Comprehensive Clinical Nephrology [6 ed.] 032347909X, 9780323479097, 9780323547192

Table of contents :
Front Cover
Inside Front Cover
Comprehensive Clinical Nephrology
Copyright Page
Table Of Contents
Preface
List of Contributors
Dedication
I Essential Renal Anatomy and Physiology
1 Renal Anatomy
Structure of the Kidney
Nephrons
Collecting Ducts
Microvasculature
Fig. 1.1 Coronal section through a unipapillary kidney.
Glomerulus (Renal Corpuscle)
Glomerular Basement Membrane
Mesangium
Mesangial cells.
Mesangial matrix.
Endothelium
Visceral Epithelium (Podocytes)
Function and Maintenance of the Filtration Barrier
Filtration pressure and expansion.
Filtrate flow and shear stress.
Barrier function.
Pathology.
Parietal Epithelium
Renal Tubule
Proximal Tubule
Intermediate Tubule
Distal Straight Tubule (Thick Ascending Limb of the Loop of Henle)
Distal Convoluted Tubule
Collecting Duct System
Collecting Ducts
Juxtaglomerular Apparatus
Renal Interstitium
References
Self-assessment Questions
2 Renal Physiology
Glomerular Structure and Ultrastructure
Glomerular Filtration Rate
Measurement of Renal Plasma Flow
Autoregulation of Renal Blood Flow and Glomerular Filtration Rate
Tubular Transport
Passive Transport
Active Transport
Transport in Specific Nephron Segments
Proximal Tubule
Loop of Henle
Distal Nephron
Glomerulotubular Balance
Countercurrent System
Role of Urea
Vasa Recta
Renal Medullary Hypoxia
Vasopressin (Antidiuretic Hormone) and Water Reabsorption
Integrated Control of Renal Function
Renal Interstitial Hydrostatic Pressure and Nitric Oxide
Renal Sympathetic Nerves
Renin-Angiotensin-Aldosterone System
Eicosanoids
Atrial Natriuretic Peptide
Endothelins
Purines
Exosomes, Other Extracellular Vesicles and Luminal Factors
References
Self-assessment Questions
II Investigation of Renal Disease
3 Assessment of Glomerular Filtration Rate
Glomerular Filtration Rate
Measurement and Estimation of the Glomerular Filtration Rate
Clearance Measurements
Concept of Clearance
Urinary Clearance
Plasma Clearance
Estimation of the Glomerular Filtration Rate
Filtration Markers
Exogenous Filtration Markers
Endogenous Filtration Markers
Creatinine
Metabolism and Excretion
Creatinine Assay
Estimated Glomerular Filtration Rate From Serum Creatinine
Equation Currently Recommended for Use
Equations Previously Recommended for Use
Other Equations That Could Be Considered for Use in Selected Populations
Cystatin C
Metabolism and Excretion
Cystatin C Assay
Estimated Glomerular Filtration Rate From Serum Cystatin C
Urea and Other Metabolites
Other Low-Molecular-Weight Serum Proteins
Clinical Application of Estimated Glomerular Filtration Rate
Chronic Kidney Disease
Acute Kidney Disease
Living Kidney Donor Candidates
Drug Dosing
References
Self-Assessment Questions
4 Urinalysis
Definition
The Urine Sample
Physical Characteristics
Color
Turbidity
Odor
Relative Density
Chemical Characteristics
pH
Hemoglobin
Glucose
Protein
Albumin Reagent Strip
24-Hour Protein Excretion
Protein-to-Creatinine Ratio and Albumin-to-Creatinine Ratio on Random Urine Sample
Specific Proteins
Albuminuria.
Tubular proteins.
Bence Jones proteinuria.
Leukocyte Esterase
Nitrites
Ketones
Urine Microscopy
Methods
Cells
Erythrocytes
Leukocytes
Renal Tubular Epithelial Cells
Transitional Epithelial Cells
Squamous Epithelial Cells
Lipids
Casts
Crystals
Common Crystals
Uric acid crystals and amorphous urates.
Calcium oxalate crystals.
Calcium phosphate crystals (brushite) and amorphous phosphates.
Triple phosphate (struvite) crystals.
Pathologic Crystals
Cholesterol crystals.
Cystine crystals.
2,8-dihydroxyadenine(2,8-DHA) crystals.
Crystals Caused by Drugs
Other Crystals
Clinical Significance of Crystals
Organisms
Contaminants
Interpretation of Urine Sediment Findings
Nephrotic Syndrome
Nephritic Syndrome
Acute Kidney Injury
Urinary Tract Infection
BK Virus Infection
Urologic Diseases
Nonspecific Urinary Abnormalities
Automated Analysis of Urine Sediment
References
Self-Assessment Questions
5 Imaging
Ultrasound
Kidney Size
Renal Echo Pattern
Renal Cysts
Simple Cysts
Complex Cysts
Bladder
Renal Vasculature
Renal Artery Duplex Scanning
Contrast-Enhanced and Three-Dimensional Ultrasound
Plain Radiography and Intravenous Urography
Renal Calcification
Intravenous Contrast Urography
Kidneys
Pelvicalyceal System
Ureters
Bladder
Retrograde Pyelography
Antegrade Pyelography
Imaging Ileal Conduits
Cystography
Computed Tomography
Tissue Density
Contrast-Enhanced and Noncontrast Computed Tomography
Computed Tomographic Angiography
Dual-Energy Computed Tomography
Limitations of Computed Tomography
Magnetic Resonance Imaging
Contrast-Enhanced Magnetic Resonance Imaging
Magnetic Resonance Urography
Magnetic Resonance Angiography
Disadvantages of Magnetic Resonance Imaging
Incidental Findings
Measurement of Glomerular Filtration Rate
Angiography
Renal Venography
Nuclear Scintigraphy
Glomerular Filtration Agents
Tubular Secretion Agents
Tubular Retention Agents
Renogram
Cortical Imaging
Vesicoureteral Reflux
Renal Transplant
Positron Emission Tomography
Molecular Imaging
Radiologic Contrast Agents
X-ray Contrast Agents
Contrast-Induced Nephropathy
Magnetic Resonance Contrast Agents
References
Self-Assessment Questions
6 Renal Biopsy
Indications for Renal Biopsy
Nephrotic Syndrome
Acute Kidney Injury
Systemic Disease Associated With Renal Dysfunction
Renal Transplant Dysfunction
Non-Nephrotic Proteinuria
Isolated Microhematuria
Unexplained Chronic Kidney Disease
Familial Renal Disease
Role of Repeat Renal Biopsy
Value of Renal Biopsy
Biopsy Adequacy
Is Renal Biopsy a Necessary Investigation?
Prebiopsy Evaluation
Contraindications to Renal Biopsy
Renal Biopsy Technique
Percutaneous Renal Biopsy
Native Renal Biopsy
Renal Transplant Biopsy
Postbiopsy Monitoring
Alternatives to the Percutaneous Approach
Transvenous (Transjugular or Transfemoral) Renal Biopsy
Open Renal Biopsy
Laparoscopic Renal Biopsy
Complications of Renal Biopsy
Pain
Hemorrhage
Arteriovenous Fistula
Other Complications
Death
References
Self-assessment Questions
III Fluid and Electrolyte Disorders
7 Disorders of Extracellular Volume
Extracellular Fluid Compartment
Regulation of Extracellular Fluid Homeostasis
Afferent (Sensor) Limb
Glomerulotubular Balance
Pressure Natriuresis
Efferent (Effector) Limb
Renin-Angiotensin-Aldosterone System
Sympathetic Nervous System
Natriuretic Peptides
Prostaglandins
Arginine Vasopressin
Other Hormones
Terms Useful for Disorders of Extracellular Fluid Volume
Extracellular Fluid Volume Contraction
Extrarenal Causes
Gastrointestinal Losses
Dermal Losses
Third-Space Sequestration
Hemorrhage
Renal Losses
Diuretic Use
Genetic and Acquired Tubular Disorders
Hormonal and Metabolic Disturbances
Renal Water Loss
Clinical Manifestations of Extracellular Fluid Volume Contraction
Laboratory Tests
Therapy of Extracellular Fluid Volume Contraction
Extracellular Fluid Volume Expansion
Pathogenesis
Capillary Hemodynamic Disturbances
Renal Sodium Retention
Primary renal sodium retention.
Secondary renal sodium retention.
Sodium and Water Retention in Heart Failure
Sodium and Water Retention in Cirrhosis
Sodium and Water Retention in Nephrotic Syndrome
Drug-Induced Edema
Idiopathic Edema
Sodium and Water Retention in Pregnancy
Clinical Manifestations of Extracellular Fluid Volume Expansion
Diagnostic and Therapeutic Approach to Extracellular Volume Expansion
Diuretics
Principles of Action
Classes of Diuretics
Loop diuretics.
Distal convoluted tubule diuretics.
Collecting duct diuretics.
Proximal tubule diuretics.
Osmotic diuretics.
Adverse Effects
Approach to Diuretic Treatment of Extracellular Fluid Volume Expansion
Diuretic Resistance
References
Self-Assessment Questions
8 Disorders of Water Metabolism
Physiology of Water Balance
Vasopressin
Osmotic Stimuli for Vasopressin Release
Nonosmotic Stimuli for Vasopressin Release
Mechanism of Vasopressin Action
Thirst and Water Balance
Quantitation of Renal Water Excretion
Serum Sodium Concentration, Osmolality, and Tonicity
Estimation of Total Body Water
Hyponatremic Disorders
Etiology and Classification of Hyponatremia
Hypovolemia: Hyponatremia Associated With Decreased Total Body Sodium
Gastrointestinal and third-space sequestered losses.
Diuretics.
Salt-losing nephropathy.
Mineralocorticoid deficiency.
Osmotic diuresis.
Cerebral salt wasting.
Hypervolemia: Hyponatremia Associated With Increased Total Body Sodium
Congestive heart failure.
Hepatic failure.
Nephrotic syndrome.
Advanced chronic kidney disease.
Euvolemia: Hyponatremia Associated With Normal Total Body Sodium
Glucocorticoid deficiency.
Hypothyroidism.
Psychosis.
Postoperative hyponatremia.
Exercise-induced hyponatremia.
Drugs causing hyponatremia.
Syndrome of inappropriate antidiuretic hormone secretion.
Clinical Manifestations of Hyponatremia
Cerebral Edema
Osmotic Demyelination
Treatment of Hyponatremia
Acute Symptomatic Hyponatremia
Chronic Symptomatic Hyponatremia
Chronic “Asymptomatic” Hyponatremia
Fluid restriction.
Increase solute excretion.
Pharmacologic inhibition of vasopressin.
Hypovolemic Hyponatremia
Hypervolemic Hyponatremia
Congestive heart failure.
Cirrhosis.
Hypernatremic Disorders
Etiology and Classification of Hypernatremia
Hypovolemia: Hypernatremia Associated With Low Total Body Sodium
Hypervolemia: Hypernatremia Associated With Increased Total Body Sodium
Euvolemia: Hypernatremia Associated With Normal Body Sodium
Diabetes Insipidus
Central diabetes insipidus
Clinical features.
Causes.
Differential diagnosis.
Treatment.
Congenital nephrogenic diabetes insipidus.
Acquired nephrogenic diabetes insipidus.
Chronic kidney disease.
Electrolyte disorders.
Pharmacologic agents.
Sickle cell anemia.
Dietary abnormalities.
Gestational diabetes insipidus.
Clinical Manifestations of Hypernatremia
Treatment of Hypernatremia
References
Self-assessment Questions
9 Disorders of Potassium Metabolism
Normal Physiology of Potassium Metabolism
Potassium Intake
Potassium Distribution
Renal Potassium Handling With Normal Renal Function
Renal Potassium Handling in Chronic Kidney Disease
Hypokalemia
Epidemiology
Clinical Manifestations
Cardiovascular
Hormonal
Muscular
Renal
Etiology
Pseudohypokalemia
Redistribution
Nonrenal Potassium Loss
Renal Potassium Loss
Drugs.
Endogenous hormones.
Genetic causes.
Magnesium depletion.
Primary renal defect.
Bicarbonaturia.
Diagnostic Evaluation
Treatment
Hyperkalemia
Epidemiology
Clinical Manifestations
Etiology
Pseudohyperkalemia
Redistribution
Excess Intake
Impaired Renal Potassium Excretion
Determining the Role of Excessive Potassium Intake in Chronic Hyperkalemia
Treatment
Acute Therapy
Blocking cardiac effects.
Cellular potassium uptake.
Potassium removal.
Chronic Treatment
References
Self-Assessment Questions
10 Disorders of Calcium, Phosphate, and Magnesium Metabolism
Calcium Homeostasis and Disorders of Calcium Metabolism
Distribution of Calcium in the Organism
Intestinal, Skeletal, and Renal Handling of Calcium
Hypercalcemia
Causes of Hypercalcemia
Malignant Neoplasias
Primary Hyperparathyroidism
Jansen Disease
Familial Hypocalciuric Hypercalcemia
Other Endocrine Causes
Other Causes
Clinical Manifestations
Diagnosis
Treatment
Hypocalcemia
Hypocalcemia Associated With Hyperphosphatemia
Hypocalcemia Associated With Hypophosphatemia
Clinical Manifestations
Laboratory and Radiographic Signs
Treatment
Phosphate Homeostasis
Distribution of Phosphate in the Organism
Hyperphosphatemia
Causes of Hyperphosphatemia
Acute Kidney Injury
Chronic Kidney Disease
Lytic States
Treatment-Induced Hyperphosphatemia
Hypoparathyroidism
Chronic Hypocalcemia
Acromegaly
Familial Tumoral Calcinosis
Respiratory Alkalosis With Prolonged Hyperventilation
Clinical Manifestations
Treatment
Hypophosphatemia
Causes of Hypophosphatemia
Inherited Forms of Hypophosphatemia
Autosomal dominant hypophosphatemic rickets.
X-linked hypophosphatemic rickets.
Autosomal recessive hypophosphatemic rickets.
Fanconi syndrome and proximal renal tubular acidosis.
Vitamin D–dependent rickets.
Distal renal tubular acidosis (type 1).
Acquired Forms of Hypophosphatemia
Alcoholism.
Hyperparathyroidism.
Post-transplant hypophosphatemia.
Acute respiratory alkalosis.
Diabetic ketoacidosis.
Total parenteral nutrition.
Oncogenic hypophosphatemic osteomalacia.
Drug-induced hypophosphatemia.
Clinical Manifestations
Treatment
Magnesium Homeostasis and Disorders of Magnesium Metabolism
Distribution of Magnesium in the Organism
Intestinal and Renal Handling of Magnesium
Hypermagnesemia
Clinical Manifestations
Treatment
Hypomagnesemia and Magnesium Deficiency
Clinical Manifestations
Treatment
References
Self-Assessment Questions
11 Normal Acid-Base Balance
Definition
Net Acid Production
Buffer Systems in Regulation of pH
Respiratory System in Regulation of pH
Renal Regulation of pH
Renal Transport Mechanisms of Hydrogen and Bicarbonate Ions
Glomerulus
Proximal Tubule
Thick Ascending Limb of the Loop of Henle
Distal Nephron
Net Acid Excretion
Ammonia Metabolism
Regulation of Renal Acidification
Blood pH
Mineralocorticoids, Distal Sodium Delivery, and Extracellular Fluid Volume
Plasma Volume
Potassium
References
Self-Assessment Questions
12 Metabolic Acidosis
Definition
Non–Anion Gap (Normal Anion Gap) Metabolic Acidosis
Metabolic Acidosis of Renal Origin
Proximal Renal Tubular Acidosis (Type 2)
Hypokalemic Distal Renal Tubular Acidosis (Type 1)
Hyperkalemic Distal Renal Tubular Acidosis (Type 4)
Renal Tubular Acidosis in Chronic Kidney Disease
Metabolic Acidosis of Extrarenal Origin
Diarrhea
Ileal Conduits
Anion Gap Metabolic Acidosis
Lactic Acidosis
Diabetic Ketoacidosis
d-Lactic Acidosis
Starvation Ketosis
Alcoholic Ketoacidosis
Ethylene Glycol and Methanol Intoxications
Salicylate
Pyroglutamic Acidosis
Alkali Treatment of Metabolic Acidosis
References
Self-Assessment Questions
13 Metabolic Alkalosis
Definition
Bicarbonate Transport Along the Nephron
Factors Affecting Bicarbonate Reabsorption and Secretion
Angiotensin II
Aldosterone
Pendrin
Hypokalemia
Pathophysiology of Metabolic Alkalosis
Secondary Stimulation of Collecting Duct Ion Transport
Chloride Depletion
Potassium Depletion
Primary Stimulation of Collecting Duct Ion Transport
Exogenous Alkali
Secondary Response to the Alkalemia Induced by HCO3− Retention
Etiology
Secondary Stimulation of Collecting Duct Ion Transport
Vomiting or Nasogastric Drainage
Diuretic Administration
Genetic Impairment of Cl−-Linked Na+ Transport
Recovery From Chronic Hypercapnia
Congenital Chloridorrhea
Other Causes of Excessive Chloride Losses
Severe K+ Deficiency
Primary Stimulation of Collecting Duct Ion Transport
Mineralocorticoid Excess
Apparent Mineralocorticoid Excess Syndromes
Alkali Administration
Other Causes
Clinical Manifestations
Diagnosis
Treatment
Chloride Depletion Metabolic Alkalosis
Mineralocorticoid and Apparent Mineralocorticoid-Induced Metabolic Alkalosis
Alkali Ingestion
Special Problems in Management
References
Self-assessment Questions
14 Respiratory Acidosis, Respiratory Alkalosis, and Mixed Disorders
Respiratory Acidosis (Primary Hypercapnia)
Definition
Etiology and Pathogenesis
Secondary Physiologic Response
Clinical Manifestations
Neurologic
Cardiovascular
Renal
Diagnosis
Treatment
Respiratory Alkalosis (Primary Hypocapnia)
Definition
Etiology and Pathogenesis
Secondary Physiologic Response
Clinical Manifestations
Diagnosis
Treatment
Mixed Acid-Base Disturbances
Definition
Etiology and Pathogenesis
Metabolic Acidosis and Respiratory Acidosis
Metabolic Alkalosis and Respiratory Alkalosis
Metabolic Alkalosis and Respiratory Acidosis
Metabolic Acidosis and Respiratory Alkalosis
Metabolic Acidosis and Metabolic Alkalosis
Mixed Metabolic Acidosis
Mixed Metabolic Alkalosis
Triple Disorders
Clinical Manifestations
Diagnosis
Treatment
References
Self-assessments Questions
IV Glomerular Disease
15 Introduction to Glomerular Disease
Definition
Clinical Evaluation of Glomerular Disease
History
Physical Examination
Laboratory Studies
Imaging
Renal Biopsy
Asymptomatic Urine Abnormalities
Asymptomatic Microhematuria
Pathogenesis
Evaluation
Asymptomatic Non-Nephrotic Proteinuria
Overflow Proteinuria
Tubular Proteinuria
Glomerular Proteinuria
Functional proteinuria.
Orthostatic proteinuria.
Fixed non-nephrotic proteinuria.
Asymptomatic Proteinuria With Hematuria
Macrohematuria
Nephrotic Syndrome
Definition
Etiology
Hypoalbuminemia
Edema
Metabolic Consequences of Nephrotic Syndrome
Negative Nitrogen Balance
Hypercoagulability
Hyperlipidemia and Lipiduria
Other Metabolic Effects of Nephrotic Syndrome
Infection
Acute and Chronic Changes in Renal Function
Acute Kidney Injury
Chronic Kidney Disease
Nephritic Syndrome
Etiology
Rapidly Progressive Glomerulonephritis
Etiology
Progressive Chronic Kidney Disease
Treatment of Glomerular Disease
General Principles
Hypertension
Treatment of Proteinuria
Treatment of Hyperlipidemia
Avoidance of Nephrotoxic Substances
Special Therapeutic Issues in Patients With Nephrotic Syndrome
Treatment of Nephrotic Edema
Correction of Hypoproteinemia
Treatment of Hypercoagulability
Management of Infection
Disease-Specific Therapies
References
Self-assessment Questions
16 Introduction to Glomerular Disease
Histologic Classification
Histopathology
Light Microscopy
Immunofluorescence and Immunoperoxidase Microscopy
Electron Microscopy
General Mechanisms of Glomerular Injury
Proteinuria
Antibody and Antigen
Complement
Mechanisms of Immune Glomerular Injury
Inflammation
Proliferation, Apoptosis, and Fibrosis
Pathogenesis of Specific Glomerular Syndromes
Minimal Change Disease
Focal Segmental Glomerulosclerosis
Membranous Nephropathy
Membranoproliferative Glomerulonephritis
Dense Deposit Disease and C3 Glomerulonephritis
Mesangial Proliferative Glomerulonephritis
Poststreptococcal Glomerulonephritis
Goodpasture Disease
Antineutrophil Cytoplasmic Antibody–Associated Vasculitis
References
Self-Assessment Questions
17 Minimal Change Disease
Epidemiology
Etiology
Pathogenesis
Circulating Factor(s)
Cytokines
Hemopexin
Microbial Products
Mechanism(s) of Proteinuria
Loss of Anionic Charges in the Glomerular Filtration Barrier as a Cause of Minimal Change Disease
Podocyte Dysfunction as a Cause of Minimal Change Disease
CD80.
Angptl-4.
Pathology
Clinical Manifestations
Laboratory Findings
Other Presentations (Complications)
Diagnosis and Differential Diagnosis
Natural History
Treatment
General Considerations
Treatment of Children
Initial Treatment
Treatment of Relapses
Treatment of Adults
Initial Treatment
Frequently Relapsing and Corticosteroid-Dependent Minimal Change Disease
Minimal Change Disease With Non-Nephrotic Proteinuria
Treatment of Secondary Minimal Change Disease
References
Self-assessment Questions
18 Primary and Secondary (Non-Genetic) Causes of Focal and Segmental Glomerulosclerosis
Etiology and Pathogenesis
Minimal Change Disease Versus Focal Segmental Glomerulosclerosis
Genetic Variants of Focal Segmental Glomerulosclerosis
Viral Induction of Focal Segmental Glomerulosclerosis
Drug-Induced Focal Segmental Glomerulosclerosis
Structural Maladaptation Leading to Focal Segmental Glomerulosclerosis
Pathogenesis of Progressive Renal Failure in Focal Segmental Glomerulosclerosis
Epidemiology
Clinical Manifestations
Diagnosis and Differential Diagnosis
Pathology
Classic Focal Segmental Glomerulosclerosis (FSGS Not Otherwise Specified)
Perihilar Variant of Focal Segmental Glomerulosclerosis
Cellular Variant of Focal Segmental Glomerulosclerosis
Collapsing Variant of Focal Segmental Glomerulosclerosis
Tip Variant of Focal Segmental Glomerulosclerosis
Other Variants of Focal Segmental Glomerulosclerosis
Distinguishing Pathologic Features of Secondary Focal Segmental Glomerulosclerosis
Natural History and Prognosis
Treatment
Corticosteroids
Other Immunosuppressive Agents and Corticosteroid Resistant Patients
Other Forms of Therapeutic Interventions
Transplantation
References
Self-assessment Questions
19 Inherited Causes of Nephrotic Syndrome
Clinical Features of Nephrotic Syndrome
Monogenic Causes of Nephrotic Syndrome Elucidate Its Pathogenesis
Genotype Phenotype Correlations
Recessive Versus Dominant Steroid-Resistant Nephrotic Syndrome
Gene-Specific Phenotypes
Allele-Specific Phenotypes
Syndromic Proteinuric Renal Disease
Galloway-Mowat Syndrome
Denys-Drash and Frasier Syndromes
Nail-Patella Syndrome
Pierson Syndrome
Genetic Testing by Whole Exome Sequencing
Specific Therapies for Hereditary Nephrotic Syndrome
Future Directions
References
Self-assessment Questions
20 Membranous Nephropathy
Definition
Etiology and Pathogenesis
Experimental Membranous Nephropathy
Human Membranous Nephropathy
Epidemiology and Genetics
Clinical and Serologic Manifestations
Pathology
Light Microscopy
Immunohistology
Electron Microscopy
Diagnosis and Differential Diagnosis
Clinical Course, Outcomes, and Complications
Predictors of Poor Outcome
Relapse After Complete Remission or Partial Remission
Treatment
Nonimmunosuppressive Therapy
Immunosuppressive Therapy
Corticosteroids
Cytotoxic Agents Combined With Corticosteroids
Calcineurin Inhibitors
Mycophenolate Mofetil
Rituximab
Eculizumab
Adrenocorticotropic Hormone
Treatment Summary
References
21 Membranoproliferative Glomerulonephritis and Cryoglobulinemic Glomerulonephritis
Membranoproliferative Glomerulonephritis
Definition
Epidemiology
Former Classification
Newer Classification Based on Etiology and Pathogenesis
Clinical Presentation and Pathology
Infection-Associated MPGN
Autoimmune-Associated MPGN
Monoclonal Immunoglobulin–Associated MPGN
MPGN With Masked Immune Deposits
Complement-Mediated MPGN
MPGN Without Immunoglobulins or Complement
Uncommon Causes of MPGN
Cryofibrinogen-related membranoproliferative glomerulonephritis.
C4 glomerulopathy.
Collagen type III glomerulopathy.
Evaluation
Infections
Autoimmune Diseases
Monoclonal Gammopathy
Treatment
Transplantation
Cryoglobulinemic Glomerulonephritis
Definition
Clinical Presentation
Evaluation
Treatment
References
Self-assessment Questions
22 Glomerulonephritis Associated With Complement Disorders
C3 Glomerulopathy
Etiology and Pathogenesis
Epidemiology
Clinical Manifestations
Dense Deposit Disease
C3 Glomerulonephritis
Laboratory Findings
Pathology
Differential Diagnosis
Treatment
References
23 Immunoglobulin A Nephropathy and IgA Vasculitis (Henoch-Schönlein Purpura)
IgA Nephropathy
Definition
Etiology and Pathogenesis
IgA Immune System
IgA Glycosylation
Role of Infection
Glomerular Injury After IgA Deposition
Animal Models of IgA Nephropathy
Genetic Basis of IgA Nephropathy
Other Modulators of the Course of IgA Nephropathy
Epidemiology
Clinical Manifestations
IgA Nephropathy
Macroscopic Hematuria
Asymptomatic Hematuria and Proteinuria
Proteinuria and Nephrotic Syndrome
Acute Kidney Injury
Chronic Kidney Disease
Clinical Associations With IgA Nephropathy
Pathology
Immune Deposits
Light Microscopy
Electron Microscopy
Differential Diagnosis
Hematuria
Nephrotic Syndrome
Chronic Kidney Disease: Hypertension, Proteinuria, Renal Impairment
Acute Kidney Injury
Natural History
IgA Nephropathy
Transplantation
Recurrent IgA Nephropathy
Treatment
Slowly Progressive IgA Nephropathy (“Intermediate Prognosis”)
Antihypertensives and proteinuria-lowering drugs.
Fish oil.
Immunosuppressive or Antiinflammatory Regimens
Corticosteroids.
Cyclophosphamide and azathioprine.
Other immunosuppressive approaches.
Dipyridamole and warfarin.
Rapidly Progressive IgA Nephropathy (“Poor Prognosis”)
Other Therapeutic Approaches to Progressive IgA Nephropathy
Reduction of IgA production.
Prevention and removal of IgA deposits.
Transplant recurrence.
IgA Vasculitis
Definition
Epidemiology
Pathogenesis
Genetics
Clinical Manifestations
Pathology
Differential Diagnosis
Natural History
Transplantation
Treatment
Rapidly Progressive Chronic Kidney Disease Caused by Crescentic Nephritis
Active IgA Vasculitis Without Renal Failure
Slowly Progressive Chronic Kidney Disease
Transplant Recurrence
References
Self-assessment Questions
24 Anti–Glomerular Basement Membrane Disease and Goodpasture Disease
Etiology and Pathogenesis
Autoimmunity to a Component of Glomerular Basement Membrane
Predisposing Factors
Precipitating Factors
Mechanisms of Renal Injury
Lung Hemorrhage
Epidemiology
Clinical Manifestations
Lung Hemorrhage
Glomerulonephritis
Pathology
Immunohistology
Pathology in Other Tissues
Differential Diagnosis
Detection of Anti–Glomerular Basement Membrane Antibodies
Patients With Anti-GBM Antibodies and Other Diseases
Antineutrophil Cytoplasmic Antibody and Systemic Small-Vessel Vasculitis
Membranous Nephropathy
Alemtuzumab Treatment
Pulmonary-Renal Syndromes
Natural History
Treatment
Immunosuppressive Regimens
Plasma Exchange and Immunosuppression
Supportive Treatment
Monitoring Effect of Treatment on Disease Activity
Duration of Treatment and Relapses
Electing Not to Treat
Treatment of Double-Positive Patients
Transplantation
Alport Syndrome Post-Transplant Anti–Glomerular Basement Membrane Disease
References
Self-assessment Questions
25 Renal and Systemic Vasculitis
Definition
Small-Vessel Vasculitis
Medium-Vessel Vasculitis
Large-Vessel Vasculitis
Small-Vessel Pauci-Immune Vasculitis
Pathogenesis
Epidemiology
Clinical Manifestations
Antineutrophil Cytoplasmic Autoantibody
Pathology
Differential Diagnosis
Natural History
Treatment
Induction Therapy
Maintenance Therapy
Relapse Therapy
Transplantation
Polyarteritis Nodosa
Pathogenesis
Epidemiology
Clinical Manifestations
Pathology
Differential Diagnosis
Natural History
Treatment
Kawasaki Disease
Definition
Pathogenesis
Epidemiology
Clinical Manifestations
Pathology
Differential Diagnosis
Natural History
Treatment
Takayasu Arteritis and Giant Cell Arteritis
Pathogenesis
Epidemiology
Clinical Manifestations
Pathology
Differential Diagnosis
Treatment
References
Self-Assessment Questions
26 Lupus Nephritis
Definition
Epidemiology
Etiology and Pathogenesis
Genetics and Environment
Autoimmunity in Systemic Lupus Erythematosus
Pathogenesis of Lupus Nephritis
Clinical Manifestations
Extrarenal Manifestations
Diagnosis and Differential Diagnosis
Immunologic Tests in Lupus
Renal Biopsy in Systemic Lupus Erythematosus
Pathology
Tubulointerstitial and Vascular Disease
Transformation of Histologic Appearance and “Silent” Lupus Nephritis
Clinical, Laboratory, and Histopathologic Correlations and Outcomes
Long-Term Prognosis and Kidney Histology
Treatment
Proliferative Lupus Nephritis: Induction
Corticosteroids
Immunosuppressive Agents
Other Immunosuppressive Strategies
Biologic Agents
Resistant Proliferative Lupus Nephritis
Renal Response to Initial Therapy
Proliferative Lupus Nephritis: Maintenance Therapy
Membranous Lupus Nephropathy
Long-Term Monitoring of Lupus Nephritis Patients
Antiphospholipid Antibody Syndrome, Atherosclerosis, and Pregnancy in Lupus Nephritis
End-Stage Renal Disease and Renal Transplantation
References
Self-assessment Questions
27 Renal Amyloidosis and Glomerular Diseases With Monoclonal Immunoglobulin Deposition
Renal Amyloidosis
General Characteristics of Amyloidosis
Definition
Amyloid Precursor–Based Classification
Other Components of All Amyloid Fibrils
General Mechanisms of Fibrillogenesis
Pathology
Immunoglobulin-Associated Amyloidosis (AL Amyloidosis)
Pathogenesis
Epidemiology
Clinical Manifestations
Diagnosis
Treatment and Outcome
Dialysis and Transplantation
Inflammatory (Secondary) Amyloidosis (AA Amyloidosis)
Epidemiology
Clinical Manifestations
Diagnosis
Natural History and Treatment
Familial Mediterranean Fever and Other Hereditary Recurrent Fever Syndromes
Monoclonal Immunoglobulin Deposition Disease
History and Definition
Epidemiology
Pathogenesis
Clinical Manifestations
Renal Manifestations
Extrarenal Manifestations
Pathology
Light Microscopy
Immunohistology
Electron Microscopy
Diagnosis
Treatment and Outcome
Renal Diseases Associated With Monoclonal Immunoglobulin Deposition Disease
Nonamyloid Fibrillary and Immunotactoid Glomerulopathies
Epidemiology
Clinical Manifestations
Pathology
Immunotactoid Glomerulopathy
Fibrillary Glomerulopathy
Diagnosis
Outcome and Treatment
Glomerular Lesions Associated With Waldenström Macroglobulinemia and Other Monoclonal Immunoglobulin M-Secreting B Cell Lymphoproliferative Disorders
Other Types of Glomerulonephritis
References
Self-assessment Questions
28 Rare Glomerular Disorders
Mesangial Proliferative Glomerulonephritis Without IgA Deposits
Immunoglobulin M Nephropathy
C1q Nephropathy
Mesangial Proliferative Glomerulonephritis Associated With Minimal Change Disease
Glomerulonephritis With Rheumatic Disease
Rheumatoid Arthritis
Mixed Connective Tissue Disease
Polymyositis and Dermatomyositis
Acute Rheumatic Fever
Ankylosing Spondylitis and Reiter Syndrome (Seronegative Spondyloarthropathies)
Scleroderma (Systemic Sclerosis)
Relapsing Polychondritis
Antiphospholipid Antibody Syndrome
Other Uncommon Glomerular Disorders
Lipoprotein Glomerulopathy
Lecithin–Cholesterol Acyltransferase Deficiency
Collagen III Glomerulopathy
Fibronectin Glomerulopathy
Nephropathic Cystinosis
Miscellaneous Storage Diseases Rarely Associated With Glomerular Lesions
Idiopathic (Nondiabetic) Nodular Glomerulosclerosis
Macrophage Activation Syndrome
DRESS Syndrome
Kimura Disease
References
Self-assessment Questions
29 Thrombotic Microangiopathies, Including Hemolytic Uremic Syndrome
Definitions
Laboratory Signs
Pathology
Mechanisms, Clinical Features, and Management of Specific Forms of Thrombotic Microangiopathy
Shiga Toxin–Producing Escherichia coli–Associated Hemolytic Uremic Syndrome
Mechanisms
Diagnosis
Clinical Course
Therapy
Hemolytic Uremia Syndrome Associated With Streptococcus pneumoniae
Mechanisms
Clinical Course and Therapy
Atypical Hemolytic Uremic Syndrome
Mechanisms
Complement factor H.
Membrane cofactor protein.
Complement factor I.
Complement factor B and C3.
Thrombomodulin.
Determinants of disease penetrance.
Diacylglycerol kinase ε.
Diagnosis of Atypical Hemolytic Uremia Syndrome and Testing for Genetic Mutations
Clinical Course
Therapy
Fresh frozen plasma.
Kidney transplantation
Complement inhibitors.
Liver-kidney transplant.
Thrombotic Microangiopathy Associated With Cobalamin C Deficiency
Thrombotic Thrombocytopenic Purpura
Mechanisms
TTP associated with Anti-ADAMTS13 antibodies.
TTP associated with genetic deficiency of ADAMTS13.
Clinical Course
Therapy
Other Forms of Thrombotic Microangiopathies Associated With Systemic Diseases or Drugs
Antiphospholipid Syndrome, Scleroderma, and Hypertensive Emergencies
Human Immunodeficiency Virus
Malignancy
Thrombotic Microangiopathy After Bone Marrow Transplantation
Drugs
References
Self-Assessment Questions
V Diabetic Kidney Disease
30 Pathogenesis, Clinical Manifestations, and Natural History of Diabetic Kidney Disease
Definitions
Pathogenesis of Diabetic Kidney Disease
Genetic and Environmental Factors
Hemodynamic Changes
Renal Hypertrophy and Mesangial Matrix Expansion
Inflammation and Diabetic Kidney Disease
Mechanisms Underlying Proteinuria
Tubular Changes
Hyperglycemia and Diabetic Kidney Disease
Role of Glucose Control
Protein kinase C pathway.
Advanced glycation end products pathway.
Polyol pathway.
Hexosamine pathway.
Adenosine monophosphate kinase.
Kallikrein-kinin pathway.
Activation of innate immunity.
Renin-Angiotensin-Aldosterone System and Diabetic Kidney Disease
Uric Acid and Fructose
Epidemiology
Clinical Manifestations and Natural History
Obesity, Metabolic Syndrome, and Renal Disease
Evolution of Diabetic Kidney Disease
Hypertension and Diabetic Kidney Disease
Associated Extrarenal Microvascular and Macrovascular Complications
Survival in Patients With Diabetic Kidney Disease
Renal Pathology
Diagnosis and Differential Diagnosis
Measurement of Albuminuria or Proteinuria
Measurement of Blood Pressure
Measurement of Serum Creatinine and Estimation of Glomerular Filtration Rate
Differential Diagnosis
Indications for Renal Biopsy
Approach to the Diabetic Patient With Impaired Renal Function
References
Self-Assessment Questions
31 Prevention and Treatment of Diabetic Kidney Disease
Glycemic Control
Glycemic Targets
Antihyperglycemic Therapeutic Options in Type 2 Diabetic Kidney Disease
SGLT2 Inhibitors
Analogues of Human Glucagon-Like Peptide-1
Dipeptidyl Peptidase-4 Inhibitors
Blood Pressure Control
Renin-Angiotensin System Blockade in the Prevention of Diabetic Kidney Disease
Renin-Angiotensin System Blockade in the Treatment of Diabetic Kidney Disease
Type 1 Diabetic Patients
Type 2 Diabetic Patients
Aldosterone Blockade in Diabetic Kidney Disease
Combination Therapy With Renin-Angiotensin System Antagonists
Dosing and Adverse Effects Associated With Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
Other Antihypertensive and Antiproteinuric Agents
Diuretics and Low Sodium Intake
Calcium Channel Blockers
β-Blockers
Treatment of Dyslipidemia
Nonpharmacologic Interventions
Emerging Treatments for Diabetic Kidney Disease
Mineralocorticoid Receptor Antagonists
Endothelin Receptor Antagonists
Vitamin D Receptor Activators
Xanthine Oxidase Inhibitors
Phosphodiesterase Inhibitors
Novel Therapeutic Approaches
References
32 Management of the Diabetic Patient With Chronic Kidney Disease
Diagnostic Considerations
General Management Considerations
Monitoring Diabetic Renal Disease (Stage CKD3b-5)
Hemoglobin A1c
Albuminuria
Management of Diabetes in Subjects With Stage 3B-5 CKD
Hypoglycemia and Hyperglycemia
Oral Hypoglycemic Agents
Biguanides
Sulfonylureas
Thiazolidinediones
Meglinitides
Incretin Mimetics: Glucagon-Like Peptide-1 Analogues
Gliptins: Dipeptidyl Peptidase-4 Inhibitors
α-Glucosidase Inhibitors
Amylin Analogues
SGLT-2 Inhibitors
Insulin
Types of insulin.
Future Therapeutics
Management of Hypertension in the Diabetic Subject With Chronic Kidney Disease
Blood Pressure Goals
What Agents Should Be Used?
Renin-Angiotensin-Aldosterone System Blockade
Cardiovascular Complications
Coronary Heart Disease
Peripheral Vascular Disease
Erectile Dysfunction
Antiplatelet Agents
Dyslipidemia
Microvascular Complications of Diabetes
Retinopathy
Neuropathy
Autonomic Neuropathy
Diabetic Foot Disease
Complications From Chronic Kidney Disease
Anemia
Mineral Bone Disease
Diet and Malnutrition
Electrolytes and Fluid Retention
End-Stage Renal Disease
Dialysis
Hemodialysis
Vascular Access
Peritoneal Dialysis
Transplantation
References
Self-assessment Questions
VI Hypertension
33 Normal Blood Pressure Control and the Evaluation of Hypertension
Normal Blood Pressure Control
Definition and Classification of Hypertension
Blood Pressure in Relation to Morbidity and Mortality
Elevation of Blood Pressure by Arbitrary Cut-Off Points
Threshold of Therapeutic Benefit
Operational Definitions
Special Definitions
Prehypertension.
White coat hypertension.
Masked hypertension.
Sustained hypertension.
Pseudohypertension.
Isolated systolic hypertension.
Resistant hypertension.
Hypertensive emergencies and urgencies.
Hypertension in children and adolescents.
Hypertension in pregnancy.
Classification by Cause of Hypertension
Evaluation of Hypertension
Blood Pressure Measurement
Variability of Blood Pressure
Office Versus Home Blood Pressure and Circadian Variation
Home and Ambulatory Blood Pressure Monitoring
Risk Assessment in Hypertension
Consideration of Primary Versus Secondary Hypertension
References
Self-Assessment Questions
34 Primary Hypertension
Definition
Etiology and Pathogenesis
Genetic (Polygene) Hypothesis
Congenital (Low Nephron Number) Hypothesis
The Role of the Immune System and Acquired Renal Injury
What Initiates the Renal Inflammatory Response?
How Does Sodium Retention Lead to Hypertension?
Pathogenic Mechanisms Driving the Current Epidemic of Hypertension
Epidemiology
Clinical Manifestations
Pathology
Diagnosis
Natural History
Kidney Disease
Effect of Antihypertensive Therapy on Natural History of Hypertensive Cardiovascular Disease and Kidney Disease Progression
Can Primary Hypertension Spontaneously Remit?
References
Self-Assessment Questions
35 Nonpharmacologic Prevention and Treatment of Hypertension
Prevention
Weight Loss
Physical Activity
Exercise Training Dose Response
Mechanisms
Antihypertensive Medication and Guidelines for Exercise
Diet
Salt Intake
Potassium Intake
Calcium, Vitamin D, and Dairy Food Intake
Magnesium Intake, Other Micronutrients, and Bioactive Food Components
Dietary Sugars and Fats
Dietary Approaches to Lower Blood Pressure
Smoking
Alcohol
Caffeine
Psychological Stress
Adopting Lifestyle Modifications
References
Self-assessment Questions
36 Pharmacologic Treatment of Hypertension
Defining Who Should Receive Pharmacologic Treatment
Blood Pressure Thresholds for Intervention (Office Blood Pressure)
Clinical Dilemma of End-Organ Damage and “Normal” Blood Pressure
Blood Pressure Thresholds for Intervention (Ambulatory and Home Blood Pressure Monitoring)
Blood Pressure Treatment Goals
Guide to Selection of Antihypertensive Agents
Key Principles From Clinical Trials
Selection of Drug Therapy
Thiazide and Thiazide-Like Diuretics
Potassium-Retaining Diuretics
β-Adrenoceptor Blockers
Calcium Channel Blockers
Blockade of Renin-Angiotensin System
Angiotensin-converting enzyme inhibitors.
Angiotensin receptor blockers.
Direct renin inhibitor.
α-Adrenergic Blockers
Combined α-Adrenergic and β-Adrenergic Blocker
Centrally Acting Sympatholytic Drugs
Direct Vasodilators
Treatment Strategies
Initial Drug Therapy
Choice of initial therapy.
Combination Therapy
Initial therapy with a two-drug combination.
Combining Renin-Angiotensin System Blockade
Resistant Hypertension
Medication to Reduce Cardiovascular Risk
Follow-Up
Withdrawal of Therapy
Indications for Specialist Referral
Hypertension in People of Black African Origin
Hypertension in Older People
References
Self-assessment Questions
37 Evaluation and Treatment of Hypertensive Emergencies and Urgencies
Etiology and Pathogenesis
Epidemiology
Diagnostic Evaluation
Treatment
General Principles for Managing Hypertensive Emergencies
Specific Aspects of Antihypertensive Drug Use for Hypertensive Emergencies
Treatment of Hypertensive Urgencies
References
Self-assessment Questions
38 Endocrine Causes of Hypertension
Etiology and Pathogenesis
Pathogenesis of Aldosterone-Dependent Hypertension
Other Hormones That Can Cause Hypertension Through Mineralocorticoid Receptor Activation
Types of Primary Aldosteronism
Familial Forms of Primary Aldosteronism
Familial Hypertension Type I
Familial Hyperaldosteronism Type II
Familial Hyperaldosteronism Type III
Familial Hyperaldosteronism Type IV
Sporadic Forms
Epidemiology
Clinical Manifestations
Diagnosis and Differential Diagnosis
Who to Screen for Primary Aldosteronism
Evaluation of Suspected Primary Aldosteronism
Use of the Aldosterone-Renin Ratio (ARR)
Effect of Drugs on Screening for Primary Aldosteronism
When to Withold Drugs That Affect the Renin-Angiotensin-Aldosterone System Before Screening
Confirmatory Testing
Differentiation of Etiology
Selection of Patients for Further Testing
Imaging Approaches
Adrenal Vein Sampling
Other Testing Options
Natural History
Treatment
Adrenalectomy
Mineralocorticoid Receptor Antagonists
Non–Mineralocorticoid Receptor Blocker Therapy
References
Self-Assessment Questions
39 Other Endocrine Causes of Hypertension
Cushing Syndrome
Definition
Etiology, Pathogenesis, and Epidemiology
Clinical Manifestations
Differential Diagnosis
Diagnosis
Treatment and Prognosis
Pheochromocytoma
Definition
Etiology, Pathogenesis, and Epidemiology
Clinical Manifestations
Diagnosis
Treatment
Adrenal Incidentaloma
Definition and Epidemiology
Management
Renin-Secreting Tumor
Definition
Etiology and Pathogenesis
Clinical Manifestations
Pathology
Diagnosis and Differential Diagnosis
Treatment
Acromegaly
Definition and Epidemiology
Clinical Manifestations
Diagnosis
Treatment
Management of Hypertension in Acromegaly
Hypothyroidism
Definition and Epidemiology
Clinical Features
Diagnosis
Hyperthyroidism
Definition and Epidemiology
Clinical Features
Diagnosis and Treatment
Primary Hyperparathyroidism
References
Self-assessment Questions
40 Neurogenic Hypertension, Including Hypertension Associated With Stroke or Spinal Cord Injury
Physiology and Pathophysiology
Neural Control of Blood Pressure
Cerebrovascular Autoregulation
Specific Syndromes
Hypertension After Stroke
Epidemiology
Pathophysiology
Diagnosis and Treatment
Acute ischemic stroke.
Intracerebral hemorrhage.
Subarachnoid hemorrhage.
Hypertension After Carotid Endarterectomy and Endovascular Procedures
Definition, Incidence, and Clinical Features
Pathophysiology
Diagnosis and Treatment
Hypertension After Spinal Cord Injury
Definition and Epidemiology
Pathophysiology and Diagnosis
Treatment
Cerebrovascular Effects of Antihypertensive Agents
References
Self-Assessment Questions
VII Renovascular Disease
41 Renovascular Hypertension and Ischemic Nephropathy
Normal Renovascular Anatomy
Clinical Syndromes Associated With Renal Vascular Disease
Renovascular Hypertension
Renal Artery Stenosis
Fibromuscular Dysplasia
Atherosclerotic Renal Artery Stenosis
Takayasu Arteritis
Coarctation and Middle Aortic Syndrome
Renal Artery Aneurysms
Ischemic Renal Disease
Heart Failure and Unstable Cardiac Conditions
Imaging Renovascular Hypertension and Renal Artery Stenosis
Treatment of Atherosclerotic Renal Artery Stenosis and Fibromuscular Dysplasia
Indications to Consider Renal Revascularization in Atherosclerotic Renal Artery Stenosis
Surgical Renal Revascularization
Transplant Renal Artery Stenosis
Renal Infarction
Treatment of Acute Renal Infarction
Atheroembolic Renal Disease
Clinical Presentation
Diagnosis
Differential Diagnosis
Pathology and Pathophysiology
Natural History
Treatment
Renal Vein Thrombosis
Acute Versus Chronic Renal Vein Thrombosis
Clinical Presentation
Etiology
Diagnosis
Treatment
References
Self-assessment Questions
VIII Pregnancy and Renal Disease
42 Renal Physiology and Complications in Normal Pregnancy
Renal Physiology in Normal Pregnancy
Anatomy
Hemodynamic Changes
Systemic
Renal
Mechanisms of Increased Glomerular Filtration Rate
Measuring Glomerular Filtration Rate
Renin-Angiotensin-Aldosterone System
Renal Tubular Changes
Sodium Handling and Osmoregulation
Potassium
Calcium
Uric Acid
Acid-Base
Urine Protein
Glucose
Renal Complications in Normal Pregnancy
Urinalysis and Microscopy
Hematuria
Definition and Epidemiology
Etiology and Outcome
Differential Diagnosis
Treatment
Proteinuria
Definition
Differential Diagnosis
Natural History
Treatment
Pyuria
Urinary Tract Infection
Definitions
Epidemiology
Pathogenesis
Clinical Manifestations
Asymptomatic Bacteriuria
Pyelonephritis
Treatment
Asymptomatic Bacteriuria
Cystitis
Pyelonephritis
Renal Calculi
Epidemiology
Pathogenesis
Clinical Manifestations
Treatment
Hypertension in Pregnancy
Definitions
Epidemiology
Preeclampsia
Epidemiology
Pathogenesis
Renal Abnormalities in Preeclampsia
Proteinuria
Decreased Glomerular Filtration Rate
Acute Tubular Necrosis
Sodium Retention
Renin-Angiotensin-Aldosterone System
Increased Uric Acid Reabsorption
Clinical Manifestations
Eclampsia
HELLP Syndrome
Natural History
Prediction and Prevention
Treatment
General Management
Blood Pressure Management
Postpartum Management
Acute Fatty Liver of Pregnancy
Pathogenesis and Pathology
Clinical Manifestations
Differential Diagnosis
Treatment and Outcome
Thrombotic Microangiopathy
Clinical Manifestations and Differential Diagnosis
Natural History
Treatment
Acute Kidney Injury
Definition
Epidemiology
Etiology and Pathogenesis
Antepartum Hemorrhage, Prolonged Intrauterine Fetal Death, or Amniotic Fluid Embolism
Sepsis
Preeclampsia, Acute Fatty Liver of Pregnancy, and Thrombotic Microangiography
Clinical Manifestations and Differential Diagnosis
Preeclampsia
Obstructive Uropathy
Natural History
Treatment
Dialysis
Ovarian Hyperstimulation Syndrome
Definition and Epidemiology
Pathogenesis
Clinical Manifestations and Investigations
Management
References
Self-assessment Questions
43 Pregnancy With Preexisting Kidney Disease
The Adverse Effects of Chronic Kidney Disease on Pregnancy
Severity of Hypertension
Proteinuria
Management Common to All Pregnancy With Preexisting Kidney Disease
Prepregnancy Counseling
Fertility Assessment
Volume Homeostasis
Urinalysis: Proteinuria
Hypertension
Renal Biopsy in Pregnancy
Superimposed Preeclampsia
Assessment of Fetal Well-Being
Timing of Delivery
Course of Chronic Kidney Disease During and After Pregnancy
Management of Specific Renal Disorders During Pregnancy
IgA Nephropathy
Diabetic Nephropathy
Lupus Nephritis
Reflux Nephropathy
Inherited Renal Disorders
Dialysis in Pregnancy
Initiating Dialysis for Progressive Chronic Kidney Disease
Dialysis Regimens in Pregnancy
Peritoneal Dialysis and Pregnancy
Renal Transplantation and Pregnancy
Timing of Pregnancy
Immunosuppression in Pregnancy
Pregnancy Outcomes
Infection in Pregnant Transplant Recipients
Male Transplant Recipients
Pregnancy in the Kidney Donor
Summary
References
Self-Assessment Questions
IX Hereditary and Congenital Diseases of the Kidney
44 Autosomal Dominant Polycystic Kidney Disease
Definition
Etiology and Pathogenesis
Genetic Mechanisms
Polycystic Kidney Disease Proteins
Mechanisms of Cyst Formation
Liver Cyst Development
Hypertension
Epidemiology
Phenotypic Variability
Diagnosis
Renal Ultrasound
Genetic Testing
Differential Diagnosis
Clinical Manifestations
Renal Manifestations
Renal Size
Pain
Hematuria and Cyst Hemorrhage
Urinary Tract Infection and Cyst Infection
Nephrolithiasis
Hypertension
End-Stage Renal Disease
Extrarenal Manifestations
Polycystic Liver Disease
Intracranial Aneurysms
Other Vascular Abnormalities
Valvular Heart Disease and Other Cardiac Manifestations
Other Associated Conditions
Pathology
Treatment
Flank Pain
Cyst Hemorrhage
Urinary Tract and Cyst Infection
Nephrolithiasis
Hypertension
Progressive Renal Failure
Polycystic Liver Disease
Intracranial Aneurysm
Novel Therapies
Vasopressin Antagonists
Somatostatin Analogues
Mammalian Target of Rapamycin (mTOR) Inhibitors
Other Investigational Therapies
Transplantation
References
Self-assessment Questions
45 Other Cystic Kidney Diseases
Autosomal Recessive Polycystic Kidney Disease
Definition
Etiology and Pathogenesis
Genetic Basis
Pathogenesis
Epidemiology
Clinical Manifestations
Pathology
Kidney
Liver
Diagnosis
Imaging
Genetic Testing
Treatment
Transplantation
Nephronophthisis: Autosomal Dominant Tubulointerstitial Kidney Disease
Definitions
Nephronophthisis
Genetic Basis
Clinical Manifestations
Renal Disease.
Associated Extrarenal Abnormalities.
Pathology
Diagnosis
Treatment
Autosomal Dominant Tubulointerstitial Kidney Disease
Medullary Sponge Kidney
Definition
Etiology and Pathogenesis
Epidemiology
Clinical Manifestations
Pathology
Diagnosis
Treatment
Tuberous Sclerosis Complex
Definition
Etiology and Pathogenesis
Epidemiology
Clinicopathologic Manifestations
Renal Angiomyolipomas
Renal Cystic Disease
Renal Neoplasms
Diagnosis
Treatment
Renal Angiomyolipomas
Renal Cystic Disease
Renal Carcinoma
Renal Replacement Therapy
Von Hippel–Lindau Disease
Definition
Etiology and Pathogenesis
Clinical Manifestations
Pathology
Diagnosis
Differential Diagnosis
Treatment
Simple Cysts
Introduction and Definition
Etiology and Pathogenesis
Clinical Manifestations
Pathology
Diagnosis
Treatment
Solitary Multilocular Cysts
Renal Lymphangiomatosis
Glomerulocystic Kidney Disease
Acquired Cystic Disease
Hypokalemic Cystic Disease
Hilar Cysts
Perinephric Pseudocysts
Acquired Cystic Disease in Renal Failure
References
Self-assessment Questions
46 Alport Syndrome and Other Familial Glomerular Syndromes
Alport Syndrome
Definition
Etiology and Pathogenesis
Type IV Collagen
Genetics
X-Linked Alport syndrome.
Autosomal recessive Alport syndrome.
Autosomal dominant Alport syndrome.
Type IV Collagen in Alport Basement Membranes
Clinical Manifestations
Renal Defects
Cochlear Defects
Ocular Defects
Leiomyomatosis
Hematologic Defects
Arterial Abnormalities
Renal Pathology
Diagnosis and Differential Diagnosis
Natural History
Treatment
Transplantation
Hereditary Angiopathy with Nephropathy, Aneurysms, and Cramps (HANAC Syndrome)
Thin Basement Membrane Nephropathy
Definition
Etiology and Pathogenesis
Clinical Manifestations
Pathology
Diagnosis and Differential Diagnosis
Treatment
Fabry Disease (Anderson-Fabry Disease)
Definition
Etiology and Pathogenesis
Clinical Manifestations and Pathology
Renal Defects
Heart Defects
Nervous System
Skin
Eyes
Lungs
Diagnosis
Treatment
Fabry Disease in Childhood
Nail-Patella Syndrome
Definition
Etiology and Pathogenesis
Clinical Manifestations
Renal Defects
Skeletal Defects
Nails
Renal Pathology
Treatment
References
Self-assessment Questions
47 Inherited Disorders of Sodium and Water Handling
Physiology of Sodium and Water Reabsorption
Sodium Transporters and the Corresponding Inherited Disorders
Water Reabsorption
Disorders of Sodium Handling
Conditions With Hypokalemia, Metabolic Alkalosis, and Low-Normal Blood Pressure
Bartter Syndrome
Pathogenesis
Clinical Manifestations
Diagnosis and Differential Diagnosis
Treatment
Outcome
Gitelman Syndrome
Pathogenesis
Clinical Manifestations and Diagnosis
Treatment
EAST Syndrome
Conditions With Hypokalemia, Metabolic Alkalosis, and Hypertension
Liddle Syndrome
Pathogenesis
Clinical Manifestations and Diagnosis
Treatment
Apparent Mineralocorticoid Excess
Pathogenesis
Clinical Manifestations and Diagnosis
Treatment
Glucocorticoid-Remediable Aldosteronism
Pathogenesis
Diagnosis
Treatment
Adrenal Enzymatic Disorders
Conditions With Hyponatremia, Hyperkalemia, Metabolic Acidosis, and Normal/Low Blood Pressure
Pseudohypoaldosteronism
Diagnosis
Clinical Features
Treatment
Aldosterone Biosynthetic Defects
A Condition With Hyperkalemia, Metabolic Acidosis, and Hypertension
Pseudohypoaldosteronism Type 2 (Gordon Syndrome)
Pathogenesis
Clinical Manifestations and Diagnosis
Treatment
Inherited Disorders of Water Handling
Congenital Nephrogenic Diabetes Insipidus
Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
Nephrogenic Syndrome of Inappropriate Antidiuresis
Pathogenesis
Clinical Features, Diagnosis, and Treatment
References
Self-Assessment Questions
48 Fanconi Syndrome and Other Proximal Tubule Disorders
Fanconi Syndrome
Definition
Etiology and Pathogenesis
Clinical Manifestations
Aminoaciduria
Glycosuria
Hypophosphatemia
Natriuresis and Kaliuresis
Hyperchloremic Metabolic Acidosis
Polyuria and Polydipsia
Growth Retardation
Hypouricemia
Proteinuria
Treatment of Fanconi Syndrome
Inherited Causes of Fanconi Syndrome
Cystinosis
Definition
Etiology and Pathogenesis
Clinical Manifestations
Renal Pathology
Treatment
Galactosemia
Etiology and Pathogenesis
Clinical Manifestations
Treatment
Hereditary Fructose Intolerance
Etiology and Pathogenesis
Clinical Manifestations
Diagnosis
Treatment
Glycogenosis
Tyrosinemia
Definition
Etiology and Pathogenesis
Clinical Manifestations
Diagnosis
Treatment
Wilson Disease
Definition
Etiology and Pathogenesis
Clinical Manifestations
Renal Pathology
Diagnosis
Treatment
Lowe Syndrome
Dent Disease
Definition
Etiology and Pathogenesis
Mitochondrial Cytopathies
Definition
Clinical Manifestations
Diagnosis
Treatment
Idiopathic Fanconi Syndrome
Acquired Causes of Fanconi Syndrome
Heavy Metal Intoxication
Tetracycline
Cancer Chemotherapy Agents
Other Drugs and Toxins
Dysproteinemias
Glomerular Disease
After Acute Kidney Injury
After Renal Transplantation
Familial Glucose-Galactose Malabsorption and Hereditary Renal Glycosuria
Definition
Etiology and Pathogenesis
Natural History
Aminoacidurias
Cystinuria
Definition
Etiology and Pathogenesis
Clinical Manifestations
Diagnosis
Treatment
Hereditary Defects in Uric Acid Handling
Hereditary Renal Hypouricemia
Familial Juvenile Hyperuricemic Nephropathy, Medullary Cystic Kidney Disease Type 2, and Uromodulin Mutations
References
Self-Assessment Questions
49 Sickle Cell Diseases and the Kidney
Sickle Cell Disease
Epidemiology
Genetics
Pathophysiology
Natural History and Clinical Manifestations
Sickle Cell Nephropathy
Genetic Modifiers of Risk for Developing Sickle Cell Nephropathy
Pathophysiology of Sickle Cell Nephropathy
Clinical Manifestations of Sickle Cell Nephropathy
Glomerular Abnormalities
Hyperfiltration
Microalbuminuria and Proteinuria
Tubular Abnormalities
Hyposthenuria
Increased Proximal Tubular Function
Acidification Defect
Hematuria, Papillary Necrosis, and Renal Medullary Carcinoma
Urinary Tract Infections
Clinical Syndromes of Renal Impairment
Acute Kidney Injury
Progressive Chronic Kidney Disease
Investigation and Management of Sickle Cell Nephropathy
Inhibition of the Renin-Angiotensin System
Hydroxycarbamide and Blood Transfusion
Erythropoiesis-Stimulating Agents
Hemopoietic Stem Cell Transplantation
Renal Replacement Therapy
Dialysis
Transplantation
Sickle Cell Trait and Chronic Kidney Disease
References
Self-Assessment Questions
50 Congenital Anomalies of the Kidney and Urinary Tract
Clinical Principles
Development of the Kidney and Urinary Tract
Pathogenesis
Epidemiology
Renal Malformations
Large Kidneys
Irregular Kidneys
Renal Dysplasia
Renal Hypoplasia (Oligomeganephronia)
Differential Diagnosis of Scarred Kidneys
Renal hypodysplasia versus reflux.
Renal scarring in adults.
Absent Kidneys
Unilateral Renal Agenesis
Bilateral Renal Agenesis
Misplaced Kidneys
Renal Ectopia, Malrotation, and Crossed Fused Kidneys
Horseshoe Kidney
Calyceal Abnormalities
Hydrocalyx and Hydrocalycosis
Megacalycosis
Calyceal Diverticulum (Calyceal Cyst)
Bardet-Biedl Syndrome
Pelviureteral Junction Obstruction
Gonadal Dysgenesis
Ureteral Abnormalities
Duplex Ureters
Pathogenesis
Clinical Manifestations
Ectopic Ureters
Ureterocele
Megaureter
Pathogenesis
Clinical Manifestations
Treatment
Bladder and Outflow Disorders
Prune-Belly Syndrome
Pathogenesis
Clinical Manifestations
Differential Diagnosis
Natural History
Treatment
Bladder Exstrophy (Ectopia Vesicae)
Pathogenesis
Clinical Manifestations
Natural History
Treatment
Neuropathic Bladder
Contractile Behavior
Intermediate Behavior
Acontractile Behavior
Myelodysplasia
Pathogenesis
Clinical Manifestations
Bladder dysfunction.
Bowel dysfunction.
Cognitive impairment.
Natural History
Treatment
Bladder Neck Obstruction
Posterior Urethral Valves
Pathogenesis
Clinical Manifestations
Natural History
Treatment
Urethral Diverticulum
Other Congenital Causes of Bladder Outflow Obstruction
Urofacial Syndrome
General Management of Congenital Renal Tract Abnormalities
Clinical Evaluation
Exclude Obstruction
Urodynamics
Surgical Correction of the Urinary Tract
Complications
Urinary Tract Infections
Glomerular Hyperfiltration
Proteinuria and Progressive Renal Failure
Hypertension
Stones
Tubular Dysfunction
Polyuria
Salt Depletion
Acidosis
Bone Disease
Urinary Diversions
Ureterosigmoidostomy
Ileal Conduits
Enterocystoplasty and Intestinal Urinary Reservoirs
End-Stage Renal Disease and Transplantation
Pretransplantation Assessment
Transplant Outcome
Management
Complications
References
Self-assessment Questions
X Infectious Diseases and the Kidney
51 Urinary Tract Infections in Adults
Definition
Epidemiology
Pathogenesis
Uncomplicated Infection
Complicated Infection
Etiologic Agents
Clinical Syndromes
Acute Uncomplicated Cystitis in Young Women
Recurrent Acute Uncomplicated Cystitis in Women
Acute Uncomplicated Pyelonephritis in Women
Complicated Infections
Chronic Kidney Disease.
Catheter-Associated Infections.
Spinal Cord Injury.
Prostatitis.
Renal Abscess.
Papillary Necrosis.
Emphysematous Pyelonephritis.
Renal Malacoplakia.
Xanthogranulomatous Pyelonephritis.
Asymptomatic Bacteriuria
Imaging of the Urinary Tract
References
Self-assessment Questions
52 Tuberculosis of the Urinary Tract
Definition
Etiology
Pathogenesis
Clinical Manifestations
Asymptomatic Presentations
Lower Urinary Tract Symptoms
Proteinuria and Nephrotic Syndrome
Low Glomerular Filtration Rate
Pain
Stone Formation
Genital Involvement
Other Manifestations
Pathology
Diagnosis and Differential Diagnosis
Differential Diagnosis
Natural History
Treatment
Surgical Treatment
Treatment Regimens in Special Situations
Women During Pregnancy and Lactation
Patients With Liver Disease
Patients With Chronic Kidney Disease
Renal Allograft Recipients
Acquired Immunodeficiency Syndrome
Patients Who Fail Treatment
Patient Monitoring
References
Self-Assessment Questions
53 Fungal Infections of the Urinary Tract
Candida
Epidemiology
Pathogenesis
Microbiology
Clinical Manifestations
Diagnosis
Treatment With Systemic Antifungal Agents
Local Antifungal Administration
Localized Candida Infections
Other Yeasts
Aspergillus and Other Molds
Endemic Fungi
References
Self-assessment Questions
54 The Kidney in Schistosomiasis
Pathogenesis
Clinical Manifestations
Lower Urinary Tract Schistosomiasis
Bladder Cancer
Upstream Consequences
Interstitial Nephritis
Glomerulonephritis
Coinfection
Human Immunodeficiency Virus
Hepatitis B Virus
Diagnosis
Schistosoma haematobium Urinary Tract Disease
Schistosoma mansoni Glomerulonephritis
Treatment
Schistosoma haematobium Urinary Tract Disease
Schistosoma mansoni Glomerulonephritis
References
Self-Assessment Questions
55 Glomerular Diseases Associated With Infection
Bacterial Infections
Poststreptococcal Glomerulonephritis
Etiology and Pathogenesis
Epidemiology
Clinical Manifestations
Pathology
Differential Diagnosis
Natural History
Treatment
IgA–Dominant Infection-Related Glomerulonephritis
Etiology and Pathogenesis
Epidemiology
Clinical Manifestations and Pathology
Differential Diagnosis, Natural History, and Treatment
Endocarditis-Associated Glomerulonephritis
Etiology and Pathogenesis
Epidemiology
Clinical Manifestations
Pathology
Differential Diagnosis, Natural History, and Treatment
Shunt Nephritis
Etiology, Pathogenesis, and Epidemiology
Clinical Manifestations and Pathology
Natural History and Treatment
Glomerulonephritis Associated With Other Bacterial Infections
Viral Infections
Hepatitis A–Associated Glomerulonephritis
Hepatitis B–Associated Glomerular Lesions
Etiology and Pathogenesis
Epidemiology
Clinical Manifestations and Pathology
Hepatitis B Virus–Associated Membranous Nephropathy
Hepatitis B Virus–Associated Membranoproliferative Glomerulonephritis
Other Hepatitis B Virus–Associated Glomerular Lesions
Polyarteritis Nodosa
Treatment
Hepatitis C–Associated Glomerular Lesions
Etiology, Pathogenesis, and Epidemiology
Clinical Manifestations and Pathology
Hepatitis C Virus–Associated Membranoproliferative Glomerulonephritis
Hepatitis C Virus–Associated Membranous Nephropathy
Polyarteritis Nodosa
Other Hepatitis C Virus–Associated Glomerular Lesions
Natural History and Treatment
Human Immunodeficiency Virus–Associated Renal Disease
Other Virus-Associated Renal Disease
Parasitic Infections
Malaria
Etiology and Pathogenesis
Epidemiology, Clinical Manifestations, and Pathology
Filariasis
Leishmaniasis
Schistosomiasis
References
Self-assessment Questions
56 Human Immunodeficiency Virus Infection and the Kidney
Epidemiology of Human Immunodeficiency Virus Chronic Kidney Disease
Developed World
The Developing World
Glomerular Disorders
Human Immunodeficiency Virus–Associated Nephropathy
Etiology and Pathogenesis
Clinical Manifestations
Pathology
Diagnosis and Differential Diagnosis
Treatment
Natural History
Human Immunodeficiency Virus Immune Complex Kidney Disease
Other Glomerular Disorders
Systemic Inflammation and Arterionephrosclerosis
Tubular Disorders
Current Antiretroviral Drug Regimens and Renal Toxicity
Tenofovir Disoproxil Fumarate and Tenofovir Alafenamide
Antiretroviral Therapy Dosing in Chronic Kidney Disease
End-Stage Renal Disease
Hemodialysis
Peritoneal Dialysis
Kidney Transplantation
Evaluation for Kidney Disease
Acknowledgment
References
Self-assessment Questions
XI Urologic Disorders
57 Nephrolithiasis and Nephrocalcinosis
Nephrolithiasis
Epidemiology
Pathogenesis
Clinical Manifestations
Pain
Hematuria
Loin Pain–Hematuria Syndrome
Asymptomatic Stone Disease
Clinical Evaluation of Stone Formers
Basic Evaluation
History.
Physical examination.
Laboratory findings.
Stone analysis.
Imaging.
Complete Evaluation
General Treatment
Medical Management
Fluid intake.
Salt intake.
Dietary protein.
Dietary calcium.
Vitamin D.
Specific Types of Stones
Calcium Stones
Hypercalciuria
Etiology.
Treatment.
Dietary recommendations.
Hyperoxaluria
Etiology.
Treatment of dietary and enteric hyperoxaluria.
Treatment of primary hyperoxaluria.
Hypocitraturia
Distal Renal Tubular Acidosis
Hyperuricosuria
Uric Acid Stones
Epidemiology
Etiology and Pathogenesis
Treatment
Struvite Stones
Etiology and Pathogenesis
Treatment
Cystine Stones
Stones Associated With Melamine Exposure
Nephrocalcinosis
Etiology and Pathogenesis
Medullary Nephrocalcinosis
Cortical Nephrocalcinosis
Clinical Manifestations
Treatment
References
Self-assessment Questions
58 Urinary Tract Obstruction
Definitions
Etiology and Pathogenesis
Congenital Urinary Tract Obstruction
Acquired Urinary Tract Obstruction
Intrinsic Obstruction
Intraluminal obstruction.
Intramural obstruction.
Extrinsic Obstruction
Pathophysiology
Changes in Glomerular Function
Changes in Tubular Function
Histopathologic Changes
Epidemiology
Clinical Manifestations
Pain
Lower Urinary Tract Symptoms
Urinary Tract Infections
Hematuria
Changes in Urine Output
Abnormal Physical Findings
Abnormal Laboratory Findings
Obstruction in Neonates or Infants
Diagnosis
Imaging
Ultrasound
Plain Abdominal Radiography
Intravenous Urography
Computed Tomography
Magnetic Resonance Urography
Retrograde Pyelography
Diuresis Renography
Pressure Flow Studies
Other Evaluations
Differential Diagnosis
Natural History
Treatment
General Considerations
Specific Therapies
Management of Postobstructive Diuresis
Future Prospects
References
Self-assessment Questions
59 Urologic Issues for the Nephrologist
Advances in Management of Kidney Stones
Improvements in Imaging
Conservative (Nonsurgical) Management
Acute Surgical Intervention
Elective Surgical Intervention
Extracorporeal Shock Wave Lithotripsy
Percutaneous Nephrolithotomy
Open Stone Surgery
Ureteroscopy
Management of Staghorn Calculus
Stones in Transplanted Kidneys
Urinary Tract Obstruction
General Aspect
Acute Management
Specific Types of Obstruction
Pelviureteral Junction Obstruction
Retroperitoneal Fibrosis
Malignant Obstruction
Benign Ureteral Strictures
Bladder Outflow Obstruction
Neurologic Diseases of the Lower Urinary Tract
Investigation of Hematuria
Evaluation of Visible Hematuria
Evaluation of Microhematuria
Cyclophosphamide
Investigation and Management of a Renal Mass
Adjunctive Therapy for Renal Cancer
Natural History of Renal Impairment After Surgical Treatment of Renal Cancer
Renal Cell Carcinoma in von Hippel–Lindau Disease
References
Self-Assessment Questions
XII Tubulointerstitial and Vascular Diseases
60 Acute Interstitial Nephritis
Definition
Pathogenesis
Epidemiology
Drug-Induced Acute Interstitial Nephritis
Clinical Manifestations
Renal Manifestations
Extrarenal Manifestations
Specific Drug Associations
Pathology
Diagnosis
Identification of the Causative Drug
Natural History
Treatment
Acute Interstitial Nephritis Secondary to Infectious Diseases
Acute Interstitial Nephritis Associated With Systemic Diseases
Sarcoidosis
Sjögren Syndrome
Systemic Lupus Erythematosus
Immunoglobulin G4–Related Disease
Other Systemic Diseases
Acute Interstitial Nephritis Associated With Malignant Neoplasms
Idiopathic Acute Interstitial Nephritis
Acute Interstitial Nephritis in Renal Transplants
Self-assessment Questions
References
61 Primary Vesicoureteral Reflux and Reflux Nephropathy
Definition
Classification
Epidemiology
Etiology and Pathogenesis
Reflux Nephropathy
Pathology
Clinical Manifestations
Presentation of Vesicoureteral Reflux
Reflux Identified Secondary to Antenatal Hydronephrosis
Reflux Identified After a Urinary Tract Infection
Vesicoureteral Reflux in a Sibling
Presentation of Vesicoureteral Reflux in Women During Pregnancy
Other Presentations
Reflux Nephropathy
Hypertension
Proteinuria
End-Stage Renal Disease
Diagnosis of Vesicoureteral Reflux and Reflux Nephropathy
Renal Ultrasound
Voiding Cystourethrography
DMSA Renal Scintigraphy
Magnetic Resonance Imaging
Proteinuria as a Marker for Reflux Nephropathy
Natural History of Vesicoureteral Reflux and Reflux Nephropathy
Treatment
Medical Management
Antibiotic Prophylaxis Versus Surveillance Only
Hypertension and Proteinuria
Surgical Management
References
Self-assessment Questions
62 Chronic Interstitial Nephritis
Definition
Pathogenesis
Epidemiology
Pathology
Clinical Manifestations
Treatment
Drug-Induced Chronic Interstitial Nephritis
Lithium Nephropathy
Definition and Epidemiology
Pathogenesis
Pathology
Clinical Manifestations
Lithium-associated diabetes insipidus.
Chronic lithium nephropathy.
Treatment
Analgesic Nephropathy
Definition and Epidemiology
Pathogenesis and Pathology
Clinical Manifestations
Diagnosis
Treatment
Chronic Interstitial Nephritis Caused by Metabolic Disorders
Chronic Uric Acid Nephropathy
Definition and Epidemiology
Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Treatment
Hypokalemic Nephropathy
Definition and Epidemiology
Pathology
Clinical Manifestations
Diagnosis
Treatment
Hypercalcemic Nephropathy
Definition and Epidemiology
Pathology
Clinical Manifestations
Chronic Interstitial Nephritis Caused by Hereditary Diseases of the Kidney
Chronic Interstitial Nephritis Associated With Heavy Metal Exposure
Lead Nephropathy
Definition and Epidemiology
Pathology
Clinical Manifestations
Diagnosis
Treatment
Other Heavy Metal–induced Nephropathies
Radiation Nephritis
Definition and Epidemiology
Pathology
Clinical Manifestations
Treatment
Interstitial Nephritis Mediated by Immunologic Mechanisms
Sjögren Syndrome
Definition and Epidemiology
Pathology
Clinical Manifestations
Treatment
Sarcoidosis
Definition and Epidemiology
Pathogenesis and Pathology
Clinical Manifestations
Treatment
Systemic Lupus Erythematosus
Definition and Epidemiology
Clinical Manifestations
Treatment
Inflammatory Bowel Disease
IgG4-Related Kidney Disease
Definition and Epidemiology
Pathogenesis
Pathology
Clinical Manifestations
Treatment
Other Forms of Immune-Mediated Interstitial Nephritis
Obstructive Uropathy
Vascular Diseases
Infection-Associated Chronic Interstitial Nephritis
References
Self-assessment Questions
63 Endemic Nephropathies
Mesoamerican Nephropathy
Definition and Epidemiology
Pathogenesis
Pathology
Clinical Manifestations
Diagnosis, Treatment, and Prognosis
Sri Lankan Nephropathy
Other Endemic Nephropathies
Potential Role of Climate Change and Global Warming
References
Self-assessment Questions
64 Myeloma and the Kidney
Etiology and Pathogenesis of Myeloma
Etiology and Pathogenesis of Renal Disease in Myeloma
Epidemiology
Clinical Presentation
Pathology
Diagnosis and Differential Diagnosis
Natural History
Treatment
Chemotherapy
Adjunctive Therapies
Dialysis and Transplantation
References
Self-assessment Questions
XIII Renal Disease and Cancer
65 Onconephrology
Cancer and Kidney Disease
Acute Kidney Injury
Prerenal Acute Kidney Injury
Intrarenal Acute Kidney Injury
Postrenal Acute Kidney Injury
Chronic Kidney Disease
Mortality in Cancer Patients With Kidney Disease
Important Malignancies Associated With Kidney Disease
Multiple Myeloma and Amyloidosis
Leukemia and Lymphoma
Anticancer Drugs and Kidney Disease
Chemotherapeutic Agents
Immunotherapies
Immune Checkpoint Inhibitors
Interferon Therapy
Targeted Therapies
Antiangiogenesis Therapy
B-RAF Inhibitors
Anaplastic Lymphoma Kinase Inhibitors
Metabolic Complications
Tumor Lysis Syndrome
Common Electrolyte Disorders
Cancer-Related Glomerulonephritis
Hematopoietic Stem Cell Transplantation
Cancer Therapy in Chronic Kidney Disease and End-Stage Renal Disease
References
Self-assessment Questions
XIV Acute Kidney Injury
66 Pathophysiology and Etiology of Acute Kidney Injury
Definition
Etiology Overview
Pathophysiology and Etiology of Prerenal Acute Kidney Injury
Pathophysiology and Etiology of Postrenal Acute Kidney Injury
Pathophysiology of Acute Tubular Necrosis
Histology
Site of Tubular Injury in Acute Tubular Necrosis
Hemodynamic Factors in the Development of Acute Tubular Necrosis
Impaired Renal Autoregulation
Intrarenal Vasoconstriction
Tubuloglomerular Feedback
Endothelial Cell Injury and the Development of Acute Tubular Necrosis
Tubular Epithelial Cell Injury and the Development of Acute Tubular Necrosis
Inflammatory Factors in the Development of Acute Tubular Necrosis
Recovery Phase
Nephrotoxic Agents and Mechanisms of Toxicity
Nonsteroidal Antiinflammatory Drugs
Acetaminophen (Paracetamol)
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
Aminoglycosides
Vancomycin
Amphotericin B
Antiviral Therapy
Acyclovir
Tenofovir
Atazanivir
Other Antiviral Agents
Hypoglycemic Therapy: SGLT2 Inhibitors
Immunosuppressive Agents
Calcineurin Inhibitors
Other Immunosuppressive Agents
Ethylene Glycol
Anticoagulation-Related Nephropathy
Acute Phosphate Nephropathy
Drugs of Abuse
Occupational Toxins
Heavy Metals
Organic Solvents
Herbal Remedies
Radiocontrast-Induced Nephropathy
Other Specific Etiologies of Acute Kidney Injury
Heme Pigment Nephropathy
Causes of Rhabdomyolysis
Causes of Hemoglobinuria
Pathogenesis of Heme Pigment Nephropathy
Atheroembolic Renal Disease
Renal Artery or Vein Occlusion
Acute Interstitial Nephritis
Thrombotic Microangiopathy
Glomerular Disease
Specific Clinical Situations
Acute Kidney Injury in the Patient With Sepsis
Acute Kidney Injury in the Trauma Patient
Acute Kidney Injury in the Postoperative Patient
After Cardiac Surgery
After Vascular Surgery
Abdominal Compartment Syndrome
Pulmonary-Renal Syndrome
Acute Kidney Injury and Liver Disease
Acute Kidney Injury in Heart Failure (Cardiorenal Syndrome)
Acute Kidney Injury in the Cancer Patient
Tumor Lysis Syndrome
Hypercalcemia
Chemotherapeutic Agents
References
Self-Assessment Questions
67 Acute Kidney Injury in the Tropics
Snakebite
Clinical and Laboratory Features
Pathology
Pathogenesis
Management
Arthropods
Bees
Caterpillars
Loxosceles
Scorpions
Natural Medicine
Malaria
Pathophysiology
Clinical Manifestations
Leptospirosis
Hemorrhagic Fevers
Dengue Fever
Yellow Fever
Ebola Virus Disease
References
68 Diagnosis and Clinical Evaluation of Acute Kidney Injury
Early Detection of Acute Kidney Injury
Diagnostic Approach to Acute Kidney Injury
Acute Kidney Injury Versus Chronic Kidney Disease
Clinical Assessment
Electronic Health Record to Predict Acute Kidney Injury
Diagnostic Evaluation
Ratio of Blood Urea Nitrogen to Creatinine
Urine Volume
Urinalysis and Urine Microscopy
Fractional Excretion of Sodium and Urea
Laboratory Evaluation of Acute Kidney Injury in Systemic Illnesses
Imaging Studies
Kidney Biopsy
Acute Kidney Injury in Specific Settings
Acute Tubular Necrosis
Acute Interstitial Nephritis
Acute Kidney Injury from Intratubular Obstruction
Rhabdomyolysis
Acute Kidney Injury in Myeloma
Contrast-Induced Nephropathy
References
Self-Assessment Questions
69 Epidemiology and Prognostic Impact of Acute Kidney Injury
Incidence of Acute Kidney Injury
Risk Factors for Acute Kidney Injury
Age
Reduced Estimated Glomerular Filtration Rate
Proteinuria
Hyperuricemia
Association Between Acute Kidney Injury and Adverse Outcomes
Mortality
Chronic Kidney Disease
Cardiovascular Risk
Health Care Costs
Acute Kidney Injury as a Public Health Issue
References
Self-assessment Questions
70 Prevention and Nondialytic Management of Acute Kidney Injury
Risk Assessment
Primary Preventive Measures
Optimizing Volume and Hemodynamic Status
Prevention of Contrast-Induced Acute Kidney Injury
Prevention of Drug-Induced and Nephrotoxin-Induced Acute Kidney Injury
Amphotericin
Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers
Nonsteroidal Antiinflammatory Drugs
Aminoglycosides
Tumor Lysis Syndrome
Traumatic and Nontraumatic Rhabdomyolysis
Hyperglycemia
Remote Ischemic Preconditioning
Pharmacologic Approaches
N-Acetylcysteine
Loop Diuretics and Natriuretics
Vasoactive Agents
Statins
Calcium Channel Blockers
Adenosine Antagonists
Emerging Agents
Summary
Treatment of Acute Kidney Injury
General Management
Fluid and Electrolyte Management
Drugs to Promote Recovery From Acute Kidney Injury
Loop Diuretics
Natriuretics
Vasoactive Agents
Other Agents
Summary
Treatment of Acute Kidney Injury Complications
Fluid Overload
Potassium Disorders
Sodium Disorders
Calcium, Phosphorus, and Magnesium Disorders
Acid-Base Disorders
Nutrition
References
Self-Assessment Questions
71 Dialytic Management of Acute Kidney Injury and Intensive Care Unit Nephrology
Organizational Aspects of Acute Renal Replacement Therapy Programs
Overview of Acute Renal Replacement Therapies
Intermittent Acute Renal Replacement Therapy
Techniques for Acute Intermittent Hemodialysis
Strategies to Reduce Intradialytic Hemodynamic Instability During Intermittent Hemodialysis
Prolonged Intermittent Renal Replacement Therapy
Dosage of Intermittent Acute Renal Replacement Therapy
Continuous Renal Replacement Therapy
Techniques for Continuous Renal Replacement Therapy
Mechanisms of Solute Removal
Hemodialysis
Hemofiltration
Hemodiafiltration
Specific Techniques
Dosage of Continuous Renal Replacement Therapy
Technical Aspects of Continuous Renal Replacement Therapy
Equipment
Hemofilters
Replacement Fluids and Dialysate
Vascular Access
Anticoagulation in Acute Renal Replacement Therapy
Modality Choice and Outcomes in Acute Renal Replacement Therapy
Acute Renal Replacement Therapy During Mechanical Circulatory Support
Technical Aspects of Acute Renal Replacement Therapy During Mechanical Circulatory Support
Access Options and Techniques
Monitoring and Management of Key Acute Renal Replacement Therapy–Related Issues
Drug Dosage in Acute Renal Replacement Therapy
References
Self-assessment Questions
72 Dialytic Management of Refractory Heart Failure
Definition and Scope of the Problem
Pathogenesis
Venous Congestion
Adenosine
Anemia
Diuretic Resistance and Adverse Effects
Treatment
General Approach and Limitations
Pharmacologic Therapeutic Strategies
Diuretics
Renin-Angiotensin-Aldosterone System Antagonists
Neprilysin Inhibitors
Miscellaneous Therapies
Medications Under Development
Nonrenal Salt and Water Removal
Paracentesis
Peritoneal Dialysis
Conventional Hemodialysis or Hemofiltration
Setting the Rate of Fluid Removal
Effect of Extracorporeal Ultrafiltration on the Pathophysiology of Heart Failure
Effect of Extracorporeal Ultrafiltration on Renal Function
Recent Advances in Extracorporeal Techniques
Safety and Risks of Extracorporeal Therapies
Summary
References
Self-Assessment Questions
73 Hepatorenal Syndrome
Definition
Pseudohepatorenal Syndrome
Pathophysiology and Pathogenesis
Circulatory Dysfunction: Renal and Systemic Hemodynamic Changes
Neurohumoral Abnormalities
Systemic Inflammation
Summary of Pathogenetic Events
Epidemiology
Clinical Manifestations
Pathology
Diagnosis and Differential Diagnosis
Natural History
Prevention and Treatment
General Principles in the Prevention of AKI
Preventive Measures
General Approach to Treatment
Pharmacotherapy
Transjugular Intrahepatic Portosystemic Shunt
Extracorporeal Liver Support Therapy
Renal Replacement Therapy
Liver Transplantation
Therapeutic Algorithm
References
Self-assessment Questions
XV Drug Therapy in Kidney Disease
74 Principles of Drug Therapy, Dosing, and Prescribing in Chronic Kidney Disease and Renal Replacement Therapy
Pharmacokinetic Principles
Absorption: Bioavailability
Distribution
Volume of Distribution
Plasma Protein Binding
Metabolism
Elimination
Prescribing Principles for Chronic Kidney Disease and Renal Replacement Therapy
Initial Assessment and Laboratory Data
Estimating Renal Function for Drug Dosage
Activity and Toxicity of Metabolites
Fraction of Active Drug (and Active or Toxic Metabolite) Excreted Unchanged in Urine
Therapeutic Index of the Drug or Metabolites
Avoiding Nephrotoxic Drugs
Drugs That Aggravate the Metabolic Effects of Renal Impairment
Effect of Renal Impairment on Pharmacodynamic or Physiologic Mechanisms
Effect of Renal Impairment on the Concentration of Drug at the Site of Action
Location of Drug Action
Method of Administration
Drug Interactions
Clinical Condition of the Patient
Methods of Dose Reduction
Loading Doses
Maintenance Doses
Interval Method
Dose Method
Combination Method
Ongoing Assessment
Therapeutic Drug Monitoring
Clinical Response
Extracorporeal Drug Losses
Hemodialysis
Peritoneal Dialysis
Continuous Renal Replacement Therapy
References
Self-Assessment Questions
75 Common Issues in Prescribing in Kidney Disease and Renal Replacement Therapy
Analgesics
Acetaminophen (Paracetamol)
Opioid Analgesics
Nonsteroidal Antiinflammatory Drugs
Drugs for Neuropathic Pain
Antimicrobial Agents
Antibacterials
Aminoglycosides
Aminoglycoside dosage schedules.
Aminoglycoside concentration monitoring.
Carbapenems.
Cephalosporins.
Fluoroquinolones.
Glycopeptides.
Lincosamides.
Macrolides.
Penicillins.
Rifamycins.
Tetracyclines.
Sulfonamides and trimethoprim.
Other antibiotics.
Antimycobacterials
Antifungals
Amphotericin.
Azole antifungals.
Other antifungals.
Antivirals
Guanine Analogues
Hepatitis B and C
Neuraminidase Inhibitors
Other Antivirals
Immunosuppressants
Calcineurin Inhibitors
Corticosteroids
Antiproliferative and Cytotoxic Agents
mTOR Inhibitors
Immunosuppressant Antibodies
Anticoagulants, Antiplatelet Agents, Thrombolytics, and Hemostatics
Unfractionated Heparin
Low Molecular Weight Heparins
Other Parenteral Anticoagulants
Oral Anticoagulants
Antiplatelet Drugs
Thrombolytics
Hemostatics
Diuretics
Thiazide Diuretics
Loop Diuretics
Potassium-Sparing Diuretics
Antihypertensives
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
β-Blockers
Calcium Channel Blockers
Other Antihypertensives
Antianginal Agents
Antiarrhythmics
Lipid-Lowering Agents
Bile Acid–Binding Resins
Statins
Fibrates
Diabetes
Diabetes Management in Peritoneal Dialysis
Biguanides
Insulins
Meglitinides
Sulfonylureas
SGLT2 Inhibitors
DPP-4 Inhibitors
Thiazolidinediones
Drugs for Thyroid Disorders
Mineral and Bone Disorders
Phosphate Binders
Vitamin D
Calcimimetics
Dyspepsia, Gastroesophageal Reflux Disease, and Peptic Ulcers
Antacids
Histamine-2 Antagonists
Proton Pump Inhibitors
Antiemetics
Dopamine Antagonists
5-HT3 Antagonists
Aperients and Laxatives
Antidiarrheals
Drugs for Erectile Dysfunction
Phosphodiesterase-5 Inhibitors
Intracavernosal Therapy
Musculoskeletal Drugs
Nonsteroidal Antiinflammatory Drugs
Miscellaneous Arthritis Drugs
Gout and Hyperuricemia
Bisphosphonates
Antiepileptics
Benzodiazepines
Carbamazepine
Phenytoin
Other Antiepileptics
Antiparkinsonian Drugs
Antimigraine Drugs
Psychotropic Drugs
Selective Serotonin Reuptake Inhibitors
Tricyclic Antidepressants
Monoamine Oxidase Inhibitors
Other Antidepressants
Antipsychotics
Benzodiazepines
Anemia Drugs
Erythropoiesis-Stimulating Proteins
Iron Therapy
Antihistamines
Vaccines
Vitamin Supplementation
References
Self-assessment Questions
76 Herbal and Over-the-Counter Medicines and the Kidney
Herbal Medications and the Kidney
Aristolochic Acid Nephropathy
Aristolochic Acids
Aristolochic Acid Nephropathy
Definition
Epidemiology
Clinical Manifestations
Pathology
Pathogenesis
Diagnosis
Treatment
Kidney Injury Caused by Other Medicinals
Acute Kidney Injury
Mushrooms
Diagnosis of Acute Kidney Injury Induced by Folk Remedies
Treatment
Other Renal Complications of Herbal Remedies
Hypertension
Crystalluria and Nephrocalcinosis
Hyperkalemia
Urinary Obstruction
Renal Toxicity From Contaminants Within Herbal Medicines
Herb-Drug Interactions Resulting in Adverse Renal Effects
Over-the-Counter Medicines and the Kidney
Analgesics
Analgesic Nephropathy
Proton Pump Inhibitors
References
Self-assessment Questions
XVI Chronic Kidney Disease and the Uremic Syndrome
77 Epidemiology of Chronic Kidney Disease and Dialysis
Defining Chronic Kidney Disease
Chronic Kidney Disease Staging
Classification Based on Estimated Glomerular Filtration Rate
Classification Based on Albuminuria
Classification Based on Chronic Kidney Disease Cause
Rationale for the Chronic Kidney Disease Definition
Associations With Adverse Outcomes
Persistent Relationships Within Subgroups
Global Burden of Chronic Kidney Disease
Risk Factors for Chronic Kidney Disease
Age
Sex and Race
Social Determinants
Comorbid Conditions
Issues With Identifying Chronic Kidney Disease
Lack of Awareness
Imperfect Biomarkers
Errors in Urine Albumin Assessment
Outcomes of Chronic Kidney Disease
Associations With Adverse Outcomes
Variation in Absolute Risk for Adverse Outcomes
Dialysis Epidemiology
Incidence and Prevalence of Chronic Dialysis
Dialysis Practice Patterns
Outcomes
Epidemiologic Concepts
Evidence Quality
References
Self-assessment Questions
78 Pathophysiology of Disease Progression in Proteinuric and Nonproteinuric Kidney Disease
From Glomerular Hypertension to Loss of Size-Selective Properties
Podocyte Response to Protein Trafficking
Crosstalk of Podocytes With Mesangial and Endothelial Cells
Activation of Parietal Epithelial Cells
Proximal Tubular Cell Injury
Tubular Cell Apoptosis
Tubular Cell Phenotypic Changes
Interstitial Inflammation and Fibrosis
Resident Monocyte and Lymphocyte Activation
Fibroblast Activation and Extracellular Matrix Deposition
Chronic Hypoxia
Primary Chronic Tubulointerstitial Injury
Analgesics and Nonsteroidal Antiinflammatory Drugs
Aristolochic Acid
Autosomal Dominant Polycystic Kidney Disease
Conclusions
References
Self-assessment Questions
79 Retarding Progression of Kidney Disease
Level of Glomerular Filtration Rate and the Risk for Natural Progression
Proteinuria Magnitude and the Risk for Natural Progression
Diagnosis of Natural Progression
Monitoring Kidney Disease Progression
Monitoring Proteinuria Trends
Monitoring Glomerular Filtration Rate Trends
Role of Cystatin C in Estimating Glomerular Filtration Rate for Clinical Management
Glomerular Filtration Rate Trajectories in Chronic Kidney Disease
Therapy for Natural Progression
Level 1 Recommendations to Slow Natural Progression
Control Blood Pressure
Renin-Angiotensin System Blockade
Combination Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Therapy
Renin Inhibitor Therapy
Avoid Dihydropyridine Calcium Channel Blockers
Control Protein Intake
Level 2 Recommendations to Slow Natural Progression
Restrict Salt Intake and Avoid Diuretic Therapy
Nondihydropyridine Calcium Channel Blocker Therapy
Control Each Component of the Metabolic Syndrome
Aldosterone Antagonist Therapy
β-Blocker Therapy
Control Serum Phosphorous
Smoking Cessation
Control Hyperuricemia
Avoid Anticoagulant-Related Nephropathy
Alkali Therapy
Monitor Serum Creatinine in Patients Receiving a Proton Pump Inhibitor
Correct Vitamin D Deficiency
Avoid or Minimize Nonsteroidal Antiinflammatory Drug Use
References
Self-Assessment Questions
80 Clinical Evaluation and Management of Chronic Kidney Disease
Definitions
Clinical Presentation
Evaluation of Chronic Kidney Disease
Establishing Chronicity
Assessment of Glomerular Filtration Rate
Assessment of Proteinuria
Kidney Imaging
Further Investigations
Predicting Prognosis
Monitoring and Defining Progression
When to Refer to the Nephrologist
Prevention of Chronic Kidney Disease Progression
Hypertension
Dietary Advice
Management of Complications of Chronic Kidney Disease
Anemia
Bone and Mineral Metabolism
Metabolic Acidosis
Cardiovascular Risk
Risk for Infections
Care of the Patient With Progressive Chronic Kidney Disease
Chronic Kidney Disease and Risk of Acute Kidney Injury
Timing the Initiation of Renal Replacement Therapy
Conservative Management
References
Self-Assessment Questions
81 Cardiovascular Disease in Chronic Kidney Disease
Epidemiology
Prevalence of Cardiovascular Complications in Chronic Kidney Disease
Cardiovascular Disease Is Present Before the Start of Renal Replacement Therapy
Racial and International Differences in Cardiovascular Disease Prevalence
Reverse Epidemiology
Etiology and Risk Factors
Traditional Risk Factors
Age, Gender, and Smoking
Diabetes Mellitus
Hypertension
Dyslipidemia
Insulin Resistance and Atherosclerosis
Nontraditional and Uremia-Specific Risk Factors
Oxidative Stress
Inflammation
Gut Dysbiosis
Endothelial Dysfunction
Anemia
Secondary Hyperparathyroidism and Mineral Metabolism
Cardiovascular Calcification
Advanced Glycation End-Products
Dialysis Modality
Clinical Manifestations and Natural History
Chest Pain, Coronary Heart Disease, and Acute Myocardial Infarction
Peripheral Arterial Disease
Cerebrovascular Disease and Atrial Fibrillation
Left Ventricular Remodeling and Hypertrophy
Extracellular Volume Overload
Pericarditis
Autonomic Dysfunction
Valvular Disease
Infective Endocarditis
Sudden Cardiac Arrest
Diagnosis and Differential Diagnosis
Blood Pressure Measurements
Electrocardiography and Echocardiography
Stress Tests and Screening Renal Transplant Candidates
Coronary Angiography
Imaging of Vascular Calcification
Biomarkers
Treatment and Prevention of Cardiovascular Disease
Risk Factor Reduction
Lifestyle Factors and Smoking
Weight and Diet
Hypertension and Coronary Heart Disease
Diabetes Mellitus
Dyslipidemia
Volume
Anemia
Inflammation
Oxidative Stress
Chronic Kidney Disease–Mineral Bone Disorder
Revascularization
References
Self-Assessment Questions
82 Anemia in Chronic Kidney Disease
Pathogenesis
Epidemiology and Natural History
Diagnosis and Differential Diagnosis
Clinical Manifestations
Treatment
Erythropoiesis-Stimulating Agents
Epoetin Therapy
Darbepoetin Alfa
Methoxy Polyethylene Glycol–Epoetin Beta (C.E.R.A.)
Adverse Effects of the Erythropoiesis-Stimulating Agents
Peginesatide
Hypoxia-Inducible Transcription Factor Stabilizers
Initiation of and Maintenance Therapy With Erythropoiesis-Stimulating Agents
Hyporesponsiveness to Erythropoiesis-Stimulating Agents
Iron Management
References
Self-assessment Questions
83 Other Blood and Immune Disorders in Chronic Kidney Disease
Immune Dysfunction
Bacterial Infections
Viral Infections
Vaccinations in Chronic Kidney Disease
Inflammation
Causes of Inflammation
Consequences of Inflammation
Immune Cell Abnormalities
Monocytes
T Lymphocytes
B Lymphocytes
Granulocytes
Platelet Dysfunction and Platelet Inhibitors in Chronic Kidney Disease
Hemorrhagic Diathesis and Uremic Platelet Dysfunction
Treatment of Uremic Platelet Dysfunction
Desmopressin
Cryoprecipitate
Tranexamic Acid
Recombinant Activated Factor VII
Estrogens
Implications for Antiplatelet Agent Therapy
Circulating Coagulation Factors
Therapeutic Intervention
References
Self-Assessment Questions
84 Bone and Mineral Disorders in Chronic Kidney Disease
Definition
Epidemiology
Pathogenesis
Osteitis Fibrosa: Hyperparathyroidism—High-Turnover Renal Bone Disease
Abnormalities of Calcium Metabolism
Abnormalities of Phosphate Metabolism
Abnormalities of Vitamin D Metabolism
Abnormalities of Parathyroid Gland Function
Abnormal Skeletal Response to Parathyroid Hormone
Clinical Manifestations of High-Turnover Renal Osteodystrophy
Diagnosis and Differential Diagnosis
Serum Biochemistry
Parathyroid Hormone
Vitamin D Metabolites
Markers of Bone Formation and Bone Resorption
Radiology of the Skeleton
Measurements of Bone Density
Bone Biopsy
Treatment of High-Turnover Bone Disease
Prevention of Hypocalcemia
Control of Phosphate
Dietary Phosphate Restriction
Phosphate Binders
Use of Vitamin D Metabolites
Role of Calcimimetics
Role of Parathyroidectomy
Synthesis of Therapeutic Strategies
Low-Turnover Renal Bone Disease
Pathogenesis of Adynamic Bone Disease
Diagnosis and Differential Diagnosis
Serum Biochemistry
Bone Biopsy
Radiology and Measurements of Bone Density
Treatment of Adynamic Bone Disease
Osteoporosis in Chronic Kidney Disease
Pathogenesis of Osteoporosis in Chronic Kidney Disease
Diagnosis and Differential Diagnosis
Treatment of Osteoporosis in Chronic Kidney Disease
β2-Microglobulin–Derived Amyloid
Pathogenesis
Epidemiology
Clinical Manifestations and Diagnosis
Diagnosis
Treatment and Prevention
References
Self-assessment Questions
85 Neurologic Complications of Chronic Kidney Disease
Uremic Encephalopathy
Pathogenesis
Clinical Manifestations
Diagnosis and Differential Diagnosis
Treatment
Peripheral Neuropathy
Autonomic Neuropathy
Cranial Neuropathies
Sleep Disorders
Restless Legs Syndrome (Ekbom Syndrome)
Neurologic Syndromes Associated With Renal Replacement Therapy
References
Self-assessment Questions
86 Gastroenterology and Nutrition in Chronic Kidney Disease
Gastrointestinal Problems in Chronic Kidney Disease
Gastrointestinal Disease in Chronic Kidney Disease
Oral Disease in Chronic Kidney Disease
Gastroesophageal Reflux Disease and Esophagitis
Peptic Ulcer Disease, Gastritis, and Duodenitis
Delayed Gastric Emptying and Gastroparesis
Large Bowel Disorders
Gastrointestinal Pseudoobstruction
Vascular Disease of the Gastrointestinal Tract
Gastrointestinal Hemorrhage
Clostridium difficile Infection
Acute Pancreatitis
Acute Abdomen
Combined Gastrointestinal and Renal Diseases
Diabetes
Systemic Vasculitis
Systemic Amyloidosis
Autosomal Dominant Polycystic Kidney Disease
Inflammatory Bowel Disease
Celiac Disease
Drugs and Gastrointestinal Disease in Chronic Kidney Disease
Specific Gastrointestinal Complications of Renal Replacement Therapy
Idiopathic Dialysis-Related Ascites
Peritoneal Dialysis–Related Gastrointestinal Conditions
Dialysis-Related Amyloidosis
Transplantation and Gastrointestinal Disturbance
Nutrition in Chronic Kidney Disease
Malnutrition: Protein-Energy Wasting
Obesity Paradox in Chronic Kidney Disease
Assessment of Nutritional Status
Estimation of Intake
Body Mass Index
Body Composition
Visceral Protein
Tools to Diagnose Protein-Energy Wasting and Assess Nutritional Status
Nutritional Guidelines
Hyperlipidemia
Hypertension
Vitamins, Minerals, and Trace Elements
Monitoring and Treatment
Enteral Supplementation
Supplementation of Dialysate Fluids
Appetite Stimulants
Gut-Targeted Therapeutics
Metabolic Acidosis
Exercise
Potassium Binders
References
Self-Assessment Questions
87 Dermatologic Manifestations of Chronic Kidney Disease
Uremic Pruritus
Clinical Manifestations
Pathogenesis
Treatment
Optimizing Dialysis and Mineral Metabolism Therapy
Skin Emollients
Antihistaminic Drugs
Phototherapy
5-Hydroxytryptamine Antagonist
Opioid Receptor Agonists
Gabapentin
Immunomodulators and Immunosuppressive Agents
Long-Chain Essential Fatty Acids
Capsaicin
Oral Activated Charcoal
Miscellaneous
Bullous Dermatoses
Calcific Uremic Arteriolopathy (Calciphylaxis)
Definition
Epidemiology, Pathogenesis, and Risk Factors
Clinical Manifestations
Pathology
Diagnosis and Differential Diagnosis
Natural History
Prevention and Treatment
Nephrogenic Systemic Fibrosis
Definition
Pathogenesis
Epidemiology
Clinical Manifestations and Natural History
Pathology
Diagnosis and Differential Diagnosis
Treatment and Prevention
References
Self-Assessment Questions
88 Acquired Cystic Kidney Disease and Malignant Neoplasms
Definition
Pathogenesis
Epidemiology
Clinical Manifestations
Acquired Cystic Kidney Disease–Associated Renal Cell Carcinoma
Pathology
Diagnosis and Differential Diagnosis
Natural History
Treatment
Cancer in Dialysis Patients
References
Self-assessment Questions
XVII Geriatric and Palliative Nephrology
89 Geriatric Nephrology
Aging-Associated Structural Changes
Anatomic Changes
Glomerular Changes
Tubular and Interstitial Changes
Vascular Changes
Aging-Associated Changes in Renal Function
Glomerular Filtration Rate
Renal Plasma Flow
Assessment of Renal Function in the Elderly
Albuminuria
Hematuria
Prevalence of Chronic Kidney Disease in the Elderly
Risk Factors for Chronic Kidney Disease in the Elderly
Pathogenesis of Age-Related Chronic Kidney Disease
Fluid and Electrolytes in Aging
Sodium Balance and Hypertension
Osmoregulation and Water Handling
Other Tubular Defects and Electrolyte Problems
Endocrine Function and Renal Hormones
Clinical Manifestations
General Considerations
Glomerular Diseases
Renovascular and Atheroembolic Disease
Diabetic Nephropathy
Acute Kidney Injury
Nephrotoxicity and Drug Dosage
End-Stage Renal Disease and Renal Replacement Therapy
Depression in Elderly Patients With Kidney Diseases
References
Self-assessment Questions
XVIII Dialytic Therapies
90 Approach to Renal Replacement Therapy
Prediction of End-Stage Renal Disease
Multidisciplinary Care in Advanced Chronic Kidney Disease
Predialysis Education Programs
Education About Transplantation
When Should Dialysis Be Started?
Limitations of a Purely Clinical Approach to the Initiation of Dialysis
Limitations of a Purely Laboratory Results–Based Approach to the Initiation of Dialysis
The Choice Between Peritoneal Dialysis and Hemodialysis
Contraindications to Peritoneal Dialysis
Fresh Intraabdominal Foreign Body
Body Size Limitations and Intolerance of Intraabdominal Fluid Volume
Bowel Disease and Other Sources of Infection
Severe Malnutrition or Morbid Obesity
Contraindications to Hemodialysis
Home Hemodialysis
Hemodialysis or Hemodiafiltration
Patient Choice of Hemodialysis or Peritoneal Dialysis
Economic Factors
Physician Preference
The Importance of Dialysis Access
The Decision Whether to Offer Renal Replacement Therapy
The Availability of Dialysis Facilities
Selection of Patients by Physicians and Nephrologists
Rationing Versus Rational Dialysis Treatment
Predictive Factors
Advising Patients About Prognosis on Dialysis
Conservative Kidney Care
The Patient Who Does Not Want Dialysis
Disagreement About a Decision to Dialyse
Management of Disruptive Patients on Dialysis
Resuscitation and Withdrawal of Dialysis
Cardiopulmonary Resuscitation
Withdrawal of Dialysis
References
Self-assessment Questions
91 Vascular Access for Dialytic Therapies
Evaluation of the Patient for Vascular Access
Primary Autogenous Vascular Access
Radiocephalic Arteriovenous Fistula
Nonmaturation of Radiocephalic Arteriovenous Fistula
Secondary Autogenous Vascular Access
Forearm Cephalic and Basilic Vein Transposition and Elevation
Elbow and Upper Arm Cephalic Vein Arteriovenous Fistula
Upper Arm Basilic Vein Arteriovenous Fistula
Nonautogenous Prosthetic Vascular Access
Measures to Improve Graft Patency
Pharmacologic Approaches for Access Patency
Lower Limb Vascular Access
Vascular Access Complications
Nonmaturation of Arteriovenous Fistulas
Stenosis and Thrombosis
Autogenous Fistula Stenosis or Thrombosis
Arteriovenous Graft Stenosis or Thrombosis
Central Venous Obstruction
Endovascular Intervention
Surgical Intervention
Vascular Access–Induced Ischemia
Diagnosis of Ischemia
Endovascular and Surgical Management of Ischemia
Central Venous Catheter Access
Nontunneled Catheters
Tunneled Catheters
Catheter Infection
Infections Involving Temporary Catheters
Exit Site Versus Tunnel Tract Infections
Catheter-Associated Bacteremia
Catheter Removal
Prevention of Infection
Catheter Obstruction
References
Self-assessment Questions
92 Diagnostic and Interventional Nephrology
Ultrasound
Applications and Limitations of Ultrasound
Chronic Kidney Disease
Acute Kidney Injury
Renal Transplantation
Renal Biopsy
Urinary Bladder
Hemodialysis Access
Renovascular Ultrasound
Equipment
Procedure
Training and Certification
Peritoneal Dialysis Catheters
Catheter Insertion
Burying (Embedding) the Peritoneal Dialysis Catheter
Complications of Peritoneal Dialysis Catheter Insertion
Catheter Repositioning
Removal of Peritoneal Dialysis Catheters
Training and Certification
Tunneled Hemodialysis Catheters
Tunneled Catheter Insertion
Catheter Dysfunction
Catheter Exchange and Fibrin Sheath Removal
Training and Certification
Procedures on Arteriovenous Fistulas and Grafts
Percutaneous Balloon Angioplasty
Percutaneous Thrombectomy
Stents
Training and Certification
References
Self-Assessment Questions
93 Hemodialysis
Dialysis System
Dialyzer Designs and Membranes
Safety Monitors
Anticoagulation
Dialysate Fluid
Water and Water Treatment
Dialysate Solution
Biocompatibility
Hemofiltration and Hemodiafiltration
Modes of Hemofiltration and Hemodiafiltration
Postdilution Hemodiafiltration
Predilution Hemodiafiltration
Mixed Dilution Hemodiafiltration
Middilution Hemodiafiltration
Uremic Toxins and Their Removal by Hemodialysis
Additional Devices and Technologies
Relative Blood Volume Monitoring
Ultrafiltration Profiling
Sodium Profiling
Online Clearance Monitoring
Blood Temperature Monitoring and Dialysate Cooling
Intradialytic Oxygen Measurement
Bioimpedance
Home Hemodialysis
Dialysis Machine Choice and Other Equipment
Water Preparation, Standards, and Plumbing
Safety
Wearable Artificial Kidney
References
Self-assessment Questions
94 Hemodialysis
Assessment of Dialysis Dose
Markers of Uremic Toxin Removal by Renal Replacement Therapy
Urea Removal
Intradialytic Urea Kinetics
Urea Reduction Ratio
Single-Pool Kt/V (spKt/V) and Equilibrated Double-Pool Kt/V (eKt/V)
Weekly Dialysis Dose and Weekly Standard: Kt/V (stdKt/V)
Middle Molecule Removal
Phosphate Removal
Prescription of Hemodialysis
Hemodialysis Dose
Hemodiafiltration Dose
Treatment Time and Frequency
Dialysate Composition
Sodium
Potassium
Calcium
Bicarbonate
Magnesium
Fluid Status and Ultrafiltration Rate
Dialysis Adequacy
Prevention of Intradialytic Hypotension
Preservation of Residual Renal Function
Maintenance or Improvement of Nutritional Status
Dialysis Adequacy in the Elderly
References
Self-Assessment Questions
95 Acute Complications During Hemodialysis
Cardiovascular Complications
Intradialytic Hypotension
Intradialytic Hypertension
Cardiac Arrhythmias
Sudden Death
Pericarditis
Dialysis-Associated Steal Syndrome
Neuromuscular Complications
Muscle Cramps
Restless Legs Syndrome
Dialysis Disequilibrium Syndrome
Seizures
Headache
Hematologic Complications
Complement Activation and Dialysis-Associated Neutropenia
Intradialytic Hemolysis
Hemorrhage
Thrombocytopenia
Pulmonary Complications
Dialysis-Associated Hypoxemia
Technical Malfunctions
Air Embolism
Incorrect Dialysate Composition
Hypernatremia
Hyponatremia
Metabolic Acidosis
Metabolic Alkalosis
Temperature Monitor Malfunction
Blood Loss
Clotting of Dialysis Circuit
Dialysis Reactions
Anaphylactic and Anaphylactoid Reactions
Clinical Presentation
First-Use Reactions
Reuse Reactions
Bradykinin-Mediated Reactions
Drug-Induced Reactions
Treatment and Prevention
Mild Reactions
Fever and Pyrogenic Reactions
Investigation of a Dialysis Pyrogenic Outbreak
Miscellaneous Complications
Postdialysis Fatigue
Pruritus
Genitourinary Problems
Hearing and Visual Loss
References
Self-assessment Questions
96 Peritoneal Dialysis
Advantages and Limitations of Peritoneal Dialysis
Principles of Peritoneal Dialysis
Three-Pore Model
Fluid Kinetics
Effective Peritoneal Surface Area
Peritoneal Access
Techniques of Peritoneal Dialysis
Peritoneal Dialysis Fluids
Electrolyte Concentration
Osmotic Agents
Assessments of Peritoneal Solute Transport and Ultrafiltration
Small-Solute Removal
Large-Solute Removal
Ultrafiltration
Peritoneal Membrane Function
Peritoneal Equilibration Test
Mini–Peritoneal Equilibration Test
Double–Mini–Peritoneal Equilibration Test
Residual Renal Function
Adequacy
Small-Solute Clearance
Fluid Balance
Management of Fluid Overload
Nutrition
Outcome of Peritoneal Dialysis
References
Self-assessment Questions
97 Complications of Peritoneal Dialysis
Catheter Malfunction
Optimal Timing and Placement of the Peritoneal Dialysis Catheter
Catheter Function: Inflow
Catheter Function: Outflow
Fibrin in the Dialysate
Fluid Leaks
External Leaks
Internal Leaks
Hydrothorax
Pain Related to Peritoneal Dialysis
Inflow Pain
Outflow Pain
Blood-Stained Dialysate
Infectious Complications
Peritonitis
Diagnosis of Peritonitis
Treatment of Peritonitis
Fungal Peritonitis
Relapsing Peritonitis
Culture-Negative Peritonitis
Exit Site Infection
Reduced Ultrafiltration and Ultrafiltration Failure
Definition and Significance of Ultrafiltration Failure
Establishing the Causes of Ultrafiltration Failure
Fast Peritoneal Solute Transport Rate–Related Ultrafiltration Failure: Diagnosis and Management
Low Osmotic Conductance–Related Ultrafiltration Failure: Diagnosis and Management
Changes in Peritoneal Structure and Function
Preventing Membrane Injury
Encapsulating Peritoneal Sclerosis
Nutritional and Metabolic Complications
Undernutrition
Acid-Base Status
Lipids and Obesity
References
Self-assessment Questions
98 Extracorporeal Therapies for Drug Overdose and Poisoning
When Should Extracorporeal Removal Be Considered?
Molecular Weight
Protein Binding
Volume of Distribution
Solute Compartmentalization
Contribution of Extracorporeal Toxin Relative to Endogenous Clearance
Treatment Modalities
Intermittent Hemodialysis, Hemofiltration, and Hemodiafiltration
Peritoneal Dialysis
Continuous Renal Replacement Therapy
Hemoperfusion
Other Modalities
Extracorporeal Therapy for Specific Drugs and Poisons
Alcohols
β-Blockers
Lithium
Metformin
Salicylates
Theophylline
Valproate
Tricyclic Antidepressant Drugs
Thallium
Barbiturates
Acetaminophen
Carbamazepine
Phenytoin
Digoxin
References
Self-Assessment Questions
99 Plasma Exchange
Techniques
Complications
Mechanisms of Action
Indications for Plasma Exchange
Anti–Glomerular Basement Membrane Antibody Disease (Goodpasture Disease)
Recommendation
Small-Vessel Vasculitis
Recommendation
Other Crescentic Glomerulonephritis
Recommendation
Focal Segmental Glomerulosclerosis
Thrombotic Microangiopathies
Infection-Associated Hemolytic-Uremic Syndrome
Thrombotic Thrombocytopenic Purpura
Atypical Hemolytic Uremic Syndrome
Recommendation
Systemic Lupus
Recommendation
Cryoglobulinemia
Myeloma
Recommendation
Transplantation
Antibody-Mediated Rejection
Anti–Human Leukocyte Antigen Antibodies
ABO-Incompatible Renal Transplantation
Recurrent Focal Segmental Glomerulosclerosis
Recommendations
References
Self-assessment Questions
XIX Transplantation
100 Immunologic Principles in Kidney Transplantation
Ischemia/Reperfusion Injury
Antigen Presentation
Antigen-Presenting Cells
T Cell Ontogeny and Major Histocompatibility Complex Specificity
Pathways of Allorecognition
Major Histocompatibility Complex
Human Leukocyte Antigen Typing and Transplantation
Human Leukocyte Antigen Inheritance
Non–Major Histocompatibility Antigens
T Cell Activation
T Cell Receptor
CD4 and CD8 Coreceptors
T Cell Receptor Engagement of Antigen: Signal 1
T Cell Costimulation: Signal 2
T Cell Clonal Expansion and Differentiation
Memory Cells
Effector Functions
Cytologic T Lymphocyte Differentiation and Function
Macrophage Activation
The Humoral Immune Response
Natural Killer Lymphocytes
Termination of the Immune Response
Allograft Rejection
Recruitment of Cells into the Interstitium of Kidney Allografts
Acute T Cell–Mediated Rejection
Acute Antibody-Mediated Rejection
Chronic Rejection
Transplantation Tolerance
References
Self-Assessment Questions
101 Immunosuppressive Medications in Kidney Transplantation
Small-Molecule Drugs
Corticosteroids
Mechanism of Action
Pharmacokinetics
Side Effects
Calcineurin Inhibitors
Mechanism of Action
Pharmacokinetics, Monitoring, and Drug Interactions
Side Effects
Mycophenolate
Mechanism of Action
Pharmacokinetics
Side Effects
Azathioprine
Mammalian Target of Rapamycin Inhibitors
Mechanism of Action
Pharmacokinetics
Side Effects
Dihydroorotate Dehydrogenase Inhibitors
Biologic Agents
Polyclonal Antilymphocyte Sera
Humanized Monoclonal Anti-CD52 Antibody
Monoclonal Anti-CD25 Antibody
B Cell–Depleting Monoclonal Anti-CD20 Antibody
Intravenous Immunoglobulin
Belatacept
Other Agents Used in Transplantation
Bortezomib
Eculizumab
References
Self-assessment Questions
102 Evaluation and Preoperative Management of Kidney Transplant Recipient and Donor
Recipient Evaluation
Cardiovascular Disease
Coronary Heart Disease and Left Ventricular Dysfunction
Cerebrovascular Disease
Peripheral Vascular Disease
Cancer
Infectious Complications
Obesity
Recurrent Disease
Gastrointestinal Disease
Genitourinary Disorders
Pulmonary Disease
Psychosocial Issues
Presence of Multiple Comorbidities
Reevaluation of Patients on the Waiting List
Donor Evaluation
Deceased Donors
Classification of the Deceased Donor
Evaluation of the Deceased Donor
Deceased Donor Management Before Transplantation
Living Donors
Mortality and Morbidity
Evaluation of the Living Donor
Assessment of Renal Function
Hypertension and Proteinuria in the Living Donor
Obesity and Abnormal Glucose Tolerance in the Living Donor
Renal Abnormalities in the Living Donor
Malignancy
Cardiovascular and Pulmonary Disease
Compatibility and Immunologic Considerations
Blood Group Compatibility
Human Leukocyte Antigen Compatibility
Assessing Human Leukocyte Antigen Sensitization
References
Self-Assessment Questions
103 Kidney Transplantation Surgery
Sources of Kidneys for Transplantation
Donation Before Cardiac Death Donors
Donation After Cardiac Death Donors
Donation After Cardiac Death Protocol
Uncontrolled Donation After Cardiac Death Donors
Controlled Donation After Cardiac Death Donors
Living Kidney Donors
Preoperative Imaging
Minimal Access (Laparoscopic) Donor Nephrectomy
Transperitoneal Laparoscopic Donor Nephrectomy
Hand-Assisted Laparoscopic Donor Nephrectomy
Retroperitoneoscopic Operative Technique
Contraindications to Minimal Access Donor Nephrectomy
Effect of Pneumoperitoneum
Graft Function and Acute Rejection
Technical Issues
Postoperative Recovery
Choice of Donor Operative Technique
Renal Preservation
Renal Transplantation Procedure
Vascular Anastomosis
Urinary Drainage
Alternative Techniques of Urinary Reconstruction
Drainage and Wound Closure
Postoperative Course
Surgical Complications of Renal Transplantation
Wound Infection
Wound Dehiscence
Vascular Complications
Bleeding From Vessels in the Renal Hilum
Anastomotic Hemorrhage
Renal Artery Thrombosis
Renal Vein Thrombosis
Transplant Renal Artery Stenosis
Lymphocele
Urologic Complications
Urinary Leaks
Ureteral Obstruction
Complications in the Transplant Bed
Transplant Nephrectomy
References
Self-assessment Questions
104 Prophylaxis and Treatment of Kidney Transplant Rejection
Definition
Antibody-Mediated Rejection
T Cell–Mediated Rejection
Borderline Rejection
Clinical Manifestations
Prophylaxis and Prevention
Prophylaxis
Prevention of Acute T Cell–Mediated Rejection: Induction Therapy
Prevention of Acute Antibody-Mediated Rejection: Desensitization
Maintenance Therapy for Prevention of Acute Rejection
Calcineurin Inhibitors in the Prevention of Acute Rejection
Antiproliferative Agents in the Prevention of Acute Rejection
Acute Rejection Rates in Calcineurin-Sparing and Corticosteroid-Sparing Immunosuppression Regimens
Treatment
Acute T Cell–Mediated Rejection
Acute Antibody-Mediated Rejection
Chronic Rejection (T Cell–Mediated and/or Antibody-Mediated)
Prognosis
Summary and Recommendations
References
Self-assessment Questions
105 Medical Management of the Kidney Transplant Recipient
Infectious Diseases
Immunizations Before and After Transplantation
Infectious Causes
Risk Factors for Post-Transplant Infectious Complications
Donor-Derived Infections
Month 1 After Transplantation
Months 1 to 6
After 6 Months
Management and Prophylactic Therapy for Selected Infections
Cytomegalovirus Infection
Clinical Manifestations
Immunomodulating Effects of Cytomegalovirus Infection
Risk Factors for Cytomegalovirus Infection
Prevention
Treatment
Candida Infections
BK Virus Infection
Other Infections
Gastrointestinal Disease
Drug-Related Gastrointestinal Complications
Infections
Cytomegalovirus Infection
Herpes Simplex Virus Infection
Fungal Infections
Helicobacter Infection
Diarrhea and Colon Disorders
Transplant-Associated Malignancy
Post-Transplant Lymphoproliferative Disorder
Risk Factors
Type of organ transplant.
Age.
Type of immunosuppression
Calcineurin inhibitors.
mTOR inhibitors.
Antimetabolites.
Induction agents.
Belatacept.
Viral infection
Epstein-Barr virus.
Hepatitis C virus.
Miscellaneous.
Clinical Manifestations
Treatment
Viral Load Monitoring and Preemptive Strategies
Skin Cancer
Management of Immunosuppressive Therapy in Post-Transplantation Malignancy
References
Self-Assessment Questions
106 Medical Management of the Kidney Transplant Recipient
Cardiovascular Disease
Conventional Cardiovascular Disease Risk Factors
Post-Transplantation Hypertension
Post-Transplantation Dyslipidemia
Statin Therapy
Nonstatin Drug Therapy
Management of Hypertriglyceridemia
Drug therapy for Hypertriglyceridemia
Fibrates.
Ezetimibe.
Bile acid resins.
Niacin.
Summary
Post-Transplantation Diabetes Mellitus (New-Onset Diabetes After Transplantation)
Risk Factors
Management of Post-Transplantation Diabetes Mellitus
Therapeutic Interventions
Nonpharmacologic Management
Modification of Immunosuppression
Pharmacologic Treatment
Cigarette Smoking
Obesity
Unconventional Cardiovascular Disease Risk Factors
Proteinuria
Belatacept Use
Common Laboratory Abnormalities
Anemia
Leukopenia and Thrombocytopenia
Erythrocytosis
Hyperkalemia
Hypophosphatemia
Hypercalcemia
Hypomagnesemia
Abnormal Liver Function Tests
Bone and Mineral Metabolism After Kidney Transplantation
Osteoporosis
Avascular Necrosis
Prevention and Management of Post-Transplantation Bone Diseases
Gout
Outpatient Care
References
Self-Assessment Questions
107 Chronic Allograft Injury
Definitions and Epidemiology
Pathogenesis: Nonimmunologic Factors
Donor Age, Donor Gender, and Donor-Recipient Size Mismatching
Ischemia/Reperfusion Injury and Delayed Graft Function
BK Virus Nephropathy
Calcineurin Inhibitor Toxicity
Recurrent and De Novo Glomerular Diseases
Cardiovascular Risk Factors
Pathogenesis: Immunological Factors
T Cell–Mediated Rejection
Antibody-Mediated Rejection
Insufficient Immunosuppression and Nonadherence to Medication
Clinical Manifestations
Pathology
Diagnosis and Differential Diagnosis
Prevention of Antibody-Mediated Allograft Injury
Treatment of Chronic Allograft Injury
References
Self-Assessment Questions
108 Recurrent Disease in Kidney Transplantation
Definitions
Recurrent Glomerulonephritis
Recurrence of Specific Glomerular Diseases
Immunoglobulin A Nephropathy and IgA Vasculitis (Henoch-Schonlein Purpura)
Membranous Nephropathy
Focal Segmental Glomerulosclerosis
Membranoproliferative Glomerulonephritis
Membranoproliferative Glomerulonephritis Type I
C3 Glomerulopathy
Membranoproliferative Glomerulonephritis Type III
Congenital Nephrotic Syndrome
Antineutrophil Cytoplasmic Antibody–Associated Pauci-immune Vasculitis
Anti–Glomerular Basement Membrane Disease
Lupus Nephritis
Thrombotic Microangiopathy and Hemolytic Uremic Syndrome
Scleroderma
Amyloid, Light-Chain Disease, and Fibrillary and Immunotactoid Glomerulopathies
Amyloidosis
Light-Chain Nephropathy
Fibrillary and Immunotactoid Glomerulopathies
Recurrence of Metabolic Diseases Affecting the Kidney Transplant
Diabetes Mellitus
Primary Hyperoxaluria
Fabry Disease
Recurrence of Virus-Associated Nephropathies and Tumors in the Transplanted Kidney
References
Self-Assessment Questions
109 Outcomes of Renal Transplantation
Methods of Measurement and Analysis
Types of Outcome Analyses
Survival Analyses
Half-Life Analysis
Graft Survival
Randomized Controlled Trials
Cohort Studies
Meta-Analyses
Case Reports
Expert Opinion Guidelines
Qualitative Studies
Economic Analysis
Types of Data Collection
Registries
International Statistical Collections
Randomized Controlled Trials: Data Collection
Structured Reviews
Variables Affecting the Outcomes of Transplantation
Deceased Donor Variables
Living Donor Variables
Other Donor Variables
Recipient Variables
Effects of Immunosuppression on Transplant Outcome
Transplant Center Variables
Transplantation Matching Variables
Outcomes Inform the Recipient Decision
References
Self-Assessment Questions
110 Pancreas and Islet Transplantation
Patient Selection Criteria for Pancreas or Islet Transplantation
Indications for Transplantation
Medical Evaluation
Pancreas Transplantation
Patient and Graft Survival
Surgical Procedure
Immunosuppression
Graft Monitoring
Antimicrobial Prophylaxis
Metabolic Monitoring
Surgical Complications
Nonsurgical Complications
Urologic Complication
Urinary Tract Infections
Enteric Conversion
Late Complications
Impact of Pancreas Transplantation on Diabetic Complications
Hypoglycemia
Hyperglycemia
Microvascular Complications
Retinopathy
Neuropathy
Nephropathy
Vascular Disease
Quality of Life and Social Issues
Pregnancy After Pancreas Transplantation
Islet Transplantation
Islet After Kidney Transplantation
Technique of Islet Transplantation
Medical Complications
Glycemic Control and Insulin Independence
Immunosuppressive Regimens
References
Self-assessment Questions
111 Kidney Disease in Liver, Cardiac, Lung, and Hematopoietic Stem Cell Transplantation
Generic Issues of Kidney Disease in Nonrenal Solid Organ Transplantation
Use of Serum Creatinine and Derived Equations to Estimate Glomerular Filtration Rate
Nephrotoxicity of Calcineurin Inhibitors
Acute Kidney Injury in the Immediate Pretransplant Period
Acute Kidney Injury in the Early Post-Transplant Period
Acute Kidney Injury in the Late Post-Transplantation Period
Chronic Kidney Disease
Management of Chronic Kidney Disease
BK Virus Nephropathy
Kidney Disease in Liver Transplantation
Kidney Disease Before Cardiac Transplantation
Kidney Disease in Lung Transplantation
Kidney Disease in Hematopoietic Stem Cell Transplantation
Acute Kidney Injury After Hematopoietic Stem Cell Transplantation
Hepatic Sinusoidal Obstructive Syndrome
Management of Acute Kidney Injury After Hematopoietic Stem Cell Transplantation
Chronic Kidney Disease After Hematopoietic Stem Cell Transplantation
Thrombotic Microangiopathy
Calcineurin Inhibitor and Sirolimus Nephrotoxicity
Glomerular Disease
Management of Hematopoietic Stem Cell Transplantation–Related Chronic Kidney Disease
References
Self-assessment Questions
XX Palliative Nephrology
112 Palliative Nephrology
Prognosis
Communication and Shared Decision Making
Conservative Care
Dialysis Withdrawal
Symptom Control and Management of Last Days
References
Self-Assessment Questions
Answers
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 21
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Chapter 51
Chapter 52
Chapter 53
Chapter 54
Chapter 55
Chapter 56
Chapter 57
Chapter 58
Chapter 59
Chapter 60
Chapter 61
Chapter 62
Chapter 63
Chapter 64
Chapter 65
Chapter 66
Chapter 68
Chapter 69
Chapter 70
Chapter 71
Chapter 72
Chapter 73
Chapter 74
Chapter 75
Chapter 76
Chapter 77
Chapter 78
Chapter 79
Chapter 80
Chapter 81
Chapter 82
Chapter 83
Chapter 84
Chapter 85
Chapter 86
Chapter 87
Chapter 88
Chapter 89
Chapter 90
Chapter 91
Chapter 92
Chapter 93
Chapter 94
Chapter 95
Chapter 96
Chapter 97
Chapter 98
Chapter 99
Chapter 100
Chapter 101
Chapter 102
Chapter 103
Chapter 104
Chapter 105
Chapter 106
Chapter 107
Chapter 108
Chapter 109
Chapter 110
Chapter 111
Chapter 112
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Inside Back Cover

Polecaj historie

Comprehensive Clinical Nephrology [7 ed.] 0323825923, 9780323825924, 9780323825931, 0323825931

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