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Calcium channel blockers can reduce the death of tubular cells in the kidney after a transplant operation

Acute tubular necrosis (ATN) is the sudden death of tubular cells in the kidney. ATN can happen after a kidney transplant if the kidney does not receive enough oxygen. Calcium channel blockers stop calcium ions flowing into the muscle cells of the heart and blood vessels. These blockers cause the muscles to widen and relax, lowering a person's blood pressure and improving their circulation. The review of 13 studies (724 participants) found that giving calcium channel blockers during a kidney transplant operation reduces the chance of ATN after the operation. The effect of giving the blockers after the operation still needs to be investigated.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Acute tubular necrosis and pre-renal acute kidney injury: utility of urine microscopy in their evaluation - a systematic review

BACKGROUND: Urine microscopy with examination of the urine sediment examination provides useful diagnostic information about the histology of the kidneys. While most nephrologists use urine microscopy to assess for the presence of glomerular diseases, they are less apt to use this diagnostic test when pre-renal acute kidney injury (AKI) or acute tubular necrosis (ATN) is clinically suspected. More often, tests such as fractional excretion of sodium (FeNa) and fractional excretion of urea (FeUrea) are used to differentiate these two causes of acute kidney injury.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities [Internet]

The purpose of this project was to provide national guidance on the optimal use of 99mTc during a situation of reduced supply. To accomplish this, our objective at CADTH was:

Optimal Use Report - Canadian Agency for Drugs and Technologies in Health.

Version: 2012
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Thyroid hormones for acute kidney injury

Acute kidney injury (AKI) has a number of causes including infection, trauma, kidney stones, toxic drugs, or acquired during hospital treatment. People with AKI suddenly lose kidney function leading to poor urine output and retention of body wastes. In every 1000 people who are discharged from hospital about 30 are diagnosed with AKI; about 6% of all critically ill patients have AKI. Many people with AKI will die from the disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Acute Kidney Injury: Prevention, Detection and Management Up to the Point of Renal Replacement Therapy [Internet]

Acute kidney injury (AKI), previously called acute renal failure, has chiefly been described as a syndrome since World War 2. Traditionally ‘acute renal failure’ was regarded as a less common organ failure, with patients typically requiring dialysis and managed by nephrologists. This view has now been overturned. AKI encompasses a wide spectrum of injury to the kidneys, not just ‘kidney failure’. It is a common problem amongst hospitalised patients, in particular the elderly population whose numbers are increasing as people live longer. Such patients are usually under the care of doctors practicing in specialties other than nephrology. For normal function the kidneys require a competent circulation. Conversely, it is known that renal function is vulnerable to even relative or quite modest hypotension or hypovolaemia. Hence AKI is a feature of many severe illnesses. Although these illnesses may affect many organs, the simple process of monitoring urine output and/or creatinine permits detection of AKI.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2013
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Urinary Tract Infection in Children: Diagnosis, Treatment and Long-term Management

In the past 30–50 years, the natural history of urinary tract infection (UTI) in children has changed as a result of the introduction of antibiotics and improvements in health care. This change has contributed to uncertainty about the most appropriate and effective way to diagnose and treat UTI in children and whether or not investigations and follow-up are justified.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2007
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Sepsis: Recognition, Assessment and Early Management

Sepsis is a clinical syndrome caused by the body's immune and coagulation systems being switched on by an infection. Sepsis with shock is a life-threatening condition that is characterised by low blood pressure despite adequate fluid replacement, and organ dysfunction or failure. Sepsis is an important cause of death in people of all ages. Both a UK Parliamentary and Health Service Ombudsman enquiry (2013) and UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2015) have recently highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined.

NICE Guideline - National Guideline Centre (UK).

Version: July 2016
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Chronic Kidney Disease (Partial Update): Early Identification and Management of Chronic Kidney Disease in Adults in Primary and Secondary Care

The Renal National Service Framework (NSF), 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.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: July 2014
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Anaemia Management in Chronic Kidney Disease: Partial Update 2015 [Internet]

Anaemia is defined internationally as a state in which the quality and/or quantity of circulating red blood cells is below normal. Blood haemoglobin (Hb) concentration serves as the key indicator for anaemia because it can be measured directly and has an international standard. In response to low tissue oxygen levels in anaemia the kidney produces the hormone erythropoietin which stimulates the bone marrow to produce red blood cells. A major cause of the anaemia of chronic kidney disease (CKD) is a reduction in erythropoietin production due to kidney damage.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: June 2015

Genetics of Kidney Cancer (Renal Cell Cancer) (PDQ®): Health Professional Version

Expert-reviewed information summary about the genetics of kidney cancer, including information about specific genes and family cancer syndromes. The summary also contains information about screening for kidney cancer and research aimed at prevention of this disease.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 12, 2017

Optimal strategies for identifying kidney disease in diabetes: properties of screening tests, progression of renal dysfunction and impact of treatment – systematic review and modelling of progression and cost-effectiveness

This study found evidence to support the use of annual screening to identify the development of early kidney disease in patients with diabetes, which is consistent with current UK guidelines. For type 1 diabetes, the costs of annual screening are well within the accepted level of cost-effectiveness, and, for patients with type 2 diabetes, annual screening is even more cost-effective.

Health Technology Assessment - NIHR Journals Library.

Version: February 2014

Immunosuppressive therapy for kidney transplantation in children and adolescents: systematic review and economic evaluation

The study found that tacrolimus maintenance therapy (with azathioprine) and basiliximab induction (with tacrolimus and azathioprine maintenance therapy) were likely to be cost-effective therapies for children and adolescents undergoing renal transplantation. When all immunosuppressive regimens were simultaneously compared using extrapolated adult data, only basiliximab induction therapy with tacrolimus and azathioprine maintenance therapy was cost-effective.

Health Technology Assessment - NIHR Journals Library.

Version: August 2016

Andrographolide induced acute kidney injury: analysis of 26 cases reported in Chinese literature

AIM: Some Chinese herbs have been known for their kidney toxicity. Andrographolide, the primary component of a traditional medicinal herb, Andrographis paniculata, is widely used in China for the treatment of upper and lower respiratory tract infection, and dysentery etc. The aim of the study was to identify and summarize any case of kidney injury attributed to its use in the Chinese literature.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Is lead chelation therapy effective for chronic kidney disease? A meta-analysis

The heavy metal lead (Pb) is a major environmental and occupational hazard. Epidemiological studies have demonstrated a strong association between lead exposure and the presence of chronic kidney injury. Some studies have suggested that chelation therapy with calcium disodium ethylenediaminetetraacetic acid (calcium disodium EDTA) might help decrease the progression of chronic kidney disease among patients with measurable body lead burdens. However, calcium disodium EDTA chelation in lead exposure is controversial due to the potential for adverse effects such as acute tubular necrosis. Therefore, we investigated the available randomized controlled trials assessing the renoprotective effects of calcium disodium EDTA chelation therapy. Our meta-analysis shows that calcium disodium EDTA chelation therapy can effectively delay the progression of chronic kidney disease in patients with measurable body lead burdens reflected by increasing the levels of estimated glomerular filtration rate (eGFR) and creatinine clearance rate (Ccr). There appears to be no conclusive evidence that calcium disodium EDTA can decrease proteinuria.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Systematic Review and Economic Modelling of the Relative Clinical Benefit and Cost-Effectiveness of Laparoscopic Surgery and Robotic Surgery for Removal of the Prostate in Men with Localised Prostate Cancer

Complete surgical removal of the prostate, radical prostatectomy, is the most frequently used treatment option for men with localised prostate cancer. The use of laparoscopic (keyhole) and robot-assisted surgery has improved operative safety but the comparative effectiveness and cost-effectiveness of these options remains uncertain.

Health Technology Assessment - NIHR Journals Library.

Version: November 2012
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MI - Secondary Prevention: Secondary Prevention in Primary and Secondary Care for Patients Following a Myocardial Infarction: Partial Update of NICE CG48 [Internet]

Myocardial infarction (MI) remains one of the most dramatic presentations of coronary artery disease (CAD). Complete occlusion of the artery often produces myocardial necrosis and the classical picture of a heart attack with severe chest pain, electrocardiographic (ECG) changes of ST-segment elevation, and an elevated concentration of myocardial specific proteins in the circulation. Such people are described as having a ST-segment elevation myocardial infarction (STEMI). Intermittent or partial occlusion produces similar, but often less severe clinical features, although no or transient and undetected ST elevation. Such cases are described as a non-ST segment elevation myocardial infarction (NSTEMI). People who have suffered from either of these conditions are amenable to treatment to reduce the risk of further MI or other manifestations of vascular disease, secondary prevention.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: November 2013

The Management of Lower Urinary Tract Symptoms in Men [Internet]

The guideline covers men (18 and over) with a clinical working diagnosis of lower urinary tract symptoms (LUTS). Options for conservative, pharmacological, surgical, and complementary or alternative treatments are considered in terms of clinical and cost effectiveness.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: 2010

Management of Renal Masses and Localized Renal Cancer [Internet]

To summarize the evidence on the effectiveness and comparative effectiveness of strategies for evaluating and treating patients with a renal mass suspicious for renal cell carcinoma, including use of composite models for predicting malignancy at initial diagnosis, use of percutaneous renal sampling (by fine needle aspiration or core biopsy) to establish a diagnosis, and comparative efficacy of radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: February 2016

Bladder Cancer: Diagnosis and Management

Bladder cancer is the seventh most common cancer in the UK, with just over 10,000 cases diagnosed each year (CRUK, 2013a). These are unevenly split between men (fourth most common cancer) and women (11th most common cancer).

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: February 2015

Advanced Breast Cancer: Diagnosis and Treatment

Breast cancer is the most common cancer for women in England and Wales, with about 37,000 new cases diagnosed and 11,000 deaths recorded in England and Wales each year. In men breast cancer is rare, with about 270 cases diagnosed, and 70 deaths in England and Wales each year. Of these new cases in women and men, around 10% are diagnosed in the advanced stages, when the tumour has spread significantly within the breast or to other organs of the body. In addition, there is a significant number of women who have been previously treated with curative intent who subsequently develop either a local recurrence or metastases. Over recent years there have been important developments in the investigation and management of these patients including new chemotherapy, and biological and hormonal agents. There is some evidence of practice variation across the country and of patchy availability of certain treatments and procedures. A clinical guideline will help to address these issues and offer guidance on best practice.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: February 2009
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