- Identify common conditions causing chronic kidney disease (CKD) in asymptomatic individuals. Plan for appropriate screening tests to aid early diagnosis, monitor and prevent progression of CKD.
- In collaboration with the patient, develop a management plan for CKD and consider comorbidities.
- Be aware of significant causes of CKD:
- diabetes mellites
- glomerulonephritis
- hypertension
- vascular disease
- connective tissue disease
- polycystic kidney disease
- obstructive nephropathy
- multiple myeloma
- medication and other rare causes such as amyloidosis.
- Appropriately screen and manage patients presenting with acute kidney injury.
- Develop a patient-centred management plan in collaboration with the patient, family and non-GP specialist to support renal transplant recipients in the community.
- Conduct a detailed history, examination and assessment of patients presenting with haematuria and consider differential diagnoses including risk factors for malignancy. Arrange appropriate investigations to arrive at a diagnosis and formulate a patient-centred management plan, considering biopsychosocial aspects.
- Identify and distinguish between the different causes of haematuria:
- transient haematuria:
- trauma
- exercise
- vaginal atrophy
- malignancy:
- renal cell carcinoma
- urothelial carcinoma including bladder cancer, prostate cancer
- infections:
- pyelonephritis
- lower urinary tract infection
- urethral caruncle
- medical disease:
- CKD
- glomerulonephritis
- congenital conditions:
- polycystic kidney disease
- obstructive disease:
- urolithiasis
- benign prostatic hyperplasia (BPH).
- transient haematuria:
- Conduct a detailed history, examination and assessment of patients presenting with lower urinary tract symptoms (LUTS), including frequency, urgency, urethral discharge, flow disturbances.
- Identify and distinguish between the different causes of LUTS, including:
- BPH
- prostatitis
- prostate cancer
- urethral stricture
- urethritis
- urethral calculi
- cystitis
- bladder cancer or neurogenic bladder secondary to medical condition.
Causes of Lower Urinary Tract Symptoms (LUTS)
| Cause | Key Features in Clinical Diagnosis | Investigations Specific to Diagnosis | Key Treatments |
|---|---|---|---|
| Benign Prostatic Hyperplasia (BPH) | – Hesitancy, weak stream, incomplete emptying, nocturia – Non-tender, enlarged prostate on DRE | – Digital Rectal Exam (DRE) – PSA levels – Ultrasound (post-void residual) | – Alpha blockers (e.g., tamsulosin) – 5-Alpha reductase inhibitors (e.g., finasteride) – TURP (Transurethral resection of the prostate) |
| Prostatitis | – Dysuria, pelvic pain, perineal pain – Fever, chills (acute) – Tender, boggy prostate on DRE | – Urinalysis and urine culture – Prostate-specific antigen (PSA) may be elevated | – Antibiotics (e.g., fluoroquinolones) – Alpha blockers – Anti-inflammatories – Sitz baths |
| Prostate Cancer | – Asymptomatic in early stages – LUTS symptoms if advanced – Hematuria, bone pain (metastasis) | – DRE (hard, irregular prostate) – PSA levels – Biopsy (transrectal ultrasound-guided) – Imaging (MRI, bone scan) | – Active surveillance (low-risk) – Surgery (prostatectomy) – Radiation therapy – Hormone therapy (androgen deprivation) |
| Urethral Stricture | – Weak stream, spraying of urine – Dysuria, recurrent UTIs | – Uroflowmetry – Cystoscopy – Retrograde urethrogram | – Urethral dilation – Urethrotomy – Urethroplasty |
| Urethritis | – Dysuria, urethral discharge – Itching, burning sensation | – Urinalysis – NAAT (Nucleic Acid Amplification Test) for STIs – Urethral swab and culture | – Antibiotics (e.g., azithromycin for Chlamydia, ceftriaxone for Gonorrhea) – Partner treatment |
| Urethral Calculi | – Severe, colicky pain radiating to the groin – Hematuria – Dysuria | – Non-contrast CT scan – Urinalysis – KUB (Kidneys, Ureters, and Bladder) | – Pain management (NSAIDs, opioids) – Alpha blockers (e.g., tamsulosin) – Lithotripsy or endoscopic removal |
| Cystitis | – Dysuria, urgency, frequency – Suprapubic pain – Hematuria (occasionally) | – Urinalysis – Urine culture | – Antibiotics (e.g., nitrofurantoin, trimethoprim/sulfamethoxazole) – Increased fluid intak |
| Bladder Cancer | – Painless hematuria – Irritative LUTS (frequency, urgency) – Pelvic pain (advanced) | – Urine cytology – Cystoscopy with biopsy – Imaging (CT urogram) | – TURBT (Transurethral resection of bladder tumor) – Radical cystectomy (advanced cases) |
| Neurogenic Bladder (secondary to medical condition) | – Urinary retention, incontinence – Frequency, urgency – History of neurological condition (e.g., spinal cord injury, MS) | – Urodynamic studies – Post-void residual measurement – MRI of the spine (if new onset) | – Clean intermittent catheterization – Anticholinergics (e.g., oxybutynin) – Botulinum toxin injections<br>- Sacral neuromodulation |
- Conduct a detailed history, examination and assessment of patients presenting with dysuria and consider differential diagnoses, including:
- urinary tract infection (UTI)
- sexually transmissible infection (STI)
- BPH
- vaginal prolapse
- trauma
- calculus.
- In patients presenting with incontinence, identify and differentiate between causes such as:
- urge, stress or mixed type incontinence
- overactive bladder
- cauda equina syndrome
- neurogenic bladder.
- In collaboration with the patient, develop an incontinence management plan that includes pharmacological, non-pharmacological and surgical options.
- In patients presenting with flank, groin or abdomen pain identify causes, including:
- urolithiasis
- pyelonephritis
- cystitis
- malignancy
- referred pain due to testicular torsion, epididymitis/orchitis.
- Screen paediatric patients presenting for newborn check or immunisation for:
- hypospadias
- cryptorchidism
- labial adhesions in female babies
- signs of hyper or under virilisations such as clitoromegaly or micro penis.
- Identify urosepsis and treat as per best evidence in significantly unwell individuals in the community and in residential aged care facilities.
- Screen for UTI with a mid-stream, clean catch or catheter sample in patients presenting with fever with no obvious cause.
- Be vigilant and screen asymptomatic individuals in high-risk populations for signs and symptoms of kidney or urological disease, including:
- proteinuria and microscopic haematuria (polycystic kidney disease, glomerulopathies, CKD, malignancies)
- asymptomatic bacteriuria (pregnancy)
- hyperuricemia in CKD
- prostate cancer.
- In babies and young children presenting with culture positive UTIs, screen for underlying conditions, including:
- vesico-ureteric reflux
- posterior urethral valve
- congenital anomalies such as duplication or absence.
- In patients presenting with urinary retention, identify common aetiological factors and manage accordingly.
- Conduct a urine dipstick test as part of examination and information gathering.
- Perform clinical examination of external genitals and speculum examination of women presenting with LUTS to rule out vaginal atrophy and urethral caruncle, before organising extensive investigation.
- Competently insert an indwelling catheter and replace supra-pubic catheters to:
- relieve distress in acute urinary retention
- collect appropriate specimens, including for children.