Login:
 

RENAL MEDICINE

 

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.

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. 

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).

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.

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.

Tracking down the cause of proteinuria in primary care

21 Feb 2013Paid-up subscribers

Proteinuria originates from the kidney and occurs as a result of injury to either the glomerulus or the renal tubule or both. It is relatively common in the general population with reported point prevalence of up to 8% but the prevalence falls to around 2% on repeated testing. Chronic glomerular injury resulting in proteinuria may be secondary to prolonged duration of diabetes or hypertension. A tubular origin of proteinuria may be associated with inflammation of renal tubules triggered by prescribed drugs or ingested toxins.

Early recognition of CKD can delay progression

21 Feb 2013Paid-up subscribers

CKD affects 8.5% of the UK population. Early recognition allows intervention that may delay or avoid progression to end-stage disease and modify the cardiovascular risk associated with CKD. The most frequent specific renal diseases resulting in progressive CKD in the UK are: diabetes mellitus, atheromatous renal vascular disease, glomerulonephritis, chronic pyelonephritis and inherited renal disease.

Early diagnosis improves survival in kidney cancer

24 Feb 2012Paid-up subscribers

Kidney cancers account for 2-3% of all adult malignancies in the UK. The incidence has been increasing which may reflect changing risk factors including a rise in obesity. Early diagnosis improves survival with five-year survival rates for renal cancer of 70-94% for localised tumours, in the UK, but this survival rate falls to 40-70% when cancer has spread beyond the kidney.  [With external links to current evidence and summaries]

Improving recognition of inherited renal disease

23 Feb 2012Paid-up subscribers

The GP is usually the first medical professional to be consulted on a hereditary disease of the kidney. Support for both the patient and their GP should be provided by renal and genetic specialists. Ongoing support in primary care is imperative. The primary care team can provide advice and reassurance to parents with regard to screening children.

Which patients with renal colic should be referred?

23 Feb 2011Paid-up subscribers

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.

Managing patients on dialysis in the community

22 Feb 2011Paid-up subscribers

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.

Acute pyelonephritis can have serious complications

15 Apr 2010Paid-up subscribers

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.

GPs should be vigilant for glomerulonephritis

14 Apr 2010Paid-up subscribers

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.

Evaluating haematuria in primary care

25 Apr 2009Paid-up subscribers

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.

Renal medicine: 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.

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?