Objectives The objectives of this study were to: 1) investigate the relationship between LUTS as defined by the American Urologic Association Symptom Index (AUA-SI) and the metabolic syndrome (MetS); and 2) determine the relationship between individual symptoms comprising the AUA-SI and MetS. Methods The Boston Area Community Health (BACH) Survey used a two-stage cluster design to recruit a random sample of 2,301 men age 30-79. Analyses were conducted on 1,899 men who provided blood samples. Urologic symptoms comprising the American Urological Association symptom index were included in the analysis. MetS was defined using a modification of the Adult Treatment Panel (ATP) III guidelines. The association between LUTS and MetS was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models. Results Increased odds of MetS were observed among men with mild to severe symptoms (AUA-SI 2-35) compared to men with an AUA-SI score of 0 or 1 (multivariate Odds Ratio (OR)=1.68, 95% confidence interval (CI): 1.21, 2.35). A statistically significant association was observed between MetS and voiding symptom score ≥5 (multivariate adjusted OR=1.73, 95%CI: 1.06, 2.80) but not for storage symptom score ≥4 (multivariate adjusted OR=0.94, 95%CI: 0.66, 1.33). Increased odds of MetS were observed even with mild symptoms, primarily for incomplete emptying, intermittency, and nocturia. These associations were observed primarily among younger men (age<60 years) and were null among older men (age≥60 years). Conclusions The observed association between urologic symptoms and MetS provides further evidence of common underlying factors between LUTS and chronic conditions outside the urinary tract.

The observed association between urological symptoms and the metabolic syndrome provides further evidence of common underlying factors between lower urinary tract symptoms and chronic conditions outside the urinary tract.

Chronic kidney disease (CKD) is recognised as a health concern globally and leads to high rates of morbidity, mortality and healthcare expenditure. CKD is itself an independent risk factor for unfavorable health outcomes that include cardiovascular disease (CVD). Coronary artery disease is the primary type of CVD in CKD patients and a significant cause of death among renal transplant patients. Traditional and non-traditional risk factors for CVD exist in patients with CKD. Traditional factors include smoking, hypertension, dyslipidemia and diabetes which are highly prevalent in CKD patients. Non-traditional risk factors of CKD are mainly uraemiaspecific and increase in prevalence as kidney function declines. Some examples of uraemia-specific risk factors that have been well documented include low levels of haemoglobin, albuminuria, and abnormal bone and mineral metabolism. Therapeutic interventions targeted at more traditional risk factors which contribute to CVD, have not had the desired effect on lowering CVD events and mortality in those suffering with CKD. Future research is warranted to delineate clear evidence to the benefit of modifying non-traditional risk factors. Key words: Cardiovascular disease; Chronic kidney disease; Risk factors; InflammationCore tip: Chronic kidney disease (CKD) has been recognised as a health concern globally and leads to high morbidity, mortality and healthcare expenditure. CKD is an independent risk factor for several different unfavourable outcomes including cardiovascular disease (CVD). Traditional and non-traditional risk factors for CVD exist in patients with CKD. Non-traditional risk factors of CKD are mainly uraemia-specific and include release of large levels of inflammatory and prothrombotic factors, low levels of haemoglobin, albuminuria, and abnormal bone and mineral metabolism. Future research is warranted to delineate clear evidence to the benefit of modifying non-traditional risk factors Alani H, Tamimi A, Tamimi N. Cardiovascular co-morbidity in chronic kidney disease: Current knowledge and future research needs. World J Nephrol 2014; 3(4): 156-168 Available from:

Drug development is an expensive, long and high-risk business taking 10–15 years and is associated with a high attrition rate. It is driven by medical need, disease prevalence and the likelihood of success. Drug candidate selection is an iterative process between chemistry and biology, refining the molecular properties until a compound suitable for advancing to man is found. Typically, about one in a thousand synthesised compounds is ever selected for progression to the clinic. Prior to administration to humans, the pharmacology and biochemistry of the drug is established using an extensive range of in vitro and in vivo test procedures. It is also a regulatory requirement that the drug is administered to animals to assess its safety. Later-stage animal testing is also required to assess carcinogenicity and effects on the reproductive system. Clinical phases of drug development include phase I in healthy volunteers to assess primarily pharmacokinetics, safety and toleration, phase II in a cohort of patients with the target disease to establish efficacy and dose-response relationship and large-scale phase III studies to confirm safety and efficacy. Experience tells us that approximately only 1 in 10 drugs that start the clinical phase will make it to the market. Each drug must demonstrate safety and efficacy in the intended patient population and its benefits must outweigh its risks before it will be approved by the regulatory agencies. Strict regulatory standards govern the conduct of pre-clinical and clinical trials as well as the manufacturing of pharmaceutical products. The assessment of the new medicinal product’s safety continues beyond the initial drug approval through post-marketing monitoring of adverse events.

In a 12-month prospective study of the initial management of patients with acute renal failure (ARF) in East Kent (population 593 000), we evaluated the initial management of ARF and assessed what proportion of ARF may have been preventable. Patients were seen and assessed on a daily basis, and were followed until discharge from hospital or death; survivors were subsequently followed for 3 years. Overall, 288 patients developed ARF (486 per million population/year). Mean age at presentation was 73 years (range 14-96). Initial assessment was often suboptimal, and key features in investigation and initial management were often lacking. In 108 cases, ARF was iatrogenic and/or potentially preventable (53 preventable, 99 iatrogenic, 44 both). Overall survival was 56% at discharge from hospital, 35% at 1-year follow-up, 31% at 2 years, and 28% at 3 years. In discharged patients, recovery of function was complete in 69%. A significant proportion of ARF is preventable. Clear guidelines, easily accessible at the point of care, could aid the diagnostic evaluation of the patient with ARF and indicate where referral for a specialist opinion is appropriate.