Nephrology Update

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Bicarbonate  versus lactate buffered solutions for acute continuous haemodiafiltration or haemofiltration

Jin Hui Tian, Bin Ma, KeHu Yang, Yali Liu, Jiying Tan, Tian Xi Liu. (5th March 2015). Cochrane Database of Systematic Reviews [Online]. [Accessed 05/03/2015]
Acute kidney injury (AKI) is a severe loss of kidney function that results in patients' inability to appropriately excrete nitrogenous wastes and creatinine. Continuous haemodiafiltration (HDF) or haemofiltration (HF) are commonly used renal replacement therapies for people with AKI. Buffered dialysates and solutions used in HDF or HF have varying effects on acid-base physiology and several electrolytes. The benefits and harms of bicarbonate- versus lactate-buffered HDF or HF solutions for treating patients with AKI remain unclear
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Altered dietary salt intake for people with chronic kidney disease
Emma J McMahon, Katrina L Campbell, Judith D Bauer, David W Mudge. [Feburary 2015]. Cochrane Database of Systematic Reviews [Online]. [Accessed 05/03/2015]
Salt intake shows great promise as a modifiable risk factor for reducing heart disease incidence and delaying kidney function decline in people with chronic kidney disease (CKD). However, a clear consensus of the benefits of reducing salt in people with CKD is lacking.
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Loop diuretics for patients receiving blood transfusions
Michael Sarai, Aaron M Tejani. [February 2015]. Cochrane Database of Systematic Reviews [Online]. [Accessed 05/03/2015]
Blood transfusions are associated with significant morbidity and mortality. Prophylactic administration of loop diuretics (furosemide, bumetanide, ethacrynic acid, or torsemide) is common practice, especially among people who are at risk for circulatory overload, pulmonary oedema or both.
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Routine blood cultures in the management of pyelonephritis in pregnancy for improving outcomes
Harumi Gomi, Yoshihito Goto, Malinee Laopaiboon, Rie Usui, Rintaro Mori
[February 2015]. Cochrane Database of Systematic Reviews [Online]. [Accessed 05/03/2015]
Pyelonephritis is a type of urinary tract infection (UTI) that affects the upper urinary tract and kidneys, and is one of the most common conditions for hospitalisation among pregnant women, aside from delivery. Samples of urine and blood are obtained and used for cultures as part of the diagnosis and management of the condition. Acute pyelonephritis requires hospitalisation with intravenous administration of antimicrobial agents. Several studies have questioned the necessity of obtaining blood cultures in addition to urine cultures, citing cost and questioning whether blood testing is superfluous. Pregnant women with bacteraemia require a change in the initial empirical treatment based on the blood culture. However, these cases are not common, and represent approximately 15% to 20% of cases. It is unclear whether blood cultures are essential for the effective management of the condition.
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Screening with urinary dipsticks for reducing morbidity and mortality
Lasse T Krogsbøll, Karsten Juhl Jørgensen, Peter C Gøtzsche. [January 2015]. Cochrane Database of Systematic Reviews [Online]. [Accessed 05/03/2015]
Urinary dipsticks are sometimes used for screening asymptomatic people, and for case-finding among inpatients or outpatients who do not have genitourinary symptoms. Abnormalities identified on screening sometimes lead to additional investigations, which may identify serious disease, such as bladder cancer and chronic kidney disease (CKD). Urinary dipstick screening could improve prognoses due to earlier detection, but could also lead to unnecessary and potentially invasive follow-up testing and unnecessary treatment.
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Vitamin B and its derivatives for diabetic kidney disease
Amit D Raval, Divyesh Thakker, Arohi N Rangoonwala, Deval Gor, Rama Walia. [January 2015]. Cochrane Database of Systematic Reviews [Online]. [Accessed 05/03/2015]
Diabetes is a leading cause of end-stage kidney disease (ESKD) mainly due to development and progression of diabetic kidney disease (DKD). In absence of definitive treatments of DKD, small studies showed that vitamin B may help in delaying progression of DKD by inhibiting vascular inflammation and endothelial cell damage. Hence, it could be beneficial as a treatment option for DKD.
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First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for hypertension
Hao Xue, Zhuang Lu, Wen Lu Tang, Lu Wei Pang, Gan Mi Wang, Gavin WK Wong, James M Wright. [January 2015]. Cochrane Database of Systematic Reviews [Online]. [Accessed 05/03/2015]
Renin-angiotensin system (RAS) inhibitors are widely prescribed for treatment of hypertension, especially for diabetic patients on the basis of postulated advantages for the reduction of diabetic nephropathy and cardiovascular morbidity and mortality. Despite widespread use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for hypertension in both diabetic and non-diabetic patients, the efficacy and safety of RAS inhibitors compared to other antihypertensive drug classes remains unclear.
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Early identification and management of chronic kidney disease in adults in primary and secondary care.NICE guidelines [CG182]  (July 2014). Commissioned by the National Institute for Health and Care Excellence

The Renal National Service Framework (NSF)87, and the subsequent NICE Clinical Practice Guideline for early identification and management of adults with chronic kidney disease (CKD) in primary and secondary care (CG73), served to emphasise the change in focus in renal medicine from treatment of established kidney disease to earlier identification and prevention of kidney disease. CKD describes abnormal kidney function and/or structure. It is common, frequently unrecognised and often coexists with other conditions (for example, cardiovascular disease and diabetes). Moderate to severe CKD also carries an increased risk of other significant adverse outcomes such acute kidney injury, falls, frailty and mortality. The risk of developing CKD increases with increasing age, and some conditions that coexist with CKD become more severe and increasingly prevalent as kidney dysfunction advances. CKD can progress to end-stage kidney disease (ESKD)in a small but significant percentage of people. CKD is usually asymptomatic but it is detectable, and tests for detecting CKD are both simple and freely available. There is evidence that treatment can prevent or delay the progression of CKD, reduce or prevent the development of complications and reduce the risk of cardiovascular disease. However, because of a lack of specific symptoms, CKD frequently remains undetected and unrecognised. As a consequence people with CKD are often not diagnosed, or diagnosed late when CKD is at an advanced stage. Late diagnosis is associated with increased morbidity, mortality and healthcare associated costs