Nephron NEWS
Nephron NEWS
Nephron NEWS
Issue 6,2010 [August, 2010]
I strongly encourage the readers of Nephron Digest to engage in a dialogue by emailing me to discuss issues of global nephrological interest. These would be addressed by expert members of the editorial board of Nephron. Also readers are encouraged to request topics that they would like to be updated upon through the Mini Review series of Nephron Clinical Practice.
Professor Meguid El Nahas, PhD, FRCP
Editor, Nephron Clinical Practice
nephron@sheffield.ac.uk
m.el-nahas@sheffield.ac.uk
Digest of issue 116/3/2010
An Update and Practical Guide to Renal Stone Management (N. Johri and colleagues, UK and Australia; Nephron Clin Pract 2010;116:c159-c171) This mini review covers aspects of epidemiology, genetics, and pathophysiology of renal stone disease and gives clear guidance on its management, merits of ESWL, endoscopic and surgical removal as well as medical management and dietary recommendations. Kidney stone disease is highly prevalent in emerging economies and is likely to increase globally with the ongoing epidemic of obesity (M.J. Semins et al., J Urol 2010;183:571-575). Nephrologists worldwide therefore need to familiarize themselves with aspects of diagnosis and management of kidney stone disease.
Clinical Transformation: The Key to Green Nephrology (A. Connor and colleagues, UK; Nephron Clin Pract 2010;116:c200-c206) The authors bring ecology to nephrology in a challenging review on 'green nephrology'. Clearly, nephrology practice cannot avoid the tide of green practices and energy conservation. In fact, energy conservation is likely to impact on general population health including causes and complications of CKD (P. Wilkinson et al., Lancet 2009;374:1917-1929). This challenge is similar to other major public health issues in that it requires to be clearly defined, evidence gathered, theories developed, alliances built, policies formulated and actions taken. Facts need to inform trends! All too often in nephrology, trends are followed before they are supported by strong evidence?!
Selective Strategy for Urethral Catheterization in Febrile Young Girls to Confirm Urinary Tract Infection Diagnosis (C. Runel-Belliard and co-authors, France and UK; Nephron Clin Pract 2010;116:c235-c240) This original article reports an approach to identify non-toilet-trained febrile girls at high risk for UTIs to restrict urethral catheterizations (UCs) to this high-risk group of patients. Absence of another source of fever on examination and the child's unusual behavior were found to be independent predictors of UTI. The authors propose a clinical decision model to selectively identify young febrile girls at high risk of UTI warranting UC in order to avoid unnecessary UCs.
Moderate Chronic Kidney Disease in Women Is Associated with Fracture Occurrence Independently of Osteoporosis (S. Kinsella and co-authors, Ireland; Nephron Clin Pract 2010;116:c256-c262) The authors draw attention to the increased risk of fractures in CKD; the adjusted odds ratios of any prior fracture for eGFR 75-89, 60-74 and 30-59 were 1.0 (reference), 1.2 (0.9-1.6) and 1.4 (1.0-1.9), respectively, adjusting simultaneously for age, T score, risk factors and treatment for osteoporosis. Moderate CKD is associated with increased morbidity and all-cause mortality (Chronic Kidney Disease Prognosis Consortium. Lancet 2010;375:2073-2081). Fractures, especially in elderly women suffering from CKD, can only increase poor outcomes.
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