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Renal & Urology — Updates Since 2020

Guideline & practice changes since 2020

  • RAS inhibitor use in advanced CKD (G4–G5) is a genuinely unresolved question — KDIGO gives only a weak/no-consensus recommendation for this group, and large observational studies conflict on whether continuing or stopping reduces the risk of needing dialysis. See Chronic Kidney Disease.
  • Post-AKI follow-up now has real substance — survivors face roughly double the subsequent mortality risk, and about half of Australian inpatient AKI diagnoses are missed or poorly communicated at discharge. See Acute Kidney Injury.
  • IgA nephropathy has a tighter BP target (120–130/70, not the general CKD <130/80), specific PBS eGFR/uACR criteria for SGLT2i authority prescribing, and two newer non-immunosuppressive options — targeted-release budesonide (Tarpeyo) and sparsentan. See IgA Nephropathy.
  • Renal colic analgesia: paracetamol and NSAIDs are both superior to opioids for analgesic efficacy (with an important CKD-specific NSAID caution), and medical expulsive therapy with tamsulosin helps mainly larger (>5mm) distal ureteric stones, not all sub-6mm stones broadly. See Renal Calculus.
  • Haematuria: occupational dye/benzene exposure and pelvic irradiation are flagged malignancy risk factors, anticoagulation doesn’t exclude the need for work-up, and imaging choice is now explicitly age-based (ultrasound under 50, CT IVP for older/ higher-risk patients). See Haematuria.
  • Recurrent UTI prevention: vaginal oestrogen and methenamine hippurate remain first-line recommended options, cranberry and D-mannose are “consider” only, probiotics are explicitly not supported, and immunoactive vaccines (OM-89, MV140, StroVac) are recommended where accessible. See Recurrent UTI.
  • Paediatric recurrent UTI now has an explicit bladder-bowel-dysfunction (BBD) framework as a contributing risk factor, and a specific circumcision consideration for uncircumcised boys under 1 with recurrent UTI or high-grade VUR. See Vesicoureteral Reflux.
  • Female stress urinary incontinence: fuller surgical-options comparison (urethral bulking agents, Burch colposuspension, autologous slings, artificial urinary sphincter) alongside the existing transvaginal mesh controversy. See Urinary Incontinence — Male & Female.
  • SGLT2 inhibitors as foundational CKD-progression therapy regardless of diabetes status (KDIGO 2024); enfortumab vedotin + pembrolizumab now first-line for metastatic urothelial cancer (EV-302 trial, nearly doubled median overall survival) on Bladder Cancer; transvaginal mesh removed from the Australian market by the TGA in 2017 on Uterovaginal Prolapse.
  • KDIGO 2024 CKD guideline, more fully applied: a GLP-1 receptor agonist (liraglutide, semaglutide or dulaglutide) is now recommended for T2D+CKD not at glycaemic target despite metformin/SGLT2i; the lipid recommendation is now age/eGFR-stratified (statin ± ezetimibe by KDIGO’s actual bands, not a flat “>50 = statin+ezetimibe” rule); metabolic acidosis gets an explicit bicarbonate-treatment threshold (<18 mmol/L); and hyperuricaemia/gout should be treated in CKD as normal — urate-lowering drugs don’t carry extra hepatotoxicity/hypersensitivity risk in this population. See Chronic Kidney Disease.
  • Bosniak renal cyst classification updated to the 2019 version (per a 2024 AJGP review): malignancy risk for category III revised from ~40–60% to 50%, and category IV from ~80–100% to 90–100%; category IIF cysts (5–10% malignancy risk, 12% progress to III/IV) get active surveillance in general practice rather than immediate referral. See Renal Cysts.

New pages added

  • Gender Affirmation Surgery — Urological Aspects — WPATH vs informed-consent assessment models, surgical options for both trans-male and trans-female patients, referral criteria, and perioperative considerations (hormone therapy timing, fertility planning, hair removal).

  • Electrolyte Disorders (Potassium, Sodium, Magnesium) — the GP/urgent-care recognition and management of hyper/hypokalaemia, hyponatraemia and hypomagnesaemia: ECG changes by severity, the 10 mmol/L/24h hyponatraemia correction-rate limit and why over-rapid correction causes osmotic demyelination, oral vs IV potassium replacement thresholds, and which derangements can be managed in general practice vs need same-day hospital referral.