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The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS).

In this episode, consultants Prof Jeremy Levy and Dr Andrew Frankel, both nephrologists at Imperial College Healthcare NHS Trust, discuss the significance and management of microscopic (non-visible) haematuria in primary care. They provide practical guidance for general practitioners on how to interpret urine dipstick findings, the appropriate steps for investigation, and when specialist referral is warranted. The conversation emphasises the importance of not overlooking persistent haematuria, while also acknowledging the challenges in balancing appropriate concern with unnecessary anxiety or over-referral.

The clinicians explore differential diagnoses, such as glomerulonephritis, IgA nephropathy, and hereditary conditions like thin basement membrane disorder or Alport syndrome. They stress the role of imaging, the presence of proteinuria, and age-based referral pathways in forming a management plan. A key theme is the long-term follow-up of patients with isolated haematuria, even when kidney function is normal, to monitor for progression via regular kidney health checks in primary care. The discussion is informative and grounded in real-world experience, aiming to clarify an area that is often perceived as ambiguous in general practice.

Three Main Takeaways:

1. Persistent microscopic haematuria warrants investigation and should not be dismissed, particularly when confirmed on repeat testing and associated with other findings such as proteinuria.
2. All patients with confirmed haematuria should undergo a renal ultrasound, and referral decisions should be guided by age and associated symptoms or findings. Generally, referrals are made to urology if the patient is over 50, and to nephrology if the patient is under 50 or if proteinuria is present.
3. Even when no serious underlying condition is identified, patients with isolated haematuria require annual monitoring, including blood pressure, kidney function (GFR), and urine albumin-to-creatinine ratio, ideally recorded in primary care records to ensure lifelong follow-up.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

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The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS).

In this episode of For Kidneys Sake, consultants Prof Jeremy Levy and Dr Andrew Frankel are joined by Dr Melanie Dani, a geriatrician, to discuss the complexities of managing chronic kidney disease (CKD) in older adults. They highlight the importance of distinguishing between chronological age and frailty, two overlapping but distinct concepts that significantly influence clinical decision-making. The conversation explores how kidney function naturally declines with age, and raises the critical question of when this becomes a pathological concern requiring medical intervention.

Dr Dani stresses the value of personalised care, reminding listeners that older adults are not a homogenous group. Whether someone is a fit 85-year-old playing tennis or a frail resident in a care home, their values, priorities and tolerance for medical treatment will differ. The episode encourages shared decision-making, consideration of overall health context, and careful use of medications like ACE inhibitors and SGLT2 inhibitors based on likely benefits and side effects, rather than age alone.

Three Key Takeaways

1. Ageing vs Frailty: Frailty is a better predictor of health outcomes than age alone. It’s essential to assess a patient’s overall vulnerability and resilience when managing CKD.
2. Reduced GFR in Older Adults: A declining GFR may reflect normal ageing rather than disease, but it still carries risks, particularly cardiovascular. Management should be tailored to the individual, not solely guided by guidelines.
3. Personalised, Contextualised Care: Decisions about referral, investigation and treatment must consider the whole person—their wishes, comorbidities, and quality of life—rather than focusing only on kidney function metrics.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

Send us a text

The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS).

Welcome to For Kidneys’ Sake! The new name for our podcast series is previously known as The Rest Is Kidneys. In this first episode of our new 20-part series, Prof Jeremy Levy and Dr Andrew Frankel return to tackle a topic that crops up frequently in both clinic and primary care: supplements, herbal remedies, and recreational drugs and what they really mean for people with chronic kidney disease (CKD).

This episode explores everything from high-dose vitamins and gym-related creatine use to the dangers of anabolic steroids, ketamine, and certain traditional herbal medicines. With their usual clarity and clinical insight, Jeremy and Andrew offer practical advice for clinicians and thoughtful guidance on how to approach these often-overlooked areas of patient care.

Key Takeaways:

1. Ask directly about supplements, herbs, and non-prescribed products – especially in anyone with reduced kidney function or a CKD diagnosis. These are often missed unless specifically asked about.
2. Standard multivitamins are safe in CKD, but high-dose vitamin C and extra vitamin D can be harmful, especially when kidney function is already reduced.
3. Creatine, high-protein diets, and muscle mass can raise creatinine without indicating CKD. Use a urine dipstick, ACR, blood pressure, and ultrasound to assess properly.
4. Anabolic steroids and ketamine carry serious risks, including nephrotic syndrome and irreversible bladder damage. These are increasingly common but poorly understood dangers.
5. Herbal remedies are not without harm – some are directly nephrotoxic, others interact with prescribed treatments. These should be avoided in CKD, but conversations must be handled with care and cultural awareness.

This opening discussion sets the tone for the series: practical, collaborative, and focused on bridging gaps between clinical insight and everyday patient care. Supplements and herbal products are everywhere, and understanding their impact is more important than ever for improving kidney health.

References:

Creatine and kidneys: Nutrients 2023, 15, 1466. doi.org/10.3390/nu15061466

Herbal medicines and CKD; Nephrology 15 (2010) 10–17 doi:10.1111/j.1440-1797.2010.01305.x

Herbs and more: Drug stewardship for people with chronic kidney disease; towards effective, safe, and sustainable use of medications: Nat Rev Nephrol. 2024 June ; 20(6): 386–401. doi:10.1038/s41581-024-00823-3

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

Send us a text

The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

Following the success of The Rest Is Kidneys, our podcast returns with a new name and a fresh series of conversations that get to the heart of kidney care. Hosted by Professor Jeremy Levy and Dr Andrew Frankel, For Kidneys Sake continues to bring primary and secondary care closer together through practical, down-to-earth discussions that inform, connect, and occasionally entertain.

In Series 2, we'll be exploring and discussing 20 new topics – from CKD supplements and elderly care to fertility, early detection, and the evolving world of cardio-renal-metabolic care. Whether you’re a clinician, a patient, or simply curious, these bite-sized episodes offer insights you can use – with clarity, warmth and the odd kidney pun thrown in.

We hope you enjoy listening.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

Send us a text

The Rest is Kidneys podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

In this special Q&A episode, Prof Jeremy Levy, Dr Andrew Frankel, and specialist nurse Joana Teles tackle key CKD questions from primary care. They discuss CKD coding adjustments, NSAID safety, and the importance of optimising RAAS inhibitors and SGLT2 inhibitors. Practical guidance is given on prescribing, managing side effects, and using diuretics like furosemide effectively.

The hosts emphasise that while lifestyle changes are crucial, medication remains key to slowing CKD progression and reducing cardiovascular risk.

Take-Home Messages:

CKD Coding – Adjust ACR coding as values improve; coding helps with safe prescribing.
NSAIDs & CKD – Generally avoid, but occasional short-term use may be safe in mild CKD.
RAASi & SGLT2 Inhibitors – Maximise doses; SGLT2 inhibitors are transformative for CKD and heart failure.
Managing Risks – Address side effects proactively but don’t let concerns block treatment.
Diuretics & Fluid Balance – Furosemide isn’t nephrotoxic; use it to relieve symptoms.
Hyperkalaemia – Potassium up to 6 mmol/L is usually safe; use binders before stopping RAASi.
Lifestyle & Medications – Diet and exercise help, but medication is often essential.

Effective CKD management balances accurate coding, lifestyle changes, and optimised medication use. While lifestyle adjustments help, RAAS and SGLT2 inhibitors are key to slowing progression and reducing cardiovascular risk.

Primary care teams should confidently adjust treatment, manage side effects, and take a pragmatic approach to NSAIDs, diuretics, and hyperkalaemia. Proactive, evidence-based care ensures better long-term kidney health.

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

Send us a text

The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

This podcast episode explores the intersection of chronic kidney disease (CKD) and heart failure, providing guidance for managing patients with both conditions. Hosts Prof Jeremy Levy and Andrew Frankel, consultant nephrologists, are joined by Dr Dominique Auger, a consultant cardiologist specialising in heart failure.

The discussion focuses on the shared pathophysiology of CKD and heart failure, optimising treatments, and addressing common clinical concerns in primary care.

Top Three Key Messages

1. CKD and Heart Failure Coexistence:

• CKD and heart failure frequently occur together, with CKD increasing the risk of cardiovascular disease and heart failure.
• Both conditions share overlapping treatments, including ACE inhibitors, ARBs, SGLT2 inhibitors, and MRAs, which improve survival, reduce symptoms, and decrease hospitalisations.

2. GFR Decline and Kidney Forgiveness:

• A decline in GFR is expected with effective therapies like RAS inhibitors and SGLT2 inhibitors.
• For heart failure with CKD, GFR reductions of up to 50% or creatinine increases to 260 µmol/L are acceptable, as kidneys often stabilise ("the kidneys forgive"). Therapy should continue with careful monitoring unless hyperkalaemia or other severe complications arise.

3. Role of Diuretics:

• Diuretics are essential for symptom control (e.g., relieving oedema and breathlessness) but have no prognostic benefit in heart failure.
• They are safe to use in CKD and heart failure, often requiring higher doses in CKD patients due to kidney resistance, and are useful for managing hyperkalaemia as well.

This episode underscores the importance of integrated, aggressive management of both CKD and heart failure, with a focus on optimising therapies that balance efficacy with patient safety.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

Send us a text

The Rest is Kidneys podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

This episode provides practical advice for primary care professionals on reviewing medications and prescribing pain relief for patients with CKD. The discussion focuses on assessing kidney function using estimated GFR (eGFR), adjusting drug dosages, and safely managing pain relief without compromising renal health. The hosts explain how eGFR should be used instead of creatinine clearance for drug dosing decisions, while taking into account patient-specific factors such as body size and muscle mass to ensure accurate assessment.

Key considerations for medication reviews are covered, including drugs that require caution such as NSAIDs, Metformin, PPIs, and cardiovascular medications. The importance of dose adjustments, monitoring for complications like hyperkalemia, and following Sick Day guidance to prevent adverse effects during acute illness is highlighted.

For pain management, the episode outlines safe options for analgesics, including paracetamol, tramadol, and opioids like fentanyl and oxycodone, while stressing the need to avoid morphine due to the risk of metabolite accumulation and toxicity. Recommendations are provided for starting with low doses and titrating carefully, particularly for neuropathic pain treatments such as Gabapentin and Pregabalin.

Take-Home Messages:

1. Kidney Function Assessment – Use estimated GFR (eGFR) rather than creatinine clearance for drug dose adjustments, considering patient-specific factors like muscle mass.
2. Medication Reviews – Avoid regular NSAIDs, adjust Metformin dosing (reduce below eGFR 45, stop below 30), review PPIs and cardiovascular drugs, and follow Sick Day rules to guide temporary medication pauses during illness.
3. Pain Management – Use paracetamol as first-line analgesia, avoid morphine, and opt for lower doses of tramadol, oxycodone, or fentanyl for stronger pain relief. Minimise long-term NSAID use and review topical gels due to absorption risks.

This episode offers clear, NICE-aligned guidance to support safer prescribing practices in CKD.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

Send us a text

The Rest is Kidneys podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

In this episode, Professor Jeremy Levy, Dr. Andrew Frankel, and clinical lead kidney nurse specialist Joana Teles discuss how to effectively educate and empower patients with Chronic Kidney Disease (CKD), focusing on delivering a CKD diagnosis with clarity and reassurance, addressing common misconceptions, and encouraging patient engagement during short consultations. Joanna highlights the importance of framing discussions around ‘kidney health’ rather than ‘kidney disease’ and shares practical tips for encouraging patients to take an active role in their care. Resources like the Know Your Kidneys education programme are vital tools for patient learning and support.

The discussion highlights that there are practical steps to help reduce fear and unnecessary worry so that patients can be reassured and empowered. For example, it is important to explain that the term ‘chronic’ describes the duration of the condition rather than its severity and to clarify that CKD stages are not comparable to cancer stages. To encourage patient involvement and understanding, Joana continues by outlining actions such as having regular ‘kidney health checks’ to monitor kidney function, protein levels, and blood pressure. The benefits of commonly used medications, such as Ramipril and SGLT2 inhibitors, are also explained. The conversation concludes by stressing the value of simple, actionable steps, such as keeping track of medications and bringing blood pressure readings to appointments, which can help patients feel more confident and engaged in managing their kidney health.

Top Three Takeaways:

1. Use clear, reassuring language to explain CKD and focus on maintaining kidney health.
2. Promote regular "kidney health checks" and educate patients on lifestyle and medication management.
3. Encourage small, actionable steps to increase patient engagement, such as participating in education programmes like Know Your Kidneys.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub