Pub Date : 2019-05-01DOI: 10.1177/1179561119847464
G. Puckrein, D. Walker, Liou Xu, Peter Congdon, K. Gooch
Objectives: To determine current and future prevalence of overactive bladder (OAB) among Medicare fee-for-service beneficiaries in the United States. Methods: Prevalence of OAB in US adults ⩾ 65 years was determined using the 2013 Medicare Beneficiary Part B Carrier Claims File, Part D Drug Event File, and Medicare Beneficiary Annual Summary File. Prevalence for 2027 was forecasted with US Census population projections. Regional projections were based on applying national OAB rates by age, sex, and race/ethnicity to zip code tabulation area beneficiary populations. Results: In the 2013 dataset, the prevalence of OAB was 7.2% (male: 7.7%; female: 6.7%). Across demographic categories, prevalence was the highest among those aged more than 74 years (9.3%), identifying as White (7.4%), and residing in urban areas (7.5%). By 2027, OAB is projected to increase by 48.1%. Discussion: OAB affects a substantial proportion of the US fee-for-service beneficiary population, with the prevalent population projected to rise substantially by 2027.
{"title":"The Prevalence and Forecast Prevalence of Overactive Bladder in the Medicare Population","authors":"G. Puckrein, D. Walker, Liou Xu, Peter Congdon, K. Gooch","doi":"10.1177/1179561119847464","DOIUrl":"https://doi.org/10.1177/1179561119847464","url":null,"abstract":"Objectives: To determine current and future prevalence of overactive bladder (OAB) among Medicare fee-for-service beneficiaries in the United States. Methods: Prevalence of OAB in US adults ⩾ 65 years was determined using the 2013 Medicare Beneficiary Part B Carrier Claims File, Part D Drug Event File, and Medicare Beneficiary Annual Summary File. Prevalence for 2027 was forecasted with US Census population projections. Regional projections were based on applying national OAB rates by age, sex, and race/ethnicity to zip code tabulation area beneficiary populations. Results: In the 2013 dataset, the prevalence of OAB was 7.2% (male: 7.7%; female: 6.7%). Across demographic categories, prevalence was the highest among those aged more than 74 years (9.3%), identifying as White (7.4%), and residing in urban areas (7.5%). By 2027, OAB is projected to increase by 48.1%. Discussion: OAB affects a substantial proportion of the US fee-for-service beneficiary population, with the prevalent population projected to rise substantially by 2027.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83468092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1177/1179561119853556
J. Galán-Llopis, C. Torrecilla-Ortiz, Maria Pilar Luque-Gálvez, Prevent-Lit Group, Xavier Peris-Nieto, Jordi Cuñé-Castellana
Introduction: We assessed the effectiveness of the joint use of a pH meter in combination with dietary supplements in restoring the urinary pH balance of patients with medical history of uric acid or calcium phosphate/calcium oxalate stones in real-world practice. Methods: An interventional, prospective, and open-label study was performed. At baseline visit, patients were assigned to a group according to the type of previous calculus and urinary pH: the alkalinizer group (uric acid stones and/or pH < 5.5) and acidifier group (calcium oxalate stones and/or pH > 6.2) received dietary supplement to increase or decrease, respectively, urinary pH. Patients were examined at baseline and after treatment for 30, 60, and 90 days. Urinary pH, type of therapy, compliance, and self-reported renal colic events were recorded at each visit. Results: The study included 143 patients, 45.5% in the alkalinizer group and 54.5% in the acidifier group, and the mean age was 53.60 years. Both nutraceuticals were significantly effective in normalizing urinary pH (P < 0.00001) at all follow-up visits compared with baseline, with a maximum percentage of patients who achieved nonlithogenic pH (54.9%) at day 60 (P < 0.00001). Analysis of the effect of treatment compliance at 60 days indicated that 71.8% of compliant and 45.9% of noncompliant patients achieved nonlithogenic pH (odds ratio [OR]: 3.03, 95% confidence interval [CI]: 1.29-6.66). A Cox-regression model indicated that nonlithogenic pH at 90 days (hazard ratio [HR]: 0.428, 95% CI: 0.193-0.947) and compliance at 60 days (HR: 0.428, 95% CI: 0.189-0.972) were independently associated with colic complaints-free survival. Conclusions: In patients with medical history of renal lithiasis, monitoring of pH in combination with dietary supplements may be useful in maintaining nonlithogenic pH values, yielding very high ratios of success, especially in compliant patients. Besides this main outcome, a reduction in self-reported colic complaints associated with pH balance was also observed.
{"title":"Urinary pH as a Target in the Management of Lithiasic Patients in Real-World Practice: Monitoring and Nutraceutical Intervention for a Nonlithogenic pH Range","authors":"J. Galán-Llopis, C. Torrecilla-Ortiz, Maria Pilar Luque-Gálvez, Prevent-Lit Group, Xavier Peris-Nieto, Jordi Cuñé-Castellana","doi":"10.1177/1179561119853556","DOIUrl":"https://doi.org/10.1177/1179561119853556","url":null,"abstract":"Introduction: We assessed the effectiveness of the joint use of a pH meter in combination with dietary supplements in restoring the urinary pH balance of patients with medical history of uric acid or calcium phosphate/calcium oxalate stones in real-world practice. Methods: An interventional, prospective, and open-label study was performed. At baseline visit, patients were assigned to a group according to the type of previous calculus and urinary pH: the alkalinizer group (uric acid stones and/or pH < 5.5) and acidifier group (calcium oxalate stones and/or pH > 6.2) received dietary supplement to increase or decrease, respectively, urinary pH. Patients were examined at baseline and after treatment for 30, 60, and 90 days. Urinary pH, type of therapy, compliance, and self-reported renal colic events were recorded at each visit. Results: The study included 143 patients, 45.5% in the alkalinizer group and 54.5% in the acidifier group, and the mean age was 53.60 years. Both nutraceuticals were significantly effective in normalizing urinary pH (P < 0.00001) at all follow-up visits compared with baseline, with a maximum percentage of patients who achieved nonlithogenic pH (54.9%) at day 60 (P < 0.00001). Analysis of the effect of treatment compliance at 60 days indicated that 71.8% of compliant and 45.9% of noncompliant patients achieved nonlithogenic pH (odds ratio [OR]: 3.03, 95% confidence interval [CI]: 1.29-6.66). A Cox-regression model indicated that nonlithogenic pH at 90 days (hazard ratio [HR]: 0.428, 95% CI: 0.193-0.947) and compliance at 60 days (HR: 0.428, 95% CI: 0.189-0.972) were independently associated with colic complaints-free survival. Conclusions: In patients with medical history of renal lithiasis, monitoring of pH in combination with dietary supplements may be useful in maintaining nonlithogenic pH values, yielding very high ratios of success, especially in compliant patients. Besides this main outcome, a reduction in self-reported colic complaints associated with pH balance was also observed.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89283259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1177/1179561119854772
N. Niwa, K. Matsumoto, T. Ohigashi, A. Komatsuda, Masahiro Katsui, Hideharu Bessyo, T. Arakawa
Objective: We investigated the efficacy and safety of retrograde intrarenal surgery (RIRS) as a primary treatment for staghorn calculi. Methods: From 2012 to 2016, we identified 39 patients with staghorn calculi who received RIRS as a primary treatment. During the study period, no staghorn calculi were treated primarily with percutaneous nephrolithotomy or any other modality. A stone-free status after RIRS was defined as no detectable stone fragments on X-rays or computed tomography scans. Results: Of 39 patients who received 134 procedures (median 3 procedures per patient; range: 1-11; mean stone length: 60.5 ± 23.0 mm), 18 (46%) and 21 (54%) had staghorn calculi <60 and >60 mm in maximum length, respectively. The stone-free rates after the first and final procedures were 21% (8 of 39) and 62% (24 of 39), respectively; overall, 39% (7 of 18) and 78% (14 of 18), respectively, for the 18 patients with <60 mm staghorn calculi; and 5% (1 of 21) and 48% (10 of 21), respectively, for the 21 patients with >60 mm calculi. Multivariate analysis revealed a maximum stone length >60 mm to be the only independent predictor of a stone-free status after the first and final procedures. During the treatment series, perioperative complications occurred in 16 (41%) patients. Only one patient presented with a Clavien-Dindo grade III complication (malposition of a ureteral stent). Conclusions: RIRS is a safe and effective treatment option for staghorn calculi.
{"title":"Clinical Outcomes of Retrograde Intrarenal Surgery as a Primary Treatment for Staghorn Calculi: A Single-Center Experience","authors":"N. Niwa, K. Matsumoto, T. Ohigashi, A. Komatsuda, Masahiro Katsui, Hideharu Bessyo, T. Arakawa","doi":"10.1177/1179561119854772","DOIUrl":"https://doi.org/10.1177/1179561119854772","url":null,"abstract":"Objective: We investigated the efficacy and safety of retrograde intrarenal surgery (RIRS) as a primary treatment for staghorn calculi. Methods: From 2012 to 2016, we identified 39 patients with staghorn calculi who received RIRS as a primary treatment. During the study period, no staghorn calculi were treated primarily with percutaneous nephrolithotomy or any other modality. A stone-free status after RIRS was defined as no detectable stone fragments on X-rays or computed tomography scans. Results: Of 39 patients who received 134 procedures (median 3 procedures per patient; range: 1-11; mean stone length: 60.5 ± 23.0 mm), 18 (46%) and 21 (54%) had staghorn calculi <60 and >60 mm in maximum length, respectively. The stone-free rates after the first and final procedures were 21% (8 of 39) and 62% (24 of 39), respectively; overall, 39% (7 of 18) and 78% (14 of 18), respectively, for the 18 patients with <60 mm staghorn calculi; and 5% (1 of 21) and 48% (10 of 21), respectively, for the 21 patients with >60 mm calculi. Multivariate analysis revealed a maximum stone length >60 mm to be the only independent predictor of a stone-free status after the first and final procedures. During the treatment series, perioperative complications occurred in 16 (41%) patients. Only one patient presented with a Clavien-Dindo grade III complication (malposition of a ureteral stent). Conclusions: RIRS is a safe and effective treatment option for staghorn calculi.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79806146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1177/1179561119864907
S. Trivedi, Pranab Patnaik, Y. Ramole, F. Khan, R. Srivastava, U. S. Dwivedi
Background: This study compared urinary and serum nerve growth factor levels and serum C-reactive protein levels in patients with overactive bladder, before and after treatment with antimuscarinic agents, to evaluate their diagnostic and therapeutic importance. Methods: This was a prospective case-control study conducted between February 2014 and December 2014 which included patients with a confirmed diagnosis of overactive bladder (overactive bladder group) and healthy controls (control group). All patients visiting urology out-patient department with urgency, frequency, and urge incontinence were assessed for overactive bladder and, if eligible, were enrolled in the study. Biomarkers were evaluated before in both groups and after antimuscarinic treatment in the overactive bladder group. Results: Overall, 80 participates were enrolled (overactive bladder, n = 40; control, n = 40). The mean age was not different between the two groups (overactive bladder, 48.6 years; control, 46.9 years [P = 1.01]) and females were more in both the groups (60% and 55%, respectively). The majority (70%) of patients presented with frequency and urgency. After 3 months of treatment with antimuscarinics, the mean overactive bladder symptom score decreased significantly from 8.4 to 4.85 (P < .001). The mean urinary and serum nerve growth factor levels and serum C-reactive protein levels also decreased significantly from baseline after 3 months of treatment with antimuscarinics (24.78 pg/mL, 22.46 pg/mL, 0.89 mg/L, respectively; P < .0001). Conclusions: Measurement of urinary and serum nerve growth factor levels has diagnostic and therapeutic potential in patients with overactive bladder.
{"title":"Role of Serum and Urinary Biomarkers in Evaluation and Management of Patients With Overactive Bladder","authors":"S. Trivedi, Pranab Patnaik, Y. Ramole, F. Khan, R. Srivastava, U. S. Dwivedi","doi":"10.1177/1179561119864907","DOIUrl":"https://doi.org/10.1177/1179561119864907","url":null,"abstract":"Background: This study compared urinary and serum nerve growth factor levels and serum C-reactive protein levels in patients with overactive bladder, before and after treatment with antimuscarinic agents, to evaluate their diagnostic and therapeutic importance. Methods: This was a prospective case-control study conducted between February 2014 and December 2014 which included patients with a confirmed diagnosis of overactive bladder (overactive bladder group) and healthy controls (control group). All patients visiting urology out-patient department with urgency, frequency, and urge incontinence were assessed for overactive bladder and, if eligible, were enrolled in the study. Biomarkers were evaluated before in both groups and after antimuscarinic treatment in the overactive bladder group. Results: Overall, 80 participates were enrolled (overactive bladder, n = 40; control, n = 40). The mean age was not different between the two groups (overactive bladder, 48.6 years; control, 46.9 years [P = 1.01]) and females were more in both the groups (60% and 55%, respectively). The majority (70%) of patients presented with frequency and urgency. After 3 months of treatment with antimuscarinics, the mean overactive bladder symptom score decreased significantly from 8.4 to 4.85 (P < .001). The mean urinary and serum nerve growth factor levels and serum C-reactive protein levels also decreased significantly from baseline after 3 months of treatment with antimuscarinics (24.78 pg/mL, 22.46 pg/mL, 0.89 mg/L, respectively; P < .0001). Conclusions: Measurement of urinary and serum nerve growth factor levels has diagnostic and therapeutic potential in patients with overactive bladder.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91209541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-03-26DOI: 10.1177/1179561118765758
P. Aguiar, T. Costa de Padua, Carmelia Maria Noia Barreto, A. del Giglio
Recently, the development of antiangiogenic drugs has changed the therapy for metastatic renal cell carcinoma (RCC). As a result, the survival of individuals with advanced RCC has more than doubled. The median overall survival improved from 12 months during the cytokines era to near 30 months with antiangiogenic drugs. In this decade, the advent of immune checkpoint inhibitors showed enthusiastic results and is the new standard of care for patients with metastatic RCC previously treated with antiangiogenic drugs. The combination of immune checkpoint inhibitors plus antiangiogenic drugs may have a synergistic activity. As a result, current studies investigate the combination for treatment-naïve patients. This may potentially change clinical practice. In this article, we will highlight new therapeutic options available and agents or combinations that are being investigated for metastatic RCC.
{"title":"Treatment of Metastatic Renal Cell Carcinoma: Latest Evidence and Ongoing Challenges","authors":"P. Aguiar, T. Costa de Padua, Carmelia Maria Noia Barreto, A. del Giglio","doi":"10.1177/1179561118765758","DOIUrl":"https://doi.org/10.1177/1179561118765758","url":null,"abstract":"Recently, the development of antiangiogenic drugs has changed the therapy for metastatic renal cell carcinoma (RCC). As a result, the survival of individuals with advanced RCC has more than doubled. The median overall survival improved from 12 months during the cytokines era to near 30 months with antiangiogenic drugs. In this decade, the advent of immune checkpoint inhibitors showed enthusiastic results and is the new standard of care for patients with metastatic RCC previously treated with antiangiogenic drugs. The combination of immune checkpoint inhibitors plus antiangiogenic drugs may have a synergistic activity. As a result, current studies investigate the combination for treatment-naïve patients. This may potentially change clinical practice. In this article, we will highlight new therapeutic options available and agents or combinations that are being investigated for metastatic RCC.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88016471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-22DOI: 10.1177/1179561117726090
R. G. Price
Cadmium is a non-essential metal which because of its extensive use in industry and agriculture presents a worldwide health hazard. Long-term exposure to cadmium results in nephropathy characterised by interstitial nephritis affecting the renal tubules. In addition to occupational exposure, cadmium can contaminate food and water increasing the number of people at risk of developing chronic renal disease. It is now known that smoking is an independent risk factor for renal disease. The current knowledge of the molecular mechanisms initiating and progressing cadmium nephrotoxicity is now partly understood and research on the molecular effects of nicotine on the kidney is ongoing. The exacerbation of renal disease by smoking is an increasing problem. It is concluded that where there is potential exposure to cadmium, either occupationally or environmentally, individuals should be encouraged to cease smoking.
{"title":"Cadmium Nephropathy and Smoking","authors":"R. G. Price","doi":"10.1177/1179561117726090","DOIUrl":"https://doi.org/10.1177/1179561117726090","url":null,"abstract":"Cadmium is a non-essential metal which because of its extensive use in industry and agriculture presents a worldwide health hazard. Long-term exposure to cadmium results in nephropathy characterised by interstitial nephritis affecting the renal tubules. In addition to occupational exposure, cadmium can contaminate food and water increasing the number of people at risk of developing chronic renal disease. It is now known that smoking is an independent risk factor for renal disease. The current knowledge of the molecular mechanisms initiating and progressing cadmium nephrotoxicity is now partly understood and research on the molecular effects of nicotine on the kidney is ongoing. The exacerbation of renal disease by smoking is an increasing problem. It is concluded that where there is potential exposure to cadmium, either occupationally or environmentally, individuals should be encouraged to cease smoking.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80701567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
One of the dreaded complications of long term analgesic intake is nephrotoxicity characterized by chronic interstitial nephritis and papillary necrosis. Much of the literature of its epidemiology dates back to 1960s and its impact on present day society is not well documented. Non steroidal anti inflammatory agents reduce pain by blocking prostaglandin generation. Prostaglandins have renal vaso dilatory effects in states of volume depletion to counteract the vasoconstrictive pressor hormones. Earlier analgesic tablets contained a mixture of aspirin, phenacetin and caffeine. Phenacetin and its metabolites have nephrotoxic potential and incidence of analgesic nephropathy was brought down in countries where it was banned. The concentration of phenacetin and its metabolite acetaminophen is increased at the tip of renal papilla due to counter current concentrating mechanism of the loop of henle. These are potent oxidants leading to cell injury due to lipid peroxidation, though their effects are normally counterbalanced by anti oxidant glutathione. Glutathione deficiency at the medulla can be precipitated by co ingestion of aspirin. The exact dose of analgesics which needs to be ingested is unclear but a daily ingestion of 5–8 tablets over 5 years results in clinical nephrotoxicity. The histopathology is one of chronic interstitial nephritis with renal fibrosis. Clinically the patient presents with polyuria, asthenia and anemia. The diagnosis is suspected in a patient with progressive chronic kidney disease without proteinuria. CT imaging of the kidneys show irregular scarred kidneys with papillary calcification and necrosis. Recently, COX-2 inhibitors are promoted as renal safe drugs, but may not be so given the multiple case reports of renal toxicity in post marketing surveys. The treatment of analgesic nephropathy includes discontinuation of offending drug, protein restricted diet, control of blood pressure and statins. In conclusion analgesic nephropathy is a preventable cause of chronic kidney disease and both the patients and treating physicians should be mindful of the potential nephrotoxcity of nonsteroidal anti inflammatory agents when administered for prolonged periods without monitoring renal function.
{"title":"Analgesic Nephropathy–-A Painful Progression","authors":"K. Sampathkumar, A. Rajiv, D. Sampathkumar","doi":"10.4137/CMU.S13179","DOIUrl":"https://doi.org/10.4137/CMU.S13179","url":null,"abstract":"One of the dreaded complications of long term analgesic intake is nephrotoxicity characterized by chronic interstitial nephritis and papillary necrosis. Much of the literature of its epidemiology dates back to 1960s and its impact on present day society is not well documented. Non steroidal anti inflammatory agents reduce pain by blocking prostaglandin generation. Prostaglandins have renal vaso dilatory effects in states of volume depletion to counteract the vasoconstrictive pressor hormones. Earlier analgesic tablets contained a mixture of aspirin, phenacetin and caffeine. Phenacetin and its metabolites have nephrotoxic potential and incidence of analgesic nephropathy was brought down in countries where it was banned. The concentration of phenacetin and its metabolite acetaminophen is increased at the tip of renal papilla due to counter current concentrating mechanism of the loop of henle. These are potent oxidants leading to cell injury due to lipid peroxidation, though their effects are normally counterbalanced by anti oxidant glutathione. Glutathione deficiency at the medulla can be precipitated by co ingestion of aspirin. The exact dose of analgesics which needs to be ingested is unclear but a daily ingestion of 5–8 tablets over 5 years results in clinical nephrotoxicity. The histopathology is one of chronic interstitial nephritis with renal fibrosis. Clinically the patient presents with polyuria, asthenia and anemia. The diagnosis is suspected in a patient with progressive chronic kidney disease without proteinuria. CT imaging of the kidneys show irregular scarred kidneys with papillary calcification and necrosis. Recently, COX-2 inhibitors are promoted as renal safe drugs, but may not be so given the multiple case reports of renal toxicity in post marketing surveys. The treatment of analgesic nephropathy includes discontinuation of offending drug, protein restricted diet, control of blood pressure and statins. In conclusion analgesic nephropathy is a preventable cause of chronic kidney disease and both the patients and treating physicians should be mindful of the potential nephrotoxcity of nonsteroidal anti inflammatory agents when administered for prolonged periods without monitoring renal function.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84779618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic kidney disease (CKD) introduces a unique set of nutritional challenges for the growing and developing child. This article addresses initial evaluation and ongoing assessment of a child with CKD. It aims to provide an overview of nutritional challenges unique to a pediatric patient with CKD and practical management guidelines. Caloric assessment in children with CKD is critical as many factors contribute to poor caloric intake. Tube feeding is a practical option to provide the required calories and fluid in children who have difficulty with adequate oral intake. Protein intake should not be limited and should be further adjusted for protein loss with dialysis. Supplementation or restriction of sodium is patient specific. Urine output, fluid status, and modality of dialysis are factors that influence sodium balance. Hyperkalemia poses a significant cardiac risk, and potassium is closely monitored. In addition to a low potassium diet, potassium binders may be prescribed to reduce potassium load from oral intake. Phosphorus and calcium play a significant role in cardiovascular and bone health. Phosphorus binders have helped children and families manage phosphorus levels in conjunction with a phosphorus-restricted diet. Nutritional management of children with CKD is a challenge that requires continuous reassessment and readjustment as the child ages, CKD progresses, and urine output decreases.
{"title":"Practical Nutrition Management of Children with Chronic Kidney Disease","authors":"L. Nguyen, R. Levitt, R. Mak","doi":"10.4137/CMU.S13180","DOIUrl":"https://doi.org/10.4137/CMU.S13180","url":null,"abstract":"Chronic kidney disease (CKD) introduces a unique set of nutritional challenges for the growing and developing child. This article addresses initial evaluation and ongoing assessment of a child with CKD. It aims to provide an overview of nutritional challenges unique to a pediatric patient with CKD and practical management guidelines. Caloric assessment in children with CKD is critical as many factors contribute to poor caloric intake. Tube feeding is a practical option to provide the required calories and fluid in children who have difficulty with adequate oral intake. Protein intake should not be limited and should be further adjusted for protein loss with dialysis. Supplementation or restriction of sodium is patient specific. Urine output, fluid status, and modality of dialysis are factors that influence sodium balance. Hyperkalemia poses a significant cardiac risk, and potassium is closely monitored. In addition to a low potassium diet, potassium binders may be prescribed to reduce potassium load from oral intake. Phosphorus and calcium play a significant role in cardiovascular and bone health. Phosphorus binders have helped children and families manage phosphorus levels in conjunction with a phosphorus-restricted diet. Nutritional management of children with CKD is a challenge that requires continuous reassessment and readjustment as the child ages, CKD progresses, and urine output decreases.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"232 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73264687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urothelial carcinoma of the bladder represents a significant health burden globally. Patients who present with or develop metastatic disease experience poor overall survival even with salvage chemotherapy. Metastasectomy has shown promise in prolonging survival and even cure in patients with pulmonary and lymph node metastasis. We describe the second patient in the available literature who underwent liver resection for a solitary liver metastasis after cystectomy with disease-free survival at 64 months and present a review of the existing literature describing metastasectomy.
{"title":"Long-term Disease-free Survival after Hepatic Metastasectomy for Urothelial Carcinoma of the Bladder: A Case Report and Review of the Literature","authors":"N. Brooks, L. Dahmoush, James A. Brown","doi":"10.4137/CMU.S29263","DOIUrl":"https://doi.org/10.4137/CMU.S29263","url":null,"abstract":"Urothelial carcinoma of the bladder represents a significant health burden globally. Patients who present with or develop metastatic disease experience poor overall survival even with salvage chemotherapy. Metastasectomy has shown promise in prolonging survival and even cure in patients with pulmonary and lymph node metastasis. We describe the second patient in the available literature who underwent liver resection for a solitary liver metastasis after cystectomy with disease-free survival at 64 months and present a review of the existing literature describing metastasectomy.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76660575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urinary incontinence in women is quite prevalent today and management can be costly. Urinary incontinence can be minimal or quite bothersome, limiting activities of daily living. It is subdivided into urgency urinary incontinence, stress urinary incontinence, and mixed urinary incontinence. As such, treatment can vary immensely depending on the clinical presentations, ranging from behavioral modification to medicinal therapies to surgical procedures. First-line management for all urinary incontinence includes lifestyle and behavioral modifications. Historically, treatment options for urgency urinary incontinence were predominantly antimuscarinics, while more recent therapies include oral beta-3 agonist administration, sacral neuromodulation, onabotulinumtoxinA injection, and posterior tibial nerve stimulation. Stress urinary incontinence can be treated with a variety of urethral bulking agent injections or sling-based procedures using mesh, autologous fascia, or cadaveric fascia, as well as urethral intrasphincteric injections of autologous muscle-derived cells in new clinical trials. These recent advances that have been developed to help better curb urinary incontinence are discussed in this review.
{"title":"Advances in the Treatment of Urinary Incontinence in Women","authors":"E. Brown, W. Reynolds, M. Kaufman, R. Dmochowski","doi":"10.4137/CMU.S13181","DOIUrl":"https://doi.org/10.4137/CMU.S13181","url":null,"abstract":"Urinary incontinence in women is quite prevalent today and management can be costly. Urinary incontinence can be minimal or quite bothersome, limiting activities of daily living. It is subdivided into urgency urinary incontinence, stress urinary incontinence, and mixed urinary incontinence. As such, treatment can vary immensely depending on the clinical presentations, ranging from behavioral modification to medicinal therapies to surgical procedures. First-line management for all urinary incontinence includes lifestyle and behavioral modifications. Historically, treatment options for urgency urinary incontinence were predominantly antimuscarinics, while more recent therapies include oral beta-3 agonist administration, sacral neuromodulation, onabotulinumtoxinA injection, and posterior tibial nerve stimulation. Stress urinary incontinence can be treated with a variety of urethral bulking agent injections or sling-based procedures using mesh, autologous fascia, or cadaveric fascia, as well as urethral intrasphincteric injections of autologous muscle-derived cells in new clinical trials. These recent advances that have been developed to help better curb urinary incontinence are discussed in this review.","PeriodicalId":89908,"journal":{"name":"Clinical medicine insights. Urology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81589879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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