The Kidney and Urinary guidelines are the latest addition to Therapeutic Guidelines’ resources, developed by a multidisciplinary group of experts in nephrology,
urology and general practice. The guidelines contain 22 brand-new topics and 6 extensively revised topics on electrolyte disturbances:
Abnormal findings in kidney function tests in adults
Abnormal findings in kidney function tests can indicate underlying disease,
and understanding the history is key to management. Guidance includes causes of elevated serum creatinine,
and tests to determine if the abnormality is related to an acute kidney injury or chronic kidney disease.
Abnormal findings in urine tests in adults
Abnormal findings in urine tests are common and can indicate important underlying disease. Guidance includes recommendations on assessing haematuria, proteinuria, pyuria and urinary casts.
Persistent haematuria can be associated with urinary tract cancer. Guidance on when to consider referring patients with haematuria to a specialist is included.
Acute kidney injury in adults
Acute kidney injury in adults includes guidance on assessment and management, including when emergency care or specialist advice should be sought.
Recommendations for rhabdomyolysis management, including strategies to prevent acute kidney injury, are included.
Autosomal dominant polycystic kidney disease
Autosomal dominant polycystic kidney disease (ADPKD) provides guidance on diagnosis,
investigations and management, including disease-modifying drug therapy with tolvaptan ,
chronic kidney disease management, screening for intracranial aneurysms, and management of kidney pain.
Benign prostatic obstruction
Benign prostatic obstruction (BPO) is a common cause of bothersome lower urinary tract symptoms in males. Guidance on management, including
drug therapy recommendations, when to refer patients to a urologist, and urinary retention (a complication of BPO), is provided.
Overview, screening and diagnosis of chronic kidney disease in adults
Screening for chronic kidney disease in at-risk individuals is important for early diagnosis and
initiation of therapies that slow decline in kidney function. Guidance on who to screen, screening tests and investigations to
identify the cause of chronic kidney disease are included.
Management of chronic kidney disease in adults
Early and proactive management of chronic kidney disease is essential to reduce cardiovascular
disease risk and slow decline in kidney function. Guidance on drug and nondrug therapy, sick-day management, family planning and pregnancy,
and management of complications is included.
Hyperkalaemia in adults
Guidance on hyperkalaemia has been extensively revised:
For acute hyperkalaemia, a new flowchart has been developed to assess how urgently potassium needs to be lowered.
Calcium gluconate is preferred for cardiac membrane stabilisation in severe hyperkalaemia, except during cardiac arrest or periarrest,
when calcium chloride is recommended as there is more evidence to support its use.
Dose recommendations for nebulised salbutamol and furosemide have been added.
New content on chronic hyperkalaemia includes dose recommendations for patiromer and sodium zirconium cyclosilicate.
Hypokalaemia in adults
Updated guidance on hypokalaemia includes a new flowchart to help determine the underlying cause.
Recommended starting doses of potassium in the drug recommendations have been updated to reduce the likelihood of overcorrection.
Hyponatraemia in adults
Guidance on hyponatraemia has been substantially changed to provide clearer, severitybased management:
A new flowchart has been developed to help clinicians identify the likely cause of hyponatraemia. Simultaneous measurement of serum osmolality, urine sodium concentration and urine osmolality
is recommended as a key step of the diagnostic work up.
A new table outlines maximum recommended increases in serum sodium concentration over time, based on hyponatraemia severity,
risk of osmotic demyelination syndrome, and intracranial pathology.
Guidance on calculating the initial infusion rate for sodium chloride 3% solution in severe hyponatraemia has been revised.
Hypermagnesaemia in adults
Guidance on hypermagnesaemia has been updated. New dose recommendations for intravenous furosemide and intravenous calcium for use in severe hypermagnesaemia have been added.
Concurrent urinary tract infection in a person with a kidney or ureteric stone warrants urgent surgical decompression.
Other indications for emergency management or specialist referral are listed here
Some people may benefit from an alpha blocker to aid passage of a stone – guidance on a trial of tamsulosin is included.
Advice on follow-up covers imaging to confirm stone passage and strategies to prevent recurrent stones.
Kidney cysts
Kidney cysts are an increasingly common incidental finding on imaging.
Guidance has been developed to help distinguish simple cysts from complex cysts, and to determine the follow-up required.
Kidney failure in adults
Content on kidney failure outlines the key features of the main management options – kidney transplantation,
dialysis and kidney supportive care. Patient preparation for kidney replacement therapy is discussed,
as well as important considerations when caring for patients with kidney failure.
Lower urinary tract symptoms
Lower urinary tract symptoms are common and can be associated with various urological and nonurological causes.
Guidance on the assessment of lower urinary tract symptoms in males and females is provided in separate topics.
These topics have been developed to support clinicians in determining the likely cause(s), guide management, and determine if early specialist referral is needed.
Digital rectal examination is recommended in males with lower urinary tract symptoms to assess for prostate abnormalities
suggestive of malignancy, and to assess anal tone, constipation (if present) and pelvic floor tone.
In males with lower urinary tract symptoms, serum PSA measurement is a useful test to assess the risk of prostate cancer.
In those with benign prostatic obstruction, serum PSA measurement is also helpful in predicting whether a 5-alpha-reductase inhibitor is likely to be effective.
Management of long-term urinary catheters in adults
Urinary catheter–related issues are common in the community. Management of long-term urinary catheters in adults
provides guidance on routine care, management strategies for common problems, and complications that require urgent management.
Nocturnal polyuria in adults
Nocturnal polyuria is one of the main causes of nocturia (needing to wake from sleep to go to the toilet).
Content on nocturnal polyuria includes diagnostic criteria, causes and contributing factors, and detailed advice on first-line management.
A trial of low-dose desmopressin may be considered if first-line management is ineffective.
Overactive bladder in adults
Guidance on overactive bladder covers neurogenic and non neurogenic presentations.
A symptom assessment tool is included to support evaluation of overactive bladder symptom severity and degree of bother, and monitor response to treatment.
People with mild or moderate symptoms should be started on bladder rehabilitation, which encompasses strategies to retrain the bladder and address contributing factors.
A combination of bladder rehabilitation and drug therapy can be considered in people with severe or particularly bothersome symptoms. Dose recommendations for beta 3 agonist and anticholinergic therapy are provided.
Stress urinary incontinence
New content on stress urinary incontinence in females and males includes guidance on assessment, when to refer to a specialist, and first-line management advice. An overview of surgical management options is also included.
Pelvic floor muscle training is an important part of first-line management in females with stress urinary incontinence – links to helpful resources on pelvic floor exercises are included.
Assessment of daytime urinary incontinence in children
Comprehensive advice on assessment of daytime urinary incontinence in children 5 years or older has been developed to support clinicians in identifying causes and contributing factors,
which guide management and referral decisions.
Advice on interpreting findings on renal tract ultrasound, and bladder and bowel diaries, is included.
Management of daytime urinary incontinence in children
Anticholinergic therapy can be considered in children with daytime urinary incontinence associated with overactive bladder if
standard urotherapy alone is ineffective. Age-specific dosage recommendations for oxybutynin and guidance on important treatment considerations are provided to
support clinical decision-making.
Assessment of enuresis in children
Assessment of enuresis in children can be complex and often requires more than one appointment.
Structured guidance on assessment is provided to classify the type of enuresis, assess the impact on the child and family, and identify if early specialist referral is needed.
Management of enuresis in children
Management of enuresis in children includes detailed advice on the choice and implementation of
first-line management options – an enuresis alarm or desmopressin.
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