Clinical nephrological problems important to the urologist J. PLANGE-RHULE,F.B. MICAH andJ.B. EASTWOOD* Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana, and *Department of Renal Medicine, St George's Hospital, London, UK Introduction The renal physician and urologist should be in frequent contact, for many of their patients have clinical problems that embrace both specialities. For the renal physician the discovery that a patient's renal failure arises from urinary tract obstruction if more than just urethral obstruction) will lead to an urgent request for assistance from the urologist. For the urologist, requests for assistance can be no less urgent. Patients in hospital for urinary tract surgery are at risk of urinary tract sepsis and when this happens loss of renal function can become the dominant clinical problem. Furthermore, there is the dif®culty of assessing ¯uid status in patients where there is no easy access to central venous pressure measurement. Of more concern is that some patients with worsening renal failure may develop hyperkalaemia and acid-base disturbances. In the outpatient setting it is not uncommon for patients with predominantly nephrological disease to be referred to the urologist. Such problems as dysuria and frequency, and macro- scopic haematuria, may have no discernible urological cause. Shared management may be important in conditions like tuberculosis of the renal tract, polycystic kidney disease, metabolic renal stone disease and many others. The patient with existing impairment of renal function How to recognize such patients All patients presenting to a urologist should have a full relevant history taken, and be examined for signs of concurrent medical and surgical conditions. Points in the history that might indicate renal disease include diabetes mellitus, hypertension and previous renal disease; other possible indicators of renal disease are oedema and macroscopic haematuria. On examination, the BP and pulse should be measured, and the state of hydration and evidence of anaemia recorded. All patients should have their urine tested routinely. Proteinuria is an important indicator of intrinsic renal disease, although it may be absent when the renal failure arises from renal arterial disease pre-renal) or obstruc- tion in the lower urinary tract post-renal). Some predominantly renal conditions are typically associated with little if any proteinuria, e.g. interstitial nephritis, re¯ux nephropathy, adult polycystic kidney disease and congenital anatomical disorders In the tropics, as in many developed countries, it is likely that diabetes mellitus is a leading cause of chronic renal failure; it is also likely that uncontrolled/untreated hypertension is an important cause. Other important causes are chronic glomerulonephritis, schistosomiasis, renal tuberculosis, re¯ux nephropathy and the sickle- cell disorders. Amyloidosis, which is a complication of both leprosy and tuberculosis, is a cause of renal failure in the tropics that is less common in the developed world. However, it is important to realize that there are currently few data on the causal factors for chronic renal failure in developing countries, and renal registries as yet exist mainly only in developed countries. Implications for the urologist Assessment of renal function. In any patient undergoing a signi®cant urological procedure, it is important to measure urea, creatinine and electrolytes. Where there is signi®cant impairment of renal function the GFR should be assessed formally, e.g. by using creatinine clearance. In most cases it is the degree of renal dysfunction and not the speci®c renal diagnosis that is important. Hypertension. In patients undergoing elective surgery and known to be hypertensive it is important to establish that the patient is on drugs that are both effec- tive and well-tolerated. Patients who at the preoperative visit are found to have a BP of >140/90 mmHg should be referred and treated as appropriate. In patients undergoing urgent surgery whose BP is unacceptably high the problem of BP control is best managed by close liaison with a physician and the anaesthetist. In such cases a calcium-channel blocker will often be an acceptable choice. b-blockers can cause bradycardia, which may mask acute bleeding after surgery. BJU International 2002), 89Suppl. 1), 44±49 # 2002 BJU International 44