Primary care
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Nephrolithiasis, commonly known as kidney stones, may be localized to any part of the urothelial system, causing common systemic symptoms, some of which may become acute. Primary care physicians increasingly are the first line of management for this condition, making recognition and prompt treatment essential. ⋯ The article concludes with management guidelines for nephrolithiasis and when primary care physicians should refer patients to nephrology or urology. In light of the current opioid epidemic, salient points for nonopioid treatment as initial treatment of nephrolithiasis likewise are discussed.
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Medications are a common cause of acute kidney injury and chronic kidney disease. Older patients with multiple comorbidities and polypharmacy are at increased risk and require extra diligence. ⋯ Awareness of such medications and their mechanisms of nephrotoxicity helps decrease morbidity and mortality. If nephrotoxic agents cannot be avoided, hydration, avoiding concomitant nephrotoxic medications, and using the lowest effective dose for the shortest duration are strategies that can decrease risk of kidney damage.
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Nephrotic syndrome is one cause of end-stage kidney disease. Because edema is a common presenting feature and hypertension and dyslipidemia are often present in nephrotic syndrome, it is important for the primary care physician to suspect this entity. Common causes in adults include diabetic nephropathy, focal segmental glomerulosclerosis, and membranous nephropathy. ⋯ A cause of the nephrotic syndrome should be established with serologic workup and renal consultation. Renal biopsy is necessary in those with an unknown cause to or classify disease. Treatment focuses on symptoms, complications, and the primary cause.
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Acute kidney injury (AKI) is defined as an increase in serum creatinine or a decrease in urine output over hours to days. A thorough history and physical examination can help categorize the underlying cause as prerenal, intrinsic renal, or postrenal. ⋯ Even one episode of AKI increases the risk of cardiovascular disease, chronic kidney disease, and death. Therefore, early determination of etiology, management, and long-term follow-up of AKI are essential.
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Volume and electrolyte evaluation and management is seen frequently in primary care practices. Some of the most common abnormalities encountered in outpatient practices are prerenal azotemia, dysnatremias, and altered potassium levels. Perturbations in volume or electrolyte concentrations can lead to serious organ dysfunction as well as hemodynamic collapse. This review focuses on the maintenance and regulation of intravascular volume and electrolytes, specifically sodium and potassium.