1. Renal Anatomy and Physiology: A Clinical Perspective 1
Pranaw Kumar Jha, Vijay Kher
Section A: Renal Anatomy 1
• Microscopic Anatomy: The Nephron 3
Section B: Renal Physiology and Urine Formation 7
• Glomerular Filtration Rate and Pressure 7
• Transport Mechanisms 8
• Tubular Transports 8
• Autoregulation 13
• Sympathetic Nervous System 13
• Renin-Angiotensin-Aldosterone System (RAAS) 13
• Endocrine Function of Kidneys 15
2. Basics of Renal Histopathology 18
Ritambhra Nada, Rajan Duggal
• Renal Biopsy Fixation and Processing 18
• Specimen Adequacy 19
• Light Microscopic Examination of Renal Biopsy 19
3. An Approach to Patient with Kidney Disease 43
Vijay Kher
• Signs and Symptoms of Kidney Disease 44
• Asymptomatic Urinary Abnormality 44
• Urinary Tract Infection 45
• Hypertension 46
• Acute Kidney Injury 47
• Rapidly Progressive Renal Failure 47
• Acute Nephritic Syndrome 47
• Nephrotic Syndrome 47
• Congenital/Genetic Syndromes 50
4. Investigations in Renal Diseases 54
Biochemical Investigations in Renal Diseases 54
Ratan Jha, Kiran Chandra Patro
• Urine Analysis 54
• Proteinuria 54
• Blood and Urine Biochemistry 55
Urinalysis 68
Sishir Gang
• Method of Collection of Urine Sample 68
• Urine Appearance 68
• Urine Odour 69
• Specific Gravity 69
• Chemical Composition of Urine 70

xvi Manual of Nephrology
• Urine Microscopy 71
• Hematuria 76
• Proteinuria 76
Radiological Examination of Kidneys 80
Ashish Nandwani, Pranaw Kumar Jha
• Recommended Imaging Modalities for Kidney Diseases 80
• Plain Film of the Abdomen 81
• Intravenous Urography 81
• Retrograde or Antegrade Pyelography 81
• Cystography 82
• Ultrasound 82
• Doppler Ultrasonography 87
• Computed Tomography 88
• Magnetic Resonance Imaging 90
Nuclear Medicine Imaging in Nephrology 95
Arun Kumar Reddy Gorla, Harbir Singh Kohli, Bhagwant Rai Mittal
5. Acute Kidney Injury 111
Vivekanand Jha
• Definition and Classification 111
• Clinical Presentation 112
• Major Causes and Classification of AKI 114
• Evaluation 114
• Management 119
• Prognosis 123
• Biomarkers in Acute Kidney Injury 124
6. Chronic Kidney Disease 128
H Sudarshan Ballal, Rohan Augustine, Vishwanath S
• Definition of Chronic Kidney Disease 128
• Staging/Estimation of Glomerular Filtration Rate in
Chronic Kidney Disease 128
• Etiology of Chronic Kidney Disease 129
• Progression of Chronic Kidney Disease 130
• Manifestations of Chronic Kidney Disease 132
• Management of Chronic Kidney Disease 134
• Principles of Management of Chronic Kidney Disease 134
• Pre End-stage Interventions 142
7. Electrolyte Disorders 148
Hyponatremia and Hypernatremia 149
Gokulnath, Ram R, Vinod Kumar K
• Regulation of Sodium and Water Balance 149
• Hyponatremia 149
• Etiology and Classification 150
• Clinical Manifestations of Hyponatremia 151
• Diagnostic Approach in Hyponatremia 151
• Treatment of Hyponatremia 157

Contents xvii
• Hypernatremia 159
• Etiology and Classification 160
• Diabetes Insipidus 160
• Clinical Manifestation of Hypernatremia 162
• Treatment of Hypernatremia 163
Hypokalemia and Hyperkalemia 165
Satish D, Gokulnath
• Hypokalemia 165
• Pathophysiology 166
• Etiology 167
• Treatment 169
• Hyperkalemia 171
• Approach to Hyperkalemia 172
• Clinical Manifestations 174
• Treatment 174
Hypocalcemia and Hypercalcemia 178
Manisha Sahay
• Regulation of Calcium Balance 178
• Factors Regulating Calcium Homeostasis 180
• Hypocalcemia 184
• Definition 184
• Etiology 184
• Symptoms and Signs 184
• Diagnosis 184
• Management 187
• Hypercalcemia 189
• Definition 189
• Etiology 189
• Symptoms and Signs 190
• Laboratory Diagnosis 191
• Treatment 192
Hypophosphatemia and Hyperphosphatemia 197
Manisha Sahay
• Phosphorus Metabolism 197
• Phosphate Homeostasis 198
• Hypophosphatemia 200
• Signs and Symptoms of Hypophosphatemia 200
• Causes of Hypophosphatemia 201
• Diagnosis and Treatment 201
• Treatment 205
• Hyperphosphatemia 206
• Epidemiology 206
• Etiology 206
• Signs and Symptoms 208
• Laboratory Studies 208
• Treatment 209

xviii Manual of Nephrology
8. Acid-base Disorders 214
Mysore Keshavmurthy Phanish
• Acid Handling by the Kidney and the Role of Kidney in the
Regulation of Plasma pH 215
• Compensatory Mechanisms 216
• Practical Interpretation of ABG: A Step-wise Approach 217
• Management of Metabolic Acidosis 221
• Renal Tubular Acidosis 221
9. Urinary Tract Infection 226
KC Prakash, V Ramasubramanian
• UTI Terminology 226
• UTI Classification 227
• Epidemiology 227
• Etiology 227
• Pathogenesis 228
• Clinical Presentation 228
• Diagnosis 230
• Management 232
10. Contrast-Induced Nephropathy 237
Pranaw Kumar Jha
• Contrast Media 237
• Pathophysiology 237
• Risk Factors 238
• Clinical Features and Diagnosis 240
• Preventing Contrast-induced Nephropathy 241
11. Urology for Nephrologist 248
Sohrab Arora, Rajesh Ahlawat
• Terms Used for Lower Urinary Tract Symptoms 248
• Common Investigations in the Evaluation of LUTS 248
• Benign Prostatic Hyperplasia 253
• Acute and Chronic Retention 255
• Urinary Tract Obstruction: Obstructive Uropathy 256
• Stone Disease 259
12. Hypertension 264
Vinay Sakhuja, Indranil Ghosh
• Definition 264
• Epidemiology 265
• Pathogenesis 267
• Diagnostic Evaluation of Hypertension 270
• Treatment 275
13. Nutrition in Renal Diseases 288
Anita Saxena, Amit Gupta
• Protein Energy Wasting 288
• Management of Nutritional Status 291

Contents xix
14. Drug Dosing in Renal Diseases 309
R Kasi Viswesaran
• Vulnerability of Kidneys 310
• Age-Related Decline in Renal Function and Importance of
Glomerular Filtration Rate 312
• Glomerular Filtration Rate in Renal Diseases 312
• Mechanisms of Drug-Induced Renal Damage 313
15. Renal Replacement Therapy in Chronic Kidney Disease Patients 325
Georgi Abraham, Tarun K George
• Renal Replacement Therapy 325
Index 339