A critique of the UK NICE guidance for the detection and management of individuals with chronic kidney disease.

The increasing global prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) has significant public health and economic implications. The recently published UK National Institute for Health and Clinical Excellence (NICE) clinical guidelines for the early identification and management of CKD provide a framework of disease management for both primary and secondary care with the stated aim of reducing the progression of CKD and the associated risk of cardiovascular death. Identification of at-risk individuals with proteinuria and inhibition of the renin-angiotensin system are the cornerstones of this strategy. However, the vast majority of patients with CKD will not develop ESRD and it is far from clear whether the NICE recommendations will reduce either ESRD or cardiovascular death associated with CKD.

Injury to a transplanted kidney during caesarean section: a case report.

As fertility is restored after renal transplant, more female recipients of a renal transplant successfully complete pregnancies that are safe for the mother, the fetus, and the renal allograft. Although the transplanted kidney lies in one of the iliac fossae, normal vaginal delivery is not impeded by this positioning. Caesarean section is indicated in many scenarios, primarily for obstetric reasons, particularly when the transplanted kidney lies in a position where it could be injured. Here, we report our experiences managing a rare instance of injury to a transplanted kidney during caesarean section and discuss the relevant aspects of its management. To our knowledge, this is the first report in the English literature of an injury to a transplanted kidney during caesarean section.