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Acute kidney injury (AKI) is characterised by a sudden decline in kidney filtration and patients with AKI have reduced (or no) urine output. AKI is clinically defined by an increase in serum creatinine and decrease in glomerular filtration rate. People with AKI need renal replacement therapy usually in the form of kidney dialysis. At present, there is no universally accepted form of dialysis for most AKI patients. Peritoneal dialysis (PD) has been favoured because it causes fewer heart and lung problems, and patients do not need anti‐clotting drugs. Tidal PD (TPD) is an automated process that fills and drains the dialysis fluid, but retains a designated proportion so the peritoneum never completely empties.

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

Version: 2012

Kidney stones are one of the most common disorders of the urinary tract. They typically affect people aged 40 to 60 years of age and are twice as common in men than women although recent data suggest the risks are more equal. Calcium stones are the most common type of kidney stone and occur in two major forms: calcium oxalate and calcium phosphate. Kidney stones can cause severe abdominal pain and may require urgent treatment; they are one of the main causes of unscheduled admissions in urological practice.

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

Version: 2015

People with reduced kidney function (chronic kidney disease; CKD) develop changes in circulating blood levels of calcium and phosphorus. The kidney gradually loses the ability to remove phosphorus from the blood and cannot activate adequate amounts of vitamin D, to maintain normal levels of calcium. The parathyroid gland senses these changes and compensates to increase calcium by elevating production and release of parathyroid hormone. These metabolic changes alter bone metabolism to release calcium and accordingly lead to bone abnormalities including altered bone production. Consequently bone deformation, bone pain, and altered risks of fracture may occur.

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

Version: 2009

Haemodialysis removes excess fluid and metabolic products from the blood in people who have limited kidney function. Haemodialysis membranes are classified as high‐flux or low‐flux based on their ability to remove fluid and molecules. It has been suggested that removal of larger solutes across high‐flux haemodialysis membranes may better reflect normal kidney function and improve clinical outcomes. To investigate this issue, we analysed 33 studies that involved 3820 people which directly compared haemodialysis using high‐flux or low‐flux membranes.

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

Version: 2016

Acute kidney injury (AKI) is very common among patients admitted to intensive care units (ICU), it is associated with a high death rated and characterised by the rapid loss of the kidney function. Patients with AKI show increased levels of serum uraemic toxins (creatinine and urea), serum potassium and metabolic acids, accumulation of water and in the most cases a reduction in urine output. In this population these chemicals and fluid overload are related to increased rates of death. Theoretically, effective removal of toxins and excess water from the bloodstream might improve patient outcomes (such as mortality rate and recovery of kidney function).

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

Version: 2016

People who have severe loss of kidney function are treated with dialysis or a kidney transplant to remove toxins and fluid. Dialysis removes waste products and fluid by filtering these across a membrane in the dialysis machine (for haemodialysis) or within the body (for peritoneal dialysis). Toxins that build‐up in the body when the kidneys fail vary in size and larger molecules are removed less well by standard haemodialysis. Newer dialysis types 'push' water across the dialysis membrane which allows the removal of unwanted molecules more efficiently. Larger molecules are removed better and the dialysis fluid has fewer impurities, leading to the potential for convective dialysis to improve the ways patients feel and survive on dialysis. The three types of convective dialysis therapy are haemodiafiltration, haemofiltration, and acetate‐free biofiltration. Use of convective therapy for dialysis is higher in Europe and lower in the USA. Given the difference between regions for uptake of this treatment and the potential benefits on patient outcomes, we have updated this Cochrane review to new additional studies available in 2015.

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

Version: 2015

Small kidney stones often pass on their own and don't need treatment as long as they don't cause any severe pain or complications. Larger kidney stones usually need to be removed. Depending on how large the kidney stones are and where they're located, they can be destroyed, removed using endoscopy or operated on.Kidney stones with a diameter of less than 5 millimeters pass on their own 70% of the time, and stones that are between 5 and 10 millimeters are flushed out in about 50% of cases. The amount of time this takes varies greatly. Small kidney stones are usually passed with the urine after one or two weeks.If a stone is expected to be flushed out with your urine without any treatment, it's usual to simply wait. Anti-inflammatory painkillers like diclofenac can provide relief if the kidney stone causes pain as it travels through the ureter.Larger stones will usually have to be broken up or surgically removed. This needs to be done in the following instances:The kidney stone isn't passed within four weeks.There are complications.It causes severe renal colic.The stone is larger than 10 mm in diameter.Uric acid stones can sometimes be dissolved using medication.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 18, 2017

Expert-reviewed information summary about the treatment of Wilms tumor.

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

Version: August 18, 2017

Kidney transplantation is well established and has a vital role in improving quality of life and longevity for people with end‐stage kidney disease (ESKD). Open surgical techniques lead to more postoperative pain, a longer hospital stay and a poorer cosmetic outcome for donors but advances in surgical techniques has meant that keyhole surgery is now the gold standard for removing donors' kidneys for transplantation. Keyhole surgery has shorter recovery times, minimal scarring and better outcomes for both donor and recipient. An alternative of this technique is for the surgeon to make a single incision (single site) in the patient's abdomen to enable removal of the kidney.

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

Version: 2016

In 2014, hospitals had to report on the quality of their work in 24 areas of care.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 1, 2016

Expert-reviewed information summary about the treatment of renal cell cancer.

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

Version: December 23, 2016

Upper tract transitional cell carcinoma is an uncommon cancer mainly affecting the draining system of the kidney (kidney pelvis) and ureter (the tube through which urine passes from the kidney to the bladder). The main treatment approach for this condition is surgical removal of the malignant area. There are a number of surgical techniques for this procedure and the aim of this review was to compare them and determine which was the most effective in terms of surgical ease, patient morbidity, clinical outcome and cost. Our search of the literature found no high quality evidence comparing different surgical techniques. Evidence from one small randomised trial and observational studies suggests that laparoscopic surgical intervention may reduce blood loss, post‐operative pain and hospital stay. However, the quality of the evidence is poor and, therefore, it is not possible to recommend the most effective surgical procedure to replace the existing clinical practice for managing upper tract transitional cell carcinoma.

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

Version: 2011

People with advanced kidney disease may be treated with peritoneal dialysis where a catheter is permanently inserted into the peritoneum (lining around abdominal contents) through the abdominal wall and sterile fluid is drained in and out a few times each day. The most common serious complication is infection of the peritoneum ‐ peritonitis. This may be caused by bacteria accidentally being transferred from the catheter. This review of different catheter types, insertion or immobilisation techniques showed that they do not reduce the incidence of peritonitis.

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

Version: 2010

People with advanced kidney disease can be treated with peritoneal dialysis (PD) which involves a catheter being permanently inserted into the lining around the abdominal organs (the peritoneum) through the abdominal wall. Sterile fluid is drained in and out several times each day. The peritoneal lining enables movement of salts and toxins that accumulate when kidney function cannot maintain usual function. Wastes from the bloodstream are moved into the dialysis fluid and removed with the fluid as it is drained from the body.

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

Version: 2014

Kidney stones are most commonly formed from masses of crystals and protein. Movement of stones from the kidney through the urinary tract is a common cause of urinary tract obstruction in adults and can cause severe pain (colic). This review aimed to determine if increased fluids and diuretics or both could hasten the passage of stones and improve symptoms. Neither our initial review nor this subsequent update identified sufficient evidence to enable conclusions to be determined about the safety and effectiveness of increasing fluids or diuretics or both to treat people with acute ureteric colic. More and larger randomised controlled studies are required.

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

Version: 2012

Expert-reviewed information summary about the treatment of renal pelvis and ureter transitional cell cancer.

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

Version: May 22, 2015

People with kidney failure may be treated with peritoneal dialysis where a catheter is permanently inserted into the peritoneum (lining around abdominal contents) through the abdominal wall and sterile fluid is drained in and out a few times each day. The most common serious complication is infection of the peritoneum, which is called peritonitis. This may be caused by bacteria accidentally being transferred from the catheter.

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

Version: April 8, 2017

Gout is caused by urate crystals forming either within or around joints. Inflammation can lead to pain, redness, warmth and swelling of the affected joints, making the area difficult to touch or move. Some of the reasons why people get gout include their genetic make‐up, being overweight, ingesting certain medications (e.g. cyclosporine), impaired kidney function and lifestyle habits such as drinking excessive amounts of alcohol and sugar‐sweetened drinks. Tophi are nodules that develop in people with poorly treated or uncontrolled chronic gout. Tophi can become infected, cause pain and lead to a decrease in function. Tophi can be treated with urate‐lowering drugs (e.g. benzbromarone, probenecid, allopurinol, febuxostat, pegloticase), surgical removal or other interventions such as haemodialysis. Surgical interventions can be used where urgent removal is required, for example, for relief of nerve compression.

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

Version: 2014

Ureteral stones (kidney stones that move down the ureter) frequently lead to renal colic, causing pain, and if left untreated, can block the urinary tract (obstructive uropathy). Both ureteroscopy (an examination by a doctor to see inside the urinary tract) and extracorporeal shock wave lithotripsy (ESWL, a procedure that uses high‐energy shockwave to break up stones into small particles that are passed out of the body in urine) achieve high success rates in managing ureteric stone disease. We analysed reports from seven randomised controlled trials of 1205 patients and found that ureteroscopy provided a better stone‐free rate after treatment, but patients had to stay in hospital longer, and there was a higher risk of complications. We found that there were many variations among the seven studies in their design, duration, and data collected which made comparison and evaluation challenging. We recommend that further evaluation and research is conducted to ensure that new and improved treatments and studies are considered to inform clinical practice.

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

Version: 2012

We assessed whether avoiding or withdrawing glucocorticosteroids was better or worse than continuing to use glucocorticosteroids for immunosuppression after liver transplantation.

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

Version: 2016

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