Secondary glomerular disease
s are those with an identifiable underlying or systemic cause, in contrast to primary diseases, where a localized or intrinsic renal pathology is present. Diabetic and hypertensive glomerulopathies are the most common forms of secondary glomerular disease, although a kidney biopsy is not usually required for their diagnosis or management. Biopsy is more commonly required in cases of suspected glomerulonephritis, where a variety of histological lesions can be seen, all of which – including podocytopathy, membranous nephropathy and various forms of proliferative glomerulonephritis – have established secondary causes or a...
Source: Medicine - March 7, 2023 Category: Internal Medicine Authors: Mukunthan Srikantharajah, Stephen McAdoo Tags: Glomerular disease Source Type: research
Primary glomerular disease
This is a review of the clinical features, pathogenesis, investigation and management of glomerulonephritis (GN). GN can occur as a primary isolated renal disease, as a manifestation of systemic diseases such as vasculitis or lupus, or secondary to drugs, infections or tumours. It is an important cause of morbidity and mortality and a potentially preventable cause of end-stage renal disease; early diagnosis is vital to allow timely referral to specialist units where renal biopsy can be performed. (Source: Medicine)
Source: Medicine - March 3, 2023 Category: Internal Medicine Authors: Peter Mathieson Tags: Glomerular disease Source Type: research
Renal dysfunction in liver disease
Acute kidney injury is a frequently encountered complication in individuals with chronic liver disease. As in the general population, pre-renal, intrinsic and post-renal causes should be considered, with particular consideration given to sepsis and gastrointestinal bleeding. Hepatorenal syndrome (HRS) is a particular phenotype of acute kidney injury found in patients with decompensated cirrhosis and ascites, the diagnosis of which should be made only after excluding other causes. Acute and chronic renal dysfunction in cirrhosis is common, and both confer a negative impact on morbidity and mortality. (Source: Medicine)
Source: Medicine - March 3, 2023 Category: Internal Medicine Authors: Sarah Faloon, William Alazawi Tags: Systemic disease and the kidney Source Type: research
Initial management of lower urinary tract symptoms and bladder outlet obstruction
Lower urinary tract symptoms (LUTS) are a common presenting complaint for both men and women, affecting>60% of men and women aged>40 years. They encompass a wide range of aetiologies and can be an indicator of covert underlying pathologies such as obesity and metabolic syndrome. The initial assessment should focus on identifying the underlying cause and assessing the impact on quality of life aided by validated objective questionnaires. Risk factors have been identified that can predict the likelihood of progression of LUTS (e.g. (Source: Medicine)
Source: Medicine - March 2, 2023 Category: Internal Medicine Authors: Abida Sultana, Mark J. Speakman Tags: Obstruction and infection Source Type: research
Tubulo-interstitial disorders
The diagnosis of tubulo-interstitial nephritis is increasing worldwide in parallel with access to healthcare, changing prescribing habits and socio-ecological changes. The histopathological differentiation of acute and chronic tubulo-interstitial nephritis is necessary to better understand the epidemiology, presentation and clinical management of the underlying aetiologies. This review endeavours to provide a clinical update on the diagnosis and management of acute and chronic tubulo-interstitial nephritis. (Source: Medicine)
Source: Medicine - March 2, 2023 Category: Internal Medicine Authors: Kalpa Jayanatha Tags: Tubulo-interstitial disorders Source Type: research
Identification and management of diabetic nephropathy
Diabetic kidney disease is the leading cause of end-stage kidney disease in developed countries. It accounts for up to 40% of patients requiring renal replacement therapy. Optimum glycaemic and blood pressure control are currently the only strategies that have shown benefits in both preventing and attenuating the progression of diabetic renal disease. However, recent discoveries of several underlying mechanisms have led to the discovery of novel promising therapeutic agents that have proved to be very effective in several outcomes studies. (Source: Medicine)
Source: Medicine - March 2, 2023 Category: Internal Medicine Authors: Michelle Allan, Kieran McCafferty, Michael Sheaff, Muhammad Magdi Yaqoob Tags: Systemic disease and the kidney Source Type: research
Thrombotic microangiopathies and the kidney
Thrombotic microangiopathies are rare but carry a high morbidity and mortality. Most are treatable if identified early. A high index of suspicion is required in individuals presenting with renal impairment and features of microangiopathy such as a low platelet count and Coombs test-negative haemolytic anaemia. In Shiga toxin-mediated haemolytic –uraemic syndrome, bacteria such as Escherichia coli O157 and O104 adhere to the intestinal mucosa and secrete a highly potent Shiga cytotoxin that binds to the glomerular endothelium and causes an endotheliopathy. (Source: Medicine)
Source: Medicine - March 2, 2023 Category: Internal Medicine Authors: Paul Warwicker Tags: Systemic disease and the kidney Source Type: research
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. They present with loin or abdominal pain, and visible or non-visible haematuria; this is followed by the eventual passage of a stone and resolution, or the need for further investigation and intervention. (Source: Medicine)
Source: Medicine - March 2, 2023 Category: Internal Medicine Authors: Pietro Manuel Ferraro, William Robertson, Robert Unwin Tags: Obstruction and infecton Source Type: research
Paraprotein-related renal disease
encompasses a group of rare diseases characterized by distinct renal injury caused by the direct or indirect effects of a nephrotoxic paraprotein. Individuals can present with proteinuric renal impairment or, more rarely, tubular dysfunction. Diagnosis is often challenging because of the wide range of disease manifestations, difficulties with detection of the pathogenic clone and the common finding of an incidental paraprotein in elderly individuals. The combination of a renal biopsy along with a full haematological work-up is required to link a paraprotein to kidney disease. (Source: Medicine)
Source: Medicine - March 2, 2023 Category: Internal Medicine Authors: Jennifer H. Pinney, Ritika Rana, Helen J. Lachmann Tags: Systemic disease and the kidney Source Type: research
Self-assessment/CPD answers
Correct answer: C. This gentleman needs a history, examination, and validated questionnaire. The International Prostate Symptom Score (IPSS) will demonstrate if he has storage or voiding symptoms or both and how much this is impacting on his life. Unless he has visible haematuria or non-visible haematuria without infection, he does not meet the criteria for urgent referral. After appropriate work-up he will need lifestyle modifications (where the bladder diary is helpful) and assessment for the risk of acute urinary retention before starting medications. (Source: Medicine)
Source: Medicine - March 2, 2023 Category: Internal Medicine Tags: Self-assessment/CPD answers Source Type: research
Contents
(Source: Medicine)
Source: Medicine - March 1, 2023 Category: Internal Medicine Source Type: research
Editorial Board
(Source: Medicine)
Source: Medicine - March 1, 2023 Category: Internal Medicine Source Type: research
Pharmacological management of cardio-renal-metabolic disease including new potassium binders
Management of cardio-renal-metabolic diseases encompasses multiple therapeutic targets including heart failure, progression of chronic kidney disease, proteinuria, hypertension and glycaemic control. Limitations in optimizing pharmacological therapy in this setting are greatest for heart failure with reduced ejection fraction. Here, the concurrent use of all four major drug classes is seen in as few as a third of patients, with worsening renal function and hyperkalaemia being major barriers to optimization. (Source: Medicine)
Source: Medicine - February 14, 2023 Category: Internal Medicine Authors: Darren Green, Benjamin James, Nehal Hussain Tags: Chronic kidney disease Source Type: research
Cardiovascular complications of chronic kidney disease
Chronic kidney disease (CKD) is a risk factor for premature cardiovascular disease (CVD). In patients with kidney failure requiring replacement therapy (KFRT) with dialysis or transplantation, CVD risk is greater, approximately 20 times that of the general population. Conventional cardiovascular risk factors such as diabetes, hypertension, smoking and dyslipidaemia worsen both CKD and CVD. Factors specific to CKD, such as proteinuria, impaired calcium –phosphate homeostasis, anaemia and inflammation, also contribute to cardiovascular risk. (Source: Medicine)
Source: Medicine - February 14, 2023 Category: Internal Medicine Authors: Kaitlin J. Mayne, Jennifer S. Lees, Patrick B. Mark Tags: Chronic kidney disease Source Type: research
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
