Symposium: Renal medicine

Visible and non-visible haematuria may herald serious disease

22 Feb 2018Paid-up subscribers

Both visible (VH) and non-visible haematuria (NVH) may herald serious pathology e.g. malignancy or vasculitis. All patients with VH or symptomatic NVH should have urinalysis, urinary protein estimation (albumin:creatinine or protein:creatinine ratio), and a renal function test. These should also be requested if asymptomatic NVH persists, i.e. in two out of three samples over 6-8 weeks.

Prompt investigation improves outcomes for kidney cancer

22 Feb 2018Paid-up subscribers

Renal cell carcinoma should be suspected in the presence of: localising symptoms such as flank pain, a loin mass or haematuria; constitutional upset including weight loss, pyrexia and/or night sweats; or unexplained test results. Smoking, obesity and hypertension are common risk factors and all three demonstrate a dose-response relationship with the relative risk of renal cell carcinoma.

Diagnosis and management of nephrotic syndrome

22 Feb 2017Paid-up subscribers

Nephrotic syndrome is uncommon in general practice. A GP may only see two or three adult cases in their career. Nephrotic syndrome develops following pathological injury to renal glomeruli. This may be a primary problem, with a disease specific to the kidneys, or secondary to a systemic disorder such as diabetes mellitus. The most common cause in children is minimal change glomerulonephritis. In white adults, nephrotic syndrome is most frequently due to membranous nephropathy whereas in populations of African ancestry the most common cause of nephrotic syndrome is focal segmental glomerulosclerosis (FSGS). Diabetic nephropathy is the most common multisystem disease that can cause nephrotic syndrome. 

Pyelonephritis can lead to life-threatening complications

22 Feb 2017Paid-up subscribers

As distinct from cystitis and lower urinary tract infection (UTI), which are much more common, pyelonephritis involves the upper tract with potentially more serious sequelae. It is most commonly caused by bacterial infections, typically ascending from the lower urinary tract; haematological seeding from bacteraemia is less common.

Managing acute and chronic renal stone disease

22 Feb 2016Paid-up subscribers

The incidence of renal stone disease is increasing globally. In the UK the lifetime risk is estimated to be 8-10%. On a population level, the increase in stone incidence, erosion of gender disparity, and younger age of onset is likely to reflect increasing prevalence of obesity and a Western diet with a high intake of animal protein and salt.

Optimising the management of polycystic kidney disease

22 Feb 2016Registered users

Polycystic kidney disease is the most common inherited renal disorder that results in chronic kidney disease. Clinical features include visible haematuria, loin pain, UTI and hypertension. The typical clinical course is a progressive increase in the number and size of renal cysts associated with gradual loss of kidney function (falling eGFR).

Improving early detection of chronic kidney disease

23 Feb 2015Paid-up subscribers

Chronic kidney disease (CKD) is defined as either a reduction in measured kidney function (eGFR) or urinary abnormalities (haematuria/proteinuria) or a combination of both, present for more than 3 months. Individuals with newly identified reduced eGFR should have acute kidney injury excluded. All newly identified CKD patients should have blood pressure, dipstick urinalysis, random urine ACR or PCR, glucose, cholesterol and full blood count checked at the earliest opportunity.

Timely diagnosis and treatment essential in glomerulonephritis

23 Feb 2015Paid-up subscribers

Glomerulonephritis is an important cause of kidney disease and, in the UK, the most common diagnosis in patients receiving chronic dialysis or waiting for kidney transplantation. A key feature is the presence of urinary abnormalities (proteinuria ± haematuria). Timely diagnosis and treatment of glomerulonephritis can help to minimise both the occurrence and severity of complications.

Risk factor control is key in diabetic nephropathy

24 Feb 2014Paid-up subscribers

Prolonged duration of diabetes, poor glycaemic control and hypertension are major risk factors for both diabetic nephropathy and cardiovascular disease. Optimising blood sugar control together with excellent control of blood pressure can reduce the risk of developing diabetic nephropathy. Diabetic nephropathy should be considered in any patient with diabetes when persistent albuminuria develops.

Renal replacement therapy should be tailored to the patient

24 Feb 2014Paid-up subscribers

End-stage renal disease describes loss of kidney function which is both substantial and irreversible. The form of renal replacement therapy (RRT) instituted should primarily be based on patient preference subsequent to an individually tailored education programme from specialist staff. This programme needs to take into account the patient’s comorbidities and any contraindications to specific modalities of RRT. For those who will be suitable for transplantation, optimum management of diabetes, smoking cessation, weight loss, and general fitness is crucial in facilitating this.


Special report

Early intervention can improve outcomes in acute kidney injury

22 Jun 2015Registered users

The incidence of acute kidney injury (AKI) is rising reflecting an increasingly elderly at-risk population, with multiple comorbidities, coupled with improved detection. AKI is potentially reversible so improvements in its recognition and early interventions could have a major impact on patient outcomes. Potential clues in the history for AKI include reduced fluid intake and/or increased fluid losses, urinary tract symptoms and recent drug ingestion.

Be vigilant for acute kidney injury in primary care

23 Oct 2013Paid-up subscribers

About 20% of all adult emergency admissions are affected by acute kidney injury (AKI) and the mortality rate is almost 25%.  It has been estimated that AKI, excluding cases in the community, causes more than 10,000 preventable deaths a year in England. AKI represents a wide spectrum of injury to the kidneys, not just kidney failure, the vast majority of AKI cases start with an illness in the community. In AKI, loss of kidney function contributes to morbidity and mortality. Patients die from AKI rather than with AKI as a complication of an underlying illness. The definition of AKI now includes any adult with ≥ 26 µmol/L rise in creatinine from baseline over 48 hours or less, or  ≥ 50% rise in creatinine from baseline known or presumed to have occurred over seven days or less.