A detailed annual history and physical examination are recommended (Table 15.3) for all patients. Patients who have received therapies with known renal toxicities may benefit from simple screening tests (including hemoglobin or hematocrit, urinalysis, BUN and creatinine), as well as from blood pressure-monitoring [57-59]. A determination of the serum electrolyte concentrations and more definitive tests, such as creatinine clearance, may be indicated in selected cases.
After nephrectomy, preservation of the residual kidney function is essential. Participation in contact sports, especially football, is not advised. Kidney guards are often recommended, although there is no data regarding their efficacy in injury prevention. More likely, the appliance serves to remind the individual of vulnerability. Although urinary tract infection should be treated aggressively in all patients, this is especially important in those with a single kidney or with renal dysfunction. To rule out obstruction, patients with anatomic alteration of the GU tract may need periodic imaging studies; they may also need periodic urine cultures to assess urine sterility. The role of chronic antimicrobial prophylaxis in patients with urinary diversion is controversial [60,61]. Urinalysis is a good screening tool following therapy for assessing possible damage to the bladder wall.
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