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Disease Knowledge Centres

Kidney and Urological Diseases - Disease Topic 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.

Renal Anaemia
MIRACEL is the first real-life study to investigate switching the treatment of Chronic Kidney Disease (CKD) patients on dialysis from commonly used shorter-acting erythropoiesis-stimulating agents (ESAs) directly to the once monthly administration of the drug Mircera^®, using pre-filled syringes.

Initial results confirm that Mircera^® maintains haemoglobin (Hb) levels in CKD patients within a narrow range. Read more about the MIRACEL study results

Chronic Kidney Disease (CKD) is characterised by a gradual and permanent loss of kidney function that worsens as it progresses from stages 1 to 5. One of the most common complications of CKD is anaemia. Anaemia in patients with CKD causes debilitating weakness and fatigue, altered cognitive function, and a negative impact on quality of life and wellbeing.¹

Anaemia is defined as a reduction of the number of circulating red blood cells to below a certain threshold level. It is also described as a low haemoglobin concentration or a low volume of packed red cells².

Renal anaemia is secondary to chronic kidney disease (CKD) and it appears early in the course of CKD, worsening as it progresses.

Because renal anaemia impairs the delivery and utilization of oxygen to tissues and organs throughout the body, it has a wide range of effects on both quality of life and overall health and well being.²

CKD-related anaemia is a major public health concern. It is associated with an increased risk of morbidity, mortality and hospitalisation, diminished physical well-being and reduced patient quality of life.^3-6

Diagnosing renal anaemia is critical in establishing early and appropriate treatment in patients.

The priority in the treatment of anaemia is to correct the underlying factors that caused the anaemia and the specific treatment strategy depends on the cause of the anaemia.

There are a number of treatment guidelines available which provide information on the management of anaemia and CKD related anaemia. Treatment of renal anaemia can significantly improve overall health in patients with chronic kidney disease (CKD).

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References

1. Lefebvre P, Vekeman F, Sarokhan B, Enny C, Provenzano R, Cremieux PY. Relationship between hemoglobin level and quality of life in anemic patients with chronic kidney disease receiving epoetin alfa. Curr Med Res Opin. 2006;22:1929-1937.
2. NAAC (National Anemia Action Council) Anemia monograph. Available at http://anemia.org/professionals/monograph/ [Accessed June 2008].
3. Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. The impact of anemia on cardiomyopathy, morbidity, and and mortality in end-stage renal disease. Am J Kidney Dis. 1996;28:53–61.
4. Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D, Burgess E, Jindal K, Barrett B, Singer J, Djurdjev O. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis. 1999;34:125–134.
5. Ofsthun N, Labrecque J, Lacson E, Keen M, Lazarus JM. The effects of higher hemoglobin levels on mortality and hospitalization in hemodialysis patients. Kidney Int. 2003;63:1908–1914.
6. Perlman RL, Finkelstein FO, Liu L, Roys E, Kiser M, Eisele G, Burrows-Hudson S, Messana JM, Levin N, Rajagopalan S, Port FK, Wolfe RA, Saran R. Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study. Am J Kidney Dis. 2005;45:658–666.

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Chronic Kidney Disease (CKD) is characterised by a gradual and permanent loss of kidney function that worsens as it progresses from stages 1 to 5. One of the most common complications of CKD is anaemia. Renal anaemia is secondary to chronic kidney disease (CKD) and it appears early in the course of CKD, worsening as it progresses.

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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.

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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.

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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.

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Latest Multi Media

An Introduction to Diagnosing Chronic Kidney Disease

Kidney and Urological Diseases Drug Data - A-Z English

Drug Updates

Macrobid Capsules 100mg B.P.

Urinary tract infections, pyelitis, prophylaxis in genito- urinary surgery.

Doralese Tiltab Tablets 20 mg

Urinary outflow obstruction due to benign prostatic hypertrophy.

Gyno-Pevaryl 1 Vaginal Pessary

Vaginitis due to Candida Albicans and other yeasts.

Latest Drug News

FDA approves Anturol (Watson Pharma) for Overactive Bladder treatment - 02-01-2012

FDA has approved Anturol (oxybutynin) from Antares Pharma/Watson Pharma as a topical gel 3% for the treatment of Overactive Bladder (OAB) with symptoms of urge urinary incontinence, urgency, and frequency. The active ingredient is delivered transdermally, and not metabolized by the liver in the same way as orally administered oxybutynin. This results in a low level of side effects, such as dry mouth and constipation. Under an exclusive licensing agreement, Watson anticipates launching the product in 2012.

Toviaz(Pfizer) success in Overactive Bladder in Older Patients - 07-12-2011

Toviaz (fesoterodine fumarate) from Pfizer has met its primary endpoint in Study A0221049.This was a 12 week trial which enrolled 562 patients aged 65 or older who were randomised to either fesoterodine or placebo. Toviaz was found to be statistically significantly superior to placebo in reducing the mean number of urgency urinary incontinence episodes per day at the end of treatment for Overactive Bladder. While the prevalence of overactive bladder increases with age, limited research has been conducted in older individuals with this condition. Toviaz, a muscarinic antagonist, is approved in both the USA and EU to treat the symptoms of Overactive Bladder.

Latest Social Media

Medical slangs anyone??
on doc2doc

Medical slangs anyone?? Well at our end RTA can mean renal tubular acidosis, as well..reason why abbreviation use is discouraged

Would CCTV cameras make you more likely to wash your hands?
on doc2doc

... information demonstrating impact of improved hand hygiene on hospital infection rates (Pittet, 2001). It is necessary that hospital ...

Would CCTV cameras make you more likely to wash your hands?
on doc2doc

... would have to prove an associated reduction in health care associated infections during / after the monitoring period to prove cost effectiveness for ...

Latest Clinical Trials

Antibody Response to Human Papillomavirus Recombinant Vaccine (Gardasil®) in Girls and Young Women With Chronic Kidney Disease

People with chronic kidney disease are known to have immune response abnormalities, including a diminished response to some vaccinations. Those with chronic kidney disease have a disproportionate burden of HPV 6-, 11-, 16- and/or 18-related genital tract disease. Due to immune response abnormalities, the CKD population may or may not respond to the recommended three-dose regimen of Gardasil®, a vaccine intended to protect against HPV 6-, 11-, 16-, and 18-related genital tract disease. The objective of this study is to measure the antibody response to Gardasil® in female patients 9-21 years of age with chronic kidney disease (CKD) (Stage 1-4), end-stage kidney disease (Stage 5 CKD), and status-post kidney transplant. Gardasil® vaccine will be administered according to the FDA-approved schedule. Blood samples to measure antibody levels to vaccine strains of human papillomavirus (HPV) will be obtained at months 0, 7 and 24.

Impact of Vitamin D Therapies on Chronic Kidney Disease

This investigation will consist of a prospective study utilizing two separate populations of patients with 25(OH)D deficiency, one population with chronic kidney disease (CKD) and one with normal renal function.

Latest Journal Publications

Clinical Science

Background: Kidney transplantation is the therapy of choice in most cases of end stage renal disease. The purpose of the present study was to evaluate serum obestatin levels in kidney transplant recipients (Tx), compare levels in patients with renal failure (CKD) with those in healthy subjects (HS), and to assess the role of this hormone in energetic metabolism. Patients and methods: A total of 95 subjects were studied: 40 were Tx; 35 had CKD and 20 were HS. Inclusion criteria were age > 18 years and good allograft function. Patients with an inflammatory disease or a diagnosis of cancer were excluded from the study. Results: Obestatin levels in Tx patients were significantly lower than in HS (3.5 [3–4.8] versus 11 [8.56–28.60] ng/mL; p < 0.0001) and patients with CKD (3.5 [3–4.8] versus 4.7 [3, 5–6, 1] ng/mL; p = 0.008). At univariate analysis, a direct correlation was found between obestatin and calcemia (p: 0.0001; r: 0.51), phosphoremia (p: 0.0005; r: 0, 46), calcium-phosphate product (p < 0.0001; r: 0.53), and parathormone (p: 0.01; r: 0.32), whereas significant inverse correlations were evidenced for BMI (p < 0.0001; r: −0.52). At multivariate analysis, significance was maintained for the correlation between obestatin and phosphoremia (β = 0.47; p = 0.008), for the calcium-phosphate product (β = 0.55; p = 0.0005) and for BMI (β = −0.53; p = 0.01). Conclusion: Obestatin, present in lower levels in Tx patients than in CKD patients and HS, plays a role in energy metabolism, affecting BMI and the metabolism of calcium–phosphorus.

Regulatory Peptides

Kidney transplantation is the therapy of choice in most cases of end stage renal disease. The purpose of the present study was to evaluate serum obestatin levels in kidney transplant recipients (Tx), compare levels in patients with renal failure (CKD) wit