SCREENING FOR CKD
As mentioned in the Clinical Review on page 24 , the RCGP, RCP and the British Renal Association have recently produced a set of comprehensive guidelines aimed at identifying patients with chronic kidney disease (CKD).
The address given here takes you to a PDF that comprises 18 pages. However, most of it is of little interest to GPs, and the relevant section, should you wish to print it, consists of pages 8-11.
These four pages comprise a series of tables that list the relevant investigations, as well as discussing serum creatinine measurement, the detection of proteinuria and haematuria, and microalbuminuria in diabetes mellitus.
The remaining pages contain details of management and the usual reams of references, and there are tables that enable you to calculate predicted glomerular filtration rates from serum creatinine levels according to age and ethnicity.
Why go there: a helpful summary.
Downside: has only four key pages.
Information from: The Renal Association website.
This address will take you to a useful extract from the Pocket Book of Nephrology which contains information on the process of peritoneal dialysis including what it involves and how it works.
There is also a helpful section on what to look out for when peritoneal dialysis patients become unwell.
Children are suitable candidates. For them and many adults, peritoneal dialysis offers greater independence and freedom to travel than haemodialysis.
Why go there: essential reading if you have a patient.
Downside: no illustrations.
Information from: Royal Infirmary of Edinburgh Renal Unit.
PATIENT INFORMATION ON PERITONEAL DIALYSIS
This site offers an excellent guide for patients who are facing the prospect of peritoneal dialysis.
It has a section entitled 'An introduction to peritoneal dialysis' that is a delight to see.
It is colourful but not garish, and its format makes it easy to read for worried patients.
At the end of the first section is a link to an animation that shows how peritoneal dialysis works.
I gave it a try, and think it is well worth recommending.
A good effort all round, and full marks to the Wellcome Trust for sponsoring it.
Why go there: I would have no hesitation in telling patients to visit.
Information from: The Kidney Patient Guide.
I rarely have a good word for herbal medicines, and not just because of the unproven claims.
What particularly disturbed me about this website is that on Google it has a sponsored link that puts it at the top of the list when you ask about herbal cures for kidney disease. This not only means it receives plenty of hits, but may appear to give more credence to the product.
The claim for this remedy called Kidney Support is that it has a 95 per cent success rate for kidney disorders regardless of 'age, constitution or severity', as well as being free from side-effects. Oh, dear.
Why go there: difficult to think why you should.
Downside: more false hope offered.
Information from: Traditional Tibetan Healing.
- Dr Barnard is a former GP in Fareham, Hampshire
WEBSITE OF THE WEEK
I've praised the Surgical Tutor website before, and it still surprises me that this source, aimed at surgeons, contains so much that is relevant to general practice.
This overview of chronic renal failure (CRF) and dialysis could hardly be simpler. It defines CRF as a glomerular filtration rate of less than 60ml per minute, and relates the stages of failure to creatinine clearance measurements.
It lists the causes of CRF, and a series of bullet-pointed paragraphs covers treatment, preservation of nephron function and conservative management.
The various methods of dialysis are shown, and peritoneal dialysis is of particular interest to GPs.
Haemodialysis is something GPs are rarely involved in, but we should be aware of the possible complications, such as the arterio-venous fistulas that are so graphically illustrated (see picture).
Why go there: clear, basic coverage of the topic.
Information from: www.surgical-tutor.org