Urological and Kidney Diseases Topic Homepage
Urological and Kidney Diseases Overview
Urology is the medical and surgical specialty that studies the kidneys and urinary tracts of men and women, and the male reproductive system (male urogenital tract). It also encompasses the diagnosis and treatment of diseases of the kidneys, ureters, bladder, urethra and male reproductive system.
Kidneys produce urine by continuous blood filtration. Each kidney is composed of approximately one million nephrons which represent...
... the functional unit. The nephrons are composed of glomeruli, tubules and tubulointerstitial spaces; it is these areas that are often affected during renal diseases.1 Nephritic,2 nephrotic,3 asymptomatic proteinuria and hematuria syndromes4 are all paediatric disorders of the glomerulus that result in the presence of large molecules in the urine. Tubulointerstitial nephritis is a disorder which causes the inflammation of the tubules and tubulointerstitial tissue and is the cause of 15% to 27% of all acute kidney injuries.5
The urinary tract is a region of possible obstruction and infection. Upper urinary tract obstructions are commonly caused by ureteric stones,6 but can also be caused by a variety of other conditions. Urinary tract infections (UTI) can be divided into upper and lower UTI; the former affects the kidneys and ureter, the latter affects the urethra and bladder7. Female populations can suffer from UTI at any point in their lives whereas men are usually only affected at the extremes of the age spectrum.8
Renal failure can be either acute or chronic, distinguished by the length of time taken for the kidneys to become incapable of filtering metabolic waste from the blood. Acute renal failure develops rapidly over a period of hours or days,9 whereas chronic renal failure develops over months or years.10 The most common causes of chronic renal failure are diabetes mellitus and hypertension.11
There are four main types of cancer effecting the kidney and urinary tract; renal cell carcinomas, transitional cell carcinomas, squamous cell carcinomas and adenocarcinomas.11 Kidney cancer accounts for 3% of all cancers in the UK. Incidence rates increase with age and it is more prevalent in men than women.12
Non-cancerous diseases of the prostate gland include prostatitis and benign prostatic hyperplasia.11 Prostate cancer accounts for 24% of new male cancers in the UK and is increasingly prevalent with advancing age in men over the age of 50.13
1. Martini F. et al. Fundamentals of Anatomy and Physiology. Pearson Education. 2005 : 717-723.
2. Niaudet P. Nephritic Syndrome. Comprehensive Pediatric Nephrology. Elsevier Inc. 2008 : 195-203.
3. Gbadegesin R. et al. Nephrotic Syndrome. Comprehensive Pediatric Nephrology. Elsevier Inc. 2008 : 195-203.
4. Milford D.B. Investigating Haematuria and Proteinuria. Paediatrics and Child Health. August 2008 ; 18 (8) : 349-353.
5. Lerma E.V. Tubulointerstitial Disease. Nephrology Secrets. Elsevier Inc. 2012 : 325-339.
6. O’Reilly P.H. et al. Urinary Tract Obstruction. Medicine. August 2007 ; 35 (8) : 420-422.
7. Schlossberg D. Clinical Infectious Disease. Cambridge University Press. 2008 : 499.
8. Tolkoff-Rubin N.E. et al. Therapy of Urinary Tract Infection. Therapy in Nephrology & Hypertension. Elsevier Inc. 2008 : 447-454.
9. Schrier R.W. Manual of Nephrology: Diagnosis and Therapy. Lippincott Williams and Wilkins. 2008 : 154.
10. Woo K.T. et al. Clinical Nephrology. World Scientific. 2002 : 287.
11. Beers M.H. et al. The Merck Manual of Medical Information. Merck research laboratories. Second home edition. 2003 : 831-878.
12. Cancer Research UK. Cancer Stats. Kidney Cancer – UK. January 2008 : 1-8.
13. Cancer Research UK. Cancer Stats. Prostate Cancer – UK. January 2008 : 1-10.
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Prostate Cancer
The Prostate Cancer Knowledge Centre is an interactive resource which provides healthcare professionals with the latest information in the field of prostate cancer.
Globally, at least 913,000 people are diagnosed with prostate cancer each year, accounting for 13.8% of new cancer cases in men. Of these approximately 385,500 new cases were identified in 2008 in Europe alone, making prostate cancer a major cause of morbidity and mortality in Europe.1
The diagnosis rate of prostate cancer is higher in the developed world following the increased usage of PSA screening,1 resulting in the diagnosis of many asymptomatic tumours. This is combined with other detection methods for a diagnosis to be achieved.
Age, family history and ethnicity are all well established risk factors of prostate cancer.2 However many risk factors usually associated with the development of other types of cancer, such as smoking, alcohol and a sedentary lifestyle, are not thought to be associated with prostate cancer.3
Following screening the majority of men are diagnosed with a low gleason-grade, hormone-sensitive prostate cancer,2 which is managed through watchful waiting and active surveillance. This is later treated with radiotherapy, radical prostatectomy and hormonal therapies. Disease progression will lead to patients being diagnosed with castrate-resistant prostate cancer. These patients will require chemotherapy treatment according to the current guidelines.2
The Prostate Cancer Knowledge Centre brings together current and detailed information relating to:
- Epidemiology
- Disease classification
- Methods of detection
- Hormone-sensitive prostate cancer
- Castration-resistant prostate cancer
- Treatment and management guidelines
References
- Ferlay J, Shin H-R, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127(12):2893–2917.
- European Association of Urology. Guidelines on prostate cancer, 2012.
- Grönberg H. Prostate cancer epidemiology. Lancet 2003;361:859-64.
Developed by EPG Online in partnership with, and financial support from, Astellas Pharma Europe Ltd
Date of preparation September 2012 EGD/12/016/EUi
Men's Health
As a disease topic Men's Health covers a broad set of issues affecting men of all ages. Some of the issues requiring greater focus and more thorough dissemination of information amongst the healthcare community, are those that have the potential to go undetected in the early stages. Diseases where early detection and more regular health checks not only improve prognosis and efficacy of treatment outcomes, but also quality of life.
These include:
Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. Although not considered a part of the aging process, it is associated with certain physiologic and psychological changes related to age. ED is most common in men between 40-70 years of age. However incidence is also higher amongst men with certain medical conditions which include, diabetes, heart disease, and hypertension. ED can also be a warning sign/symptom of these underlying conditions. 1
Hypogonadism (low testosterone)
Testosterone is an essential male hormone produced in the testes that plays a crucial role in the health and well being of male bodies. It is responsible for typical male sexual characteristics and is required by all men for a healthy life physically and psychologically.
Low testosterone, clinically known as hypogonadism, consists of decreased functional activity of the testes with diminished production and action of testosterone. Although there is a progressive decline in testosterone levels as men age, hypogonadism can occur in men of any age.
Men with low testosterone are also at increased risk of cardiovascular disease, diabetes and metabolic syndrome and osteoporosis.
For your information, the Mens Health knowledge centre concentrates on the understanding, management and treatment of erectile dysfunction and hypogonadism. The website also provides extensive details on up-coming conferences as well as an extensive library of useful resource. You can also access the knowledge centre via www.menshealthfocus.com.
Enter the Men's Health Knowledge Centre
References
1. McVary, Kevin T. Erectile. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL et al., editors. Harrison's Internal Medicine. 16th ed. New York: McGraw-Hill; 2005. p. 272-274
Renal Cell Carcinoma
Kidney cancer is the 14th most common cancer and there were approximately 200,000 new kidney cancer cases worldwide in 2002. RCC is a global problem, but its incidence varies considerably by geographical location. Rates of RCC are high in North America, Europe and Australia, whereas rates are low in Africa, India and China. Until recently, the worldwide incidence of RCC has increased by approximately 2% every year.
It is estimated that there will be 54,390 new cases of kidney cancer and 13,010 kidney cancer-related deaths in the US in 2008 alone. Global incidence data on mRCC are lacking, but can be estimated from figures for overall RCC rates.
In 2006, there were estimated to be 63,300 new cases of kidney cancer (tenth most common cancer in the European Union [EU]1) and 26,400 kidney cancer-related deaths in the EU. The Czech Republic, Estonia and Iceland have the highest RCC rates in Europe. Although the worldwide incidence of RCC is thought to be increasing,2 data from a recent European study, which analysed kidney cancer incidence in 1980– 2004, indicate a shift towards stabilization or a decrease in incidence in recent years in both sexes. Recently, kidney cancer incidence rates also have decreased or stabilized in some countries in Northern Europe, except for England, Scotland and Ireland, whereas incidence in Eastern Europe has generally increased (except for women in the early 2000s). The highest sustained decreases in incidence rates were seen in Sweden; declines were observed in both sexes throughout the 25-year study period.
Enter the Renal Cell Carcinoma Knowledge Centre
References
1.Ferlay J, Autier P, Boniol M et al. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18:581-592.
2. Matthew A, Devesa SS, Fraumeni JF, Jr.., Chow WH. Global Increases in kidney cancer incidence, 1973-1992. Eur J Cancer Prev. 2002;11:171-178.
Clinical Case Studies
Proctitis: Focus on Lymphogranuloma Venereum
Infection: Genitourinary InfectionAndrew J. Winter, Consultant in Genitourinary Medicine, Sandyford Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
Case History
A 28-year-old man was referred by his general practitioner with several weeks of painful defecation and constipation.
Management of Acute Uncomplicated Pyelonephritis
Infection: Genitourinary InfectionBeryl Oppenheim, Consultant Microbiologist, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
Case History
A 37-year-old woman presented to an accident and emergency department. She complained to the assessing doctor that she had had severe right loin pain and had been experiencing fevers and shivering for the past 24 hours.
Drug News
Astellas withdraws from tivozanib collaboration with Aveo Pharma in Europe
29-05-2013
Aveo Pharmaceuticals Inc reported that it was informed by its partner Astellas Pharma Inc that it would not be seeking marketing approval for their experimental kidney cancer drug, tivozanib, in...
Vesomni (Astellas) approved in the Netherlands for Overactive Bladder
27-05-2013The Dutch Medicines Evaluation Board has granted marketing authorisation for Vesomni (solifenacin and tamsulosin), from Astellas, in the Netherlands for treatment of moderate to severe storage...
STRATO study of LCP-Tacro (Veloxis Pharmaceuticals) shows benefits for Kidney Transplant patients
22-05-2013Data from the STRATO study demonstrates the potential for LCP-Tacro (tacrolimus once daily), from Veloxis Pharmaceuticals, to improve tacrolimus-induced tremors in stable Kidney Transplant...
Urological and Kidney Diseases Drug Data - A-Z
Possible searches include drugs or medicines (by brand, generic ingredient or drug class), diseases, conditions and more.
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Recent Drug Updates
TOVIAZ Tablets
13-06-2013Treatment of the symptoms (increased urinary frequency and/or urgency and/or urgency incontinence) that may occur in patients with overactive bladder syndrome. ...
Tolterodine Tartrate 1 mg Film-coated Tablet
05-06-2013Symptomatic treatment of urge incontinence and/or increased urinary frequency and urgency as may occur in patients with overactive bladder syndrome....
GYNO-DAKTARIN
23-05-2013For the local treatment of vulvovaginal candidosis and superinfections due to gram-positive bacteria. ...
Medical Images
Clinical Guidelines
Guidelines on Urolithiasis
Mar 2013The European Association of Urology (EAU) Urolithiasis Guidelines Panel have prepared these..
... guidelines to help urologists assess evidence-based management of stones/calculi and incorporate recommendations into clinical practice.
The document covers most aspects of the disease, which is still a cause of significant morbidity despite technological and scientific advances. The Panel is aware of the geographical variations in healthcare provision.
Guidelines on Urinary Incontinence
Mar 2013Urinary incontinence (UI) is an extremely common complaint in every part of the world. It causes a..
... great deal of distress and embarrassment, as well as significant costs, to both individuals and societies. Estimates of prevalence vary according to the definition of incontinence being used and the populations being studied.
However, there is universal agreement about the importance of the problem, both in terms of human suffering and economic costs.
These Guidelines do not mention topics such as the causation, basic science, epidemiology and psychology of UI. The focus of these Guidelines is entirely on assessment and treatment reflecting clinical practice. The Guidelines also do not consider patients with UI caused by neurological disease.
Online CME
Urology & Sexual Health In Primary Care: Erectile Dysfunction In Primary Care
Apr 2013
... erectile dysfunction in primary care as well as the link with diabetes or CVD.
Assessment and Management of the Patient With Hypogonadism and Mild Enlargement of the Prostate
Apr 2013
... treat hypogonadism.
Clinical Trials
Cranberry-lingonberry Juice Started During Acute Infection in Prevention of Urinary Tract Infections in Children
21-05-2013Cranberry and cranberry-lingonberry juice prevented urinary tract infections in children and in adults in our earlier clinical trials. The preventive effect was, however, observed late in the follow-up and the next recurrence was not prevented in children. The investigators hypothesize that cranberry-lingonberry juice..
... should be started already during the antimicrobial treatment of acute urinary tract infection in order to maximize the preventive efficacy of the juice. In addition, the investigators aim to find the explanation for the efficacy of cranberry-lingonberry juice by analyzing the concomitant changes in the chemical composition of urine and feces as well as the changes of gut microbiota.
Effect of 3g Versus 2 g MMF in Combination With Tacrolimus on Progression of Renal Allograft Interstitial Fibrosis
18-05-2013Development of chronic changes (scarring) in transplanted kidney tissue is a major cause of long-term kidney function deterioration and ultimately graft loss. It results from both immunologic and non-immunologic mechanisms. Mycophenolate mofetil (MMF) is immunosuppressive drug used for prevention of rejection after..
... kidney transplant, usually in combination with a calcineurin inhibitor (tacrolimus or cyclosporine), with or without corticosteroids. Besides immunosuppression, MMF may also have direct antifibrotic properties. Tacrolimus has potent immunosuppressive effects and is the cornerstone of contemporary posttransplant immunosuppressive therapy in kidney recipients. However, it is also nephrotoxic. The hypothesis of the present study is that in the setting of similar net immunosuppression, higher dose of MMF (3 g daily) will result in slower progression of kidney fibrosis during first year posttransplant as compared to MMF 2 g daily. To test this hypothesis, the present study will randomly assign low immunological risk kidney transplant recipients to either 2g or 3 g MMF daily, in combination with tacrolimus, with, or without maintenance steroids. All patients will have kidney biopsy at implantation and at 12 months after transplantation. Main outcome will be 1-year change in chronic kidney histology (interstitial fibrosis) assessed by protocol biopsy.
Medical Videos
Medical Journal Abstracts
Using Hounsfield Unit Measurement and Urine Parameters to Predict Uric Acid Stones
Urology
May 2013
Objective: To determine the in vivo ability to predict uric acid stone composition by Hounsfield units (HU) with the addition of urine parameters. Methods: We reviewed all consecutive stones sent for analysis during a 4-year period from our institution for patients with an in-house computed tomography (CT) scan within..
Reverse Mode of the Sodium/Calcium Exchanger Subtype 3 in Interstitial Cells of Cajal From Rat Bladder
Urology
May 2013
Objective: To investigate how the sodium/calcium exchanger subtype 3 (NCX3) and its reverse mode contribute to the function of interstitial cells of Cajal (ICCs) from the rat bladder. Methods: The study used 20 female Wistar rats. We observed the expression of the NCX3 expression in the bladder using reverse..
Medical Apps
Kidney eGFR Estimator for iPad - £1.49
UTI - Urinary Tract Infection - Free
DrawMD Urology - Free
Urology glossary - £0.62
Social Media
Frailty. Is it an important clinical syndrome?
on doc2doc... of treatments, one should consider doses in patients with renal failure, heart failure, liver dysfunction, depressed immune system, undernourished ...
High temperature and urinary tract pain
on doc2docHigh temperature and urinary tract pain I agree - don't be in a hurry to start those particular anti-infective agents - Ofloxacin is probably 'OTT' as ...
What's the most ridiculous rule your hospital has enforced?
on doc2doc... bare below the elbows"? - my local infection control person can't. All the rules around the infection control risks of clothing (ties, earing ...
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