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Renovascular disease is common, and atherosclerotic renovascular disease (ARVD) accounts for 90% of renal artery stenosis (RAS) in Western populations, the remainder being due to fibromuscular disease (FMD). FMD usually presents as hypertension in young patients and there is often a successful response after angioplasty. ARVD is frequently associated with hypertension and renal dysfunction and is...
Inherited metabolic conditions of the kidney are uncommon. This article focuses on four conditions, fabry disease, cystinosis, methylmalonic aciduria (MMA) and primary hyperoxaluria type I. These conditions present with renal impairment predominantly in childhood but with appropriate treatments, survival into adult life is becoming more common.
Disturbances of fluid and electrolyte balance are common in clinical practice, especially in a hospital setting, and may be iatrogenic or compounded by inappropriate medical or surgical treatment. Their recognition and appropriate management are not necessarily difficult or complex; while specific formulae and standard protocols can be helpful at the bedside, there is no substitute for an understanding,...
Kidney function is typically assessed by measuring the glomerular filtration rate (GFR). Many approaches have been used: accuracy demands complex techniques involving the use of exogenous filtration markers (e.g inulin, iohexol, 99m Tc-diethylenetriaminepentaacetic acid, 125 I-iothalamate, 51 Cr-ethylenediaminetetraacetic acid). For most clinical purposes, accuracy is sacrificed...
The renal tract is mainly investigated for abnormal renal function and to identify causes of renal colic and haematuria. Increasing use of ultrasound and computed tomography have limited the role of plain radiographs. However, they are still used in the initial assessment of abdominal colic to evaluate potential renal or bowel abnormalities. Intravenous urograms are radiological examinations of the...
For centuries, physicians have attempted to use urine as a non-invasive means of assessing disease. Today, urinalysis, and in particular identification and measurement of proteinuria, underpins the routine assessment of patients with renal disease. Urine dipstick analysis can also be used to screen for urinary tract infections (nitrites and leucocyte esterase), diabetes mellitus (glucose) and confirm...
The management of hypertension in renal disease is best understood by classifying patients according to their stage of chronic kidney disease (CKD). Many of the pathophysiological mechanisms are common to all patients, but in post-transplant recipients there are additional factors to be considered. The benefits of good blood pressure control in CKD 3/4 are a slowing in the rate of progression of renal...
Anaemia is a common complication of chronic kidney disease. Aetiology is multifactorial, but a major factor is an inappropriately low production of erythropoietin in the peritubular cells of the kidney. Chronic anaemia causes quite a number of debilitating symptoms, particularly tiredness and lethargy, muscle fatigue, reduced exercise capacity, and breathlessness on exertion. There are adverse consequences...
Recent studies have shown that the prevalence of chronic renal failure (CRF) is higher than was widely believed. The prevalence of renal replacement therapy (RRT) is rising progressively, although the rising incidence has stabilized in some developed countries. Needs may differ widely between countries depending on ethnic mix, social deprivation, prevalence of diabetes, and quality of healthcare....
Peritoneal dialysis (PD) is a home-based renal replacement therapy for patients with end-stage kidney disease, offering patients some degree of autonomy and flexibility of lifestyle. After the placement of a catheter into the peritoneal cavity the patient is instructed how to perform dialysis exchanges where dialysate is instilled into the peritoneal cavity. These exchanges can either be performed...
Any untreated obstruction to the developing renal tract can lead to irreversible damage to the developing kidneys and accounts for 25% of chronic renal failure seen in childhood. This article focuses on congenital and acquired causes of renal tract obstruction including posterior urethral valves (PUV), pelvi-ureteric junction (PUJ) obstruction, Prune belly syndrome, neuropathic bladder and renal tract...
Symptomatic urinary tract infections (UTI) are either uncomplicated or complicated. Uncomplicated infections occur in healthy women in the community and are usually caused by Escherichia coli. Complicated infections are associated with anatomical, functional, or metabolic abnormalities of the urinary tract that disable the natural innate host defences and lead to tissue injury. Patients with symptomatic...
The haemodialysis population continues to increase rapidly and is becoming more elderly and dependent. Despite major advances in technology, long-term clinical outcomes are disappointing, even in low-risk patients. Current definitions of dialysis adequacy, based on urea clearance, need to be broadened to encompass parameters such as β 2 -microglobulin clearance, salt and water balance, and...
Acute renal failure (acute kidney injury) is a clinical syndrome characterized by a rapid reduction in renal excretory function underpinned by a variety of causes. Key aspects in the assessment of patients presenting with acute renal failure include assessment of volume status, assessment aimed at eliminating intrinsic renal disease as a cause and an assessment of renal morphology and presence or...
Renal stone disease (urolithiasis, nephrolithiasis) covers many conditions causing kidney, ureteric or bladder stones. These include metabolic and inherited disorders, anatomical defects of the upper or lower urinary tract, and chronic urinary infection. However, most cases of renal stones are idiopathic and present with loin or abdominal pain, and macro- or microscopic haematuria; leading to the...
Urinary tract obstruction is a common problem. It may be acute or chronic, affect the upper or lower urinary tract, or both, and often presents as a urological emergency. In non-acute cases, appropriate management is necessary to prevent irreversible nephron loss and renal failure. In recent years, the techniques available to accurately diagnose the site and extent of obstructive uropathy have become...
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