Renal and Urinary Conditions

It was an interesting coincidence to be working on this edition of FP Essentials when a friend contacted me. He is in his mid-60s and underwent imaging because of a back problem. The imaging revealed an incidental finding of a kidney cyst. I guess the orthopedist he was seeing did not know much about kidney cysts, and whatever he told my friend caused him a great deal of anxiety. Fortunately, I had just finished editing Section Two of this edition, which is about kidney cysts and tumors. I was able to reassure my friend and share that half or more of people his age have kidney cysts, and they are almost always of no concern.

There is lots of other useful information in this edition. Although the reviews of glomerulonephritis (Section One) and nephrotic syndrome (Section Three) will make you realize how complicated it can be to manage these conditions, or even to keep track of all the terminology, there also is practical information to help you ensure that you evaluate patients according to current guideline recommendations. And Section Four on urinary tract infections—something all family physicians see regularly in practice—provides an update on current management recommendations. This section also makes the important point that we should not be so quick to treat asymptomatic bacteriuria except in pregnant patients.

I hope you will find this edition of FP Essentials to be as informative and useful as I did.

Barry D. Weiss, MD, FAAFP, Associate Medical Editor
Professor, Department of Family and Community Medicine
University of Arizona College of Medicine, Tucson

Alain Michael P. Abellada, MD, DFPHM, is a family medicine hospitalist and faculty member at the Womack Army Medical Center (WAMC) Family Medicine Residency Program in Fort Liberty, North Carolina. He also is an assistant professor in the Department of Family Medicine at the F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland.

Darrell “Edward” Jones, DO, DFPHM, FAAFP, is program director of the Family Medicine Hospitalist Fellowship Program at WAMC. He also is an assistant professor in the Department of Family Medicine at the F. Edward Hébert School of Medicine at USUHS.

Stephanie J. Sexton, MD, is chief of the Urology Division in the Department of Surgery at WAMC. She is a clinical and academic instructor for WAMC residents and an assistant professor in the Department of Surgery at the F. Edward Hébert School of Medicine at USUHS.

Madison L. Paul, MD, is a family medicine hospitalist and faculty member at the Madigan Army Medical Center Family Medicine Residency Program at Joint Base Lewis-McChord, Washington. She also is an assistant professor in the Department of Family Medicine at the F. Edward Hébert School of Medicine at USUHS.

Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect the official policy of the Department of the Army, Department of Defense, or the US government.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

• Describe the common clinical presentations of patients with glomerulonephritis (GN).
• Discuss supportive and protective strategies, including blood pressure control, drugs to block the renin-angiotensin system, and lifestyle modifications, for patients with GN to minimize cardiovascular risk.
• Describe the Bosniak Classification of Cystic Renal Masses and discuss its use in developing treatment plans for patients with kidney cysts.
• Summarize appropriate interval screening for kidney cancers in patients with hereditary cancer syndromes.
• Diagnose patients with nephrotic syndrome (NS) and test for secondary causes when indicated.
• Describe clinical situations in which it is appropriate to prescribe antithrombotic therapy for patients with NS.
• Avoid unnecessary treatment of patients with asymptomatic bacteriuria.
• Describe when imaging is appropriate for patients with pyelonephritis who have not improved with treatment.