Kidney and urinary tract diseases (extending from kidneys to urethra) account for 1.4% of Australia’s total burden of disease. Of this, the majority (86%) is from chronic kidney disease (CKD)1 which represents a significant cost to the health system, accounting for about one in six (17%) hospitalisations. Hospitalisation due to kidney failure is 70 times more likely in Aboriginal and Torres Strait Islander peoples than non-Indigenous people in rural and remote areas.2 Deaths due to renal failure are four times higher in Aboriginal and Torres Strait Islander peoples,3 with critical gaps in access to kidney care, particularly transplantation.4 CKD increases all-cause mortality and cardiac death by two to threefold,5 and represents one in nine deaths in Australia every year. The rates of CKD-related deaths are almost twice as high in remote and lower socioeconomic areas when compared to major cities.6
CKD is still an under-recognised condition in Australia.7 Fewer than 10% of people with CKD attending general practice are aware that their kidney health is compromised. Early detection and management reduces the risk of further deterioration in kidney function by up to 50%, and in some cases damage can be reversible.5 General practitioners (GPs) are well placed to undertake identification of high-risk patients, screening, early detection and appropriate management of kidney disease, as well as to reduce the risk of kidney injury by implementing strategies such as patient education and medication reviews.8 GPs also play a role in identifying community resources, appropriate care pathways and initiating early referral to a urologist or nephrologist for further assessment in patients with red flags.9 They also play a role in providing supportive care for post-renal transplant patients and people with kidney failure.10
Acute kidney injury (AKI) affects 8–20% of adults admitted to hospital. Acute renal replacement therapy is initiated in approximately 1% of all hospitalised patients and doubles the risk of subsequent death.11 The period after AKI represents an opportunity to improve care provided in general practice especially in rural and remote communities to reduce the disease burden.
Urinary tract malignancies (prostate, kidney and bladder cancers) account for three of the 20 most commonly diagnosed malignancies and cancer deaths.12 GPs therefore play a significant role in early identification of urinary tract malignancies by being alert to possible indicators such as haematuria or progressive lower urinary tract symproms,13 and conducting screening as appropriate.14
Other presentations such as bladder emptying disorders, dysuria and haematuria are common in adults. Urinary tract infections (UTIs) are extremely common in women; up to half of all women will get a UTI in their lifetime, and they are 50 times more likely to develop a UTI than men.15 While an occasional uncomplicated UTI is simple to treat, recurrent UTIs and cystitis with variable or negative urine culture are a complex diagnostic and therapeutic challenge. UTIs in women are a cause of great personal morbidity as well as cost to the health system.9 UTIs also occur in children and account for 12% of all UTI hospital admissions.16 Other common paediatric presentations include bladder emptying disorders such as enuresis,17 congenital anomalies, dysuria, proteinuria and haematuria. Lower urinary tract symptoms are also common among Australian men over the age of 45 years, most of whom will have benign prostatic hyperplasia (BPH) 18. GPs need to identify and manage these presentations to prevent recurrence and kidney damage. Those with uncertain diagnoses may require referral to a urologist.