Recurrent nephrolithiasis and loss of kidney function: a cohort study.

PURPOSE: To evaluate whether symptomatic recurrent nephrolithiasis leads to loss of kidney function. METHODS: Adults who presented to the Emergency Department at least twice with symptomatic and radiologically confirmed nephrolithiasis were retrospectively recruited. Primary endpoint was the change in glomerular filtration rate (GFR) between baseline and at the time of data collection. Secondary endpoints include GFR slope defined as the mean rate of change in GFR from baseline to the end of the study period. RESULTS: 240 patients had recurrent symptomatic nephrolithiasis. Median follow-up was 5.4 years. The median age of first acute presentation was 51.6 years and the median baseline serum creatinine (bsCr) was 85.5 umol/l. 17.5% (n = 42) had worsening GFR, with the average change in GFR of - 8.64 ml/min/1.73 m2 per year. Four patients progressed to ESKD requiring haemodialysis. 14.5% (n = 35) had calcium oxalate stones. Univariate analysis showed older patients (p < 0.001), more symptomatic stone episodes (p < 0.001) and non-calcium-containing stones (p < 0.001) were strongly associated with deteriorating kidney function. Age (p = 0.002) and number of acute stone episodes (p = 0.011) were significant predictive factors when unadjusted to co-morbidities. Age (p = 0.018) was the only predictive factor of worsening GFR when adjusted for co-morbidities. Average mean GFR slope was - 2.83/min/1.73 m2 per year. CONCLUSIONS: Recurrent symptomatic nephrolithiasis is associated with loss of kidney function, in older patients, increased episodes of symptomatic nephrolithiasis and non-calcium-containing stones. Age is the only predictive factor for progression to chronic kidney disease in this subgroup.

Predicting re-presentation following discharge from the emergency department with non-specific chest pain.

OBJECTIVE: To determine the 30 day major adverse cardiac events (MACE) and re-presentation rates of non-specific chest pain (NSCP) patients following four different disposition pathways and to contrast re-presentation rates of patients with NSCP with those for all other patients presenting to the ED. METHODS: Cases were derived from the ED database for two large teaching hospitals where patients aged 18 or over were triaged between 2009 and 2016, and their diagnosis on leaving the ED was NSCP. Statewide 30 day rates of MACE and ED re-presentations were calculated, and multivariable logistic regression analysis identified significant predictors of both. RESULTS: A total of 40 183 cases were included; 16 014 discharged directly from the ED, while the remainder were admitted under Cardiology (n = 7286), General Medicine (n = 7739) or an ED observation unit (n = 4086). Compared to discharge directly from the ED, admission was associated with a decreased 30 day re-presentation rate (OR = 0.857; 95% CI 0.795-0.923; P < 0.001). However, there was no significant difference in adjusted re-presentation between admitting units. The rates of 30 day MACE were higher in admitted patients, particularly in those admitted to general medicine; however, this difference was accounted for by differing patient characteristics. CONCLUSION: Despite a slightly increased rate of re-presentation in patients with NSCP sent home from the ED, we conclude that there is minimal advantage in admitting many patients who lack a diagnosis for their chest pain. For a selected patient population, discharge from the ED may become a safe and cost-effective approach. A prospective randomised study is required.

The incidence of Ross River virus disease in South Australia, 1992 to 2003.

Ross River virus (RRV) disease is the most frequently notified arboviral disease in Australia, and the burden of this disease to Australian society is significant. We have studied the incidence of RRV disease between 1992 and 2003 in South Australia. Our findings suggest that the incidence of the disease in South Australia over the study period was relatively stable. There were four epidemics in the study period, with the majority of cases acquired from regions along the River Murray. There was some evidence of spread of the disease to regions in which activity of RRV had not been previously recognised, such as the Mid-North and the South-East. In terms of disease distribution amongst the population, it was found that the highest rates occurred in the 30-49 year age range. There was no significant difference in disease rates between males and females. In order to facilitate further research into RRV disease transmission, we recommend that the suspected region of acquisition be a mandatory component of the national notification dataset.