Non-pharmacological management of chronic kidney disease
Non-pharmacological management of long-term conditions includes components such as diet, physical activity and lifestyle behaviour modification, and plays an integral role in optimal person-centred care for people living with chronic kidney disease (CKD). However, in order for these approaches to be successful, they require active engagement from the individual. Activating and empowering individuals to take an active role in their own health and healthcare is the focus of person-centred care. Identifying and improving an individual's level of activation and ability to effectively self-manage their condition can help to tai...
Source: Medicine - February 3, 2023 Category: Internal Medicine Authors: Courtney J. Lightfoot, Thomas J. Wilkinson, Alice C. Smith Tags: Chronic kidney disease Source Type: research

Urological disorders in children that progress to chronic kidney failure
This article focuses on congenital and acquired causes of renal tract obstruction, including posterior urethral valves, pelvi-ureteric junction obstruction, prune belly syndrome, neurogenic bladder, renal tract calculi and vesico-ureteric reflux. (Source: Medicine)
Source: Medicine - February 3, 2023 Category: Internal Medicine Authors: Ola Saad, Joanna Clothier Tags: Chronic kidney disease Source Type: research

Contents
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Source: Medicine - February 1, 2023 Category: Internal Medicine Source Type: research

Editorial Board
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Source: Medicine - February 1, 2023 Category: Internal Medicine Source Type: research

Renal transplantation
Individuals with kidney failure face a future requiring long-term treatment with either dialysis or renal transplantation. Renal transplantation is the preferred form of renal replacement therapy, and is associated with a better quality of life, and usually increased longevity. Unfortunately, owing to excessive co-morbidities, only 30% of patients who develop end-stage renal failure are fit enough for transplantation. Over 90% of kidney transplants still function after 1 year, and most function for>15 years. (Source: Medicine)
Source: Medicine - January 28, 2023 Category: Internal Medicine Authors: Richard J. Baker, Chris J. Callaghan, Christopher J.E. Watson, Matthew P. Welberry Smith Tags: Renal transplantation Source Type: research

Kidney disease in older people
Chronic kidney disease (CKD) and acute kidney injury (AKI) are more common in older individuals owing to ageing-related changes in the kidney. Renal disease in older people is forming an increasing proportion of the workload of nephrologists, specialists in internal medicine and general practitioners because of the ageing of the general population. AKI in older people can often be anticipated and prevented. Published guidelines concerning the management of CKD in younger adults may not be universally implementable in older patients, and may ignore complications and challenges specific to this age group. (Source: Medicine)
Source: Medicine - January 28, 2023 Category: Internal Medicine Authors: William White Tags: Management of end-stage kidney disease Source Type: research

Conservative kidney management
(CKM) is a non-dialysis treatment strategy for end-stage kidney disease (ESKD) that is associated with survival and health-related quality-of-life outcomes comparable to those of dialysis in certain older adults living with frailty and significant co-morbidity. CKM seeks to establish an individual's care goals through shared decision-making, placing a particular emphasis on quality-of-life outcomes. Early in the disease course, CKM can emphasize the medical management of advanced chronic kidney disease to limit progression, whereas later the focus can shift to managing the unpleasant symptoms of ESKD and to advance care p...
Source: Medicine - January 28, 2023 Category: Internal Medicine Authors: Ted J. FitzGerald, Edwina A. Brown Tags: Management of end-stage kidney disease Source Type: research

Assessment and management of acute kidney injury
Acute kidney injury (AKI) is a common syndrome associated with both short- and long-term morbidity and mortality. It is often predictable and sometimes preventable, and rapid recognition and management can lead to improved outcomes. Most individuals with AKI are not under the care of renal specialists. This review presents a structured approach to diagnosis and management to support routine clinical care by non-specialists. (Source: Medicine)
Source: Medicine - January 27, 2023 Category: Internal Medicine Authors: Lynne Sykes Tags: Acute kidney injury Source Type: research

Epidemiology and causes of chronic kidney disease
Chronic kidney disease (CKD) is diagnosed when evidence of kidney damage (reduced glomerular filtration rate (GFR) or proteinuria) has been present for>3  months. It is divided into categories depending on GFR and urine albumin:creatinine ratio. CKD is common, affecting 11% of the adult population globally; the prevalence rises sharply with age. Recognition of CKD is important because it is associated with multiple adverse outcomes including increas ed risk of cardiovascular events, acute kidney injury (AKI) and progression to end-stage kidney disease (ESKD). (Source: Medicine)
Source: Medicine - January 27, 2023 Category: Internal Medicine Authors: Bethany Lucas, Maarten W. Taal Tags: Chronic kidney disease Source Type: research

Renal bone disease
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 of 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 influence of treatment, and particularly if they have diabetes, evolve in a different direction; here, low-turnover adynamic bone disease develops, associated with relative suppression of the parathyroid glands. (Source: Medicine)
Source: Medicine - January 27, 2023 Category: Internal Medicine Authors: Thomas Phillips, Cathy Pogson, Kristin Veighey, John Cunningham Tags: Chronic kidney disease Source Type: research

Anaemia and chronic kidney disease
Anaemia is a common complication of chronic kidney disease. The most important contributory factor is an abnormally low circulating concentration of erythropoietin, which is produced by the kidney peritubular cells. Anaemia of kidney disease is likely to develop once the glomerular filtration rate (GFR) is (Source: Medicine)
Source: Medicine - January 27, 2023 Category: Internal Medicine Authors: Adam Rumjon Tags: Management of end-stage kidney disease Source Type: research

Haemodialysis
End-stage kidney disease affects around 1 in 1000 people in the UK, well over a third of whom are treated with haemodialysis. The population undergoing haemodialysis continues to expand, with an increasing prevalence of elderly dependent patients. Despite major advances in technology, long-term clinical outcomes are suboptimal, even in low-risk patients. Poor outcomes are driven by high rates of cardiovascular disease and infection. Current definitions of dialysis adequacy, based on urea clearance, should be broadened to encompass parameters including middle molecule clearance, salt and water balance, and patient-reported ...
Source: Medicine - January 27, 2023 Category: Internal Medicine Authors: Oscar Swift, Enric Vilar, Ken Farrington Tags: Management of end-stage kidney disease Source Type: research

Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - January 27, 2023 Category: Internal Medicine Tags: Self-assessment/CPD answers Source Type: research

Peritoneal dialysis
(PD) is a home-based renal replacement therapy for patients with end-stage kidney disease that allows relative independence from the hospital and benefits for quality of life compared with centre-based dialysis. After the catheter has been placed into the peritoneal cavity, the patient is trained to perform dialysis exchanges during which dialysate is instilled and then drained from the peritoneal cavity. These exchanges can be performed manually (continuous ambulatory PD (CAPD)) or using a machine (automated PD (APD)). (Source: Medicine)
Source: Medicine - January 26, 2023 Category: Internal Medicine Authors: Shailesh Agarwal, Martin Wilkie Tags: Management of end-stage kidney disease Source Type: research

Genetic renal disorders and genomic screening of renal disease
Genetic kidney disease (GKD) accounts for 10 –15% of end-stage kidney disease (ESKD). The introduction of next-generation genomic sequencing has improved the diagnostic yield for pathogenic gene variants associated with GKD and is increasingly available to UK clinicians. An early disease onset, family history and extra-renal features are use ful but not essential criteria for diagnosing GKD. Autosomal dominant polycystic kidney disease (ADPKD), the most common monogenic cause of ESKD, is characterized by cyst development, hypertension and progressive chronic kidney disease (CKD). (Source: Medicine)
Source: Medicine - January 10, 2023 Category: Internal Medicine Authors: Osasuyi Iyasere, Emily Craft Tags: Genetic disorders Source Type: research