Renal stone disease is a common, and potentially recurrent, condition that affects 5-15% of the population worldwide.Symptomatic renal stone disease is at least twice as common in men as women.The incidence has risen over two decades and 1-2 people per thousand present with an acute episode of pain caused by renal stones each year. Annually there are more than 12,000 renal stone-related hospital admissions and considerably more GP consultations for management of renal colic. Data from NHS Direct showed that 80% of patients with renal colic symptoms were advised to contact their GP as the first port of call. The challenge for GPs is to identify which cases may be treated safely at home and which need immediate referral to hospital.

There are approximately 50,000 people in the UK on renal replacement  therapy (RRT) and this number is increasing each year. In an average GP practice there will be one or two patients currently on RRT and a larger number with progressive chronic kidney disease who will reach end stage renal disease (ESRD). The options for RRT are kidney transplantation, haemodialysis (HD) or peritoneal dialysis (PD). The management of an individual with ESRD may involve all of these modalities during the course of their lifetime. For many patients with ESRD, treatment at home allows greater flexibility and independence than can be facilitated by inpatient HD. Others value the security of receiving their RRT in a hospital environment and would resent the intrusion of dialysis into their home life. All patients appreciate early information about the options for RRT so that they and their family can make an informed decision about the best treatment for them. The aim is to provide personalised information to patients at least three months before they need to begin RRT.

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.

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.

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.

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.

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

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

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

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