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Acute renal failure is a commonly encountered condition in the hospital setting. In many cases accurate history-taking, careful examination of the patient and meticulous monitoring of volume balance may reverse this process. However, acute renal failure presents a unique set of metabolic derangements which, if untreated, will result in death. We outline the initial management of acute renal failure...
Sustained loss of kidney function leads to the evolution of progressive secondary hyperparathyroidism associated with a characteristic high-turnover form of metabolic bone disease. The drivers to hyperparathyroidism include the failure of renal bioactivation of vitamin D, phosphate retention and in some cases hypocalcaemia. As renal impairment becomes more severe, some patients, particularly under...
The aim of renal replacement therapy (RRT) is to prolong the quantity of life without diminishing the quality of remaining years. Unfortunately, in some patients, this is far from reality. Maximal conservative management is the support of patients with end-stage renal failure (ESRF) without resorting to RRT. This support addresses the patient’s physical, emotional and spiritual needs until the end...
There have been significant advances in the use of lasers for skin disorders. New generation pulsed dye lasers and dual wavelength lasers have optimized the treatment of vascular lesions such as port wine stains. The improved safety of lasers for hair removal has enabled children with pathologically excessive hair to be treated safely, and for treatment to be carried out on dark-skinned individuals...
The premature development of cardiovascular diseases is a major factor contributing to the limited lifespan of patients with chronic kidney disease (CKD). Detection and treatment are an important component of patient care and have become a standard part of the workup required before patients can be listed for kidney transplantation. Current guidelines for cardiovascular risk reduction in CKD patients...
Management of chronic kidney disease (CKD) requires a systematic approach that includes all components of the chronic disease model. National guidelines are now available for the identification, management and referral of CKD. Some causes of CKD require specific additional management directed at the underlying cause. For many patients, control of cardiovascular risk factors is the most important intervention,...
Over the last five years, the popularity of hormone replacement therapy (HRT) has declined as recent data have added to our knowledge of the risk–benefit balance of prescribing hormones in the postmenopausal period. Many women now opt not to take HRT and healthcare professionals have been confused by the changing evidence base. HRT is still a highly effective treatment for menopausal symptoms and...
A microangiopathy is seen in a wide range of conditions, including haemolytic uraemic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), antiphospholipid syndrome (APS), malignant hypertension, pre-eclampsia, the HELLP syndrome, scleroderma and acute allograft vascular rejection. Underlying all these conditions is endothelial cell activation, which is associated with a procoagulant phenotype...
Secondary glomerular diseases are common worldwide and can manifest in many ways. Bacterial and viral infections, especially hepatitis and HIV, can cause a variety of patterns of glomerular injury often presenting with nephrotic syndrome, as can tumours and drugs. Diabetes and systemic lupus erythematosus are also important causes. Identifying underlying agents leads to specific treatments and can...
Renal transplantation is the preferred treatment option for end-stage renal failure in the appropriate patient. The kidney may come from a deceased donor or a living donor. The kidney is placed extraperitoneally in the iliac fossa, the renal vessels are usually anastomosed to the iliac vessels and the ureter to the dome of the bladder. Complications relating to the operation include renal artery thrombosis,...
Chronic renal failure (CRF) is accompanied by tubulo-interstitial atrophy and fibrosis, regardless of the cause. Disorders of the renal vasculature, the glomeruli, or of urinary drainage all culminate in chronic tubulo-interstitial damage, the severity of which is the histological feature that correlates best with progression to end-stage renal failure (ESRF). However, there are diverse conditions...
Women with known renal disease should be counseled about the risks pregnancy may pose to them and their fetus before they conceive.Although worse baseline function and hypertension are associated with worse outcome, all women with renal disease should be advised whether their medication needs to be modified, whether they are likely to suffer irreversible renal damage, and that they have a higher risk...
Systemic infections may result in renal damage by a wide variety of mechanisms, including pre- and post-renal, as well as causing intrinsic renal disease. Glomerular lesions are most often immunologically mediated and often accompanied by deposition of immunoglobulins and complement. Tubulo-interstitial disease is most commonly caused by toxic damage or by direct infection by the pathogen, though...
Paraprotein-related renal diseases present as renal impairment and proteinuria in mainly older patients. The underlying haematological conditions are often subtle and may only be detected after the diagnosis is made at renal biopsy. The major renal diseases caused by deposition of aggregated monoclonal immunoglobulins are: myeloma cast nephropathy, AL amyloidosis and light chain deposition disease...
Multi-system autoimmune diseases, including systemic lupus erythematosus (SLE) and vasculitis, are inflammatory conditions of unknown cause. Renal involvement can occur in a variety of forms and usually represents a severe disease manifestation. SLE is frequently complicated by renal involvement (lupus nephritis). The main renal manifestation of vasculitis is ‘rapidly progressive glomerulonephritis’...
Diabetic nephropathy (DN) is a common complication of diabetes mellitus which has a major impact on patient morbidity and mortality, and therefore a profound impact on the delivery of health care in this country. It affects more than one-third of patients with type I diabetes and an ever-increasing proportion of patients with type II diabetes, such that it is the single most common cause of end-stage...
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