with shoe size

17 Dec 2008Paid-up subscribers

 
 

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