Manual de Nefrología

SECTION 1: FLUID, ELECTROLYTES, ACID-BASE DISORDERS AND CALCIUM-PHOSPHORUS METABOLISMS
1. Evaluation of Patients with Kidney Disease 3
Anil K Agarwal, Uday Nori
Assessment of GFR 4; Assessment of Tubular Function 5; Renal Biopsy 13
2. Physiology of Urinary Concentration and Dilution and Diabetes Insipidus 15
Karen S Servilla, Antonios H Tzamaloukas
Physiology of Urinary Dilution and Concentration 15; Vasopressin Release and its Mode of Action 18;
Abnormalities of Urinary Concentration 20
3. Hyponatremia: Etiology, Pathophysiology, and Management 26
Anil K Mandal
Definition  26;  Associated Conditions  26;  Symptoms and Signs of Hyponatremia  28;
Summary of Diagnosis of Hyponatremia  32;  Key Points  36
4. Hypernatremia: Pathophysiology, Diagnosis, and Management 37
Anil K Mandal
Etiology 37; Pathophysiology 38; Management of Hypernatremia 42; Key Points 45
5. Hypokalemia: Prevention and Treatment 46
Anil K Mandal
Pathophysiology  46;  Causes of Hypokalemia  47;  Clinical Manifestations of Hypokalemia  50;
Diagnosis of the Etiology of Hypokalemia  53;  Treatment of Hypokalemia  54;
Hypokalemia in Patients with CHF  57;  Key Points  61
6. Hyperkalemia: Pathophysiology, Diagnosis, Treatment, and Prevention 62
Anil K Mandal
Decrease in K+ Excretion  62;  Increase in Potassium Load (Includes Intake)  63;
Redistribution of Potassium  64;  Other Causes of Hyperkalemia  64;  Diagnosis of Hyperkalemia  65;
Management of Hyperkalemia  66;  Key Points  68
7. Metabolic Acidosis and Metabolic Alkalosis 70
Nabil J Haddad, Anil K Agarwal
Production of Metabolic Acidosis  70;  Metabolic Alkalosis  78
8. Metabolic Alkalosis: Pathophysiology and Management 81
Anil K Mandal
Development of Metabolic Alkalosis  81;  Diagnosis  83;  Management  83;
Dosage Regimen and Side Effects 84; Treatment of Choice 85; Key Points 85
xviii Textbook of Nephrology
9. Polyuria and Diabetes Insipidus 86
Anil K Mandal
Polyuria  86;  Diabetes Insipidus  87;  Polyuria of Hypercalcemia  89;
Treatment  91;  Referral  92;  Key Points  92
10. Calcium and Phosphorus Metabolism Associated with Clinical Disorders
in Pediatric and Adult Population 94
Rajendra Bhimma, Anil K Mandal
Calcium  94;  Phosphate  105;  Key Points  109
11. Generalized Edema (Anasarca): A Systematic Approach to Diagnosis and Management 112
Anil K Mandal
Anatomy and Physiology of Edema 112; Etiologies of Edema 113;
Idiopathic Edema 114; Signs, Symptoms, and Laboratory Testing 114;
Assessment of Edema  116;  Therapeutic Options  116;  Key Points  123
SECTION 2: DIABETES
12. Diabetes: Logical Approach to Management of Diabetes with a Goal to Prevention of Complications 127
Anil K Mandal
Hindrance to Control of Hyperglycemia 127; Therapy for Diabetes 131;
Hypoglycemia  139;  Key Points  143
13. Diabetes and Sexual Dysfunction: Etiology, Pathology, and Treatment 145
Anil K Mandal
Erectile Dysfunction in Men  145;  Sexual Life in Diabetic Women  149;  Key Points  151
14. Diabetes: What does High Glucose do to Body Function? 152
Anil K Mandal
15. Nondiabetic Renal Disease in Patients with Type 2 Diabetes Mellitus 158
Jai Prakash
Prevalence of NDRD in Type 2 DM  158;  Clinical Features of NDRD in Type 2 DM  159;
Histological Lesions of NDRD in Type 2 Diabetic Patients  160;
Renal-Retinal Relationship in Proteinuric Type 2 Diabetes  161;
Management of NDRD in Type 2 Diabetic Patients  162;  Key points  164
SECTION 3: RENAL FAILURE
16. Pathophysiology, Prevention and Treatment of Progressive Renal Failure
Associated with Severe Congestive Heart Failure 169
Anil K Mandal
Pathophysiology of Renal Failure, Fluid Overload, and Electrolyte Imbalance in Severe CHF  169;
Prevention and Treatment 171; Patients’ Presentation 173
17. Acute Intrinsic Renal Failure 177
Jai Prakash
Categories of Acute Renal Failure  177;  ARF in Specific Situations  184;  Key Points  188
18. A Reversible Syndrome of Acute Renal Failure Associated with Renin-Angiotensin Inhibitor Drugs 190
Anil K Mandal
Introduction and Case Reports  190;  Key Points  197
Contents xix
19. Chronic Renal Failure: Clinical Perspective, Prevention and Nondialysis Treatment 199
Anil K Mandal
Definition and Introduction  199;  Technique  200;  Diabetes-Dialysis Business Enterprise  204;
Nondialysis Treatment of CRF 207; Key Points 213
20. Effect of Proteinuria on Renal Function in Diabetic and Nondiabetic Renal Disease 215
Anil K Mandal, Linda M Hiebert, Aswini Patnaik
Overview of Current Status of Treatment of Proteinuria  215;
Case Studies from the Authors’ Experience 217;
Overall Comments from the Case Findings 220; Key Points 222
21. Cystic Diseases of the Kidney 225
Anil K Agarwal, Soni Dhanireddy
Simple Cysts 225; Polycystic Kidney Disease 227; Tuberous Sclerosis 231;
Von Hippel Lindau (VHL) Syndrome  232;  Acquired Cystic Kidney Disease (ACKD)  233;
Other Cystic Diseases 234
22. Acute and Chronic Urinary Tract Obstruction in Adults: Pathophysiology, Diagnosis and Management 236
Anil K Mandal
Anatomy of the Urinary Tract  236;  Urinary Tract Obstruction  237;  Therapy  239;
Pathophysiology  239;  Diagnosis  240;  Diuresis Renography (or Diuretic Radionuclide Urography)  241;
Prognosis 243
23. Pathogenesis and Management of Bleeding Disorders in Renal Failure 244
Anil K Mandal
Types of Bleeding Manifestations 244; Pathophysiology 245;
Relevant Questions that may be Asked in Uremic Bleeding  246;  Therapeutic Strategies  247
24. Renal Osteodystrophy 252
Shalini Sundar, Arnold J Felsenfeld
Prevalence of Different Types of Renal Bone Disease  256;  Key Points  269
25. An Overview of Leptospirosis: Renal and Hepatic Syndrome 271
R Kasi Visweswaran
History 271; Microbiology and Taxonomy 271; Epidemiology 272; Pathology 273;
Pathogenesis 273; Clinical Features 274; Urinalysis 275; Blood Counts 275;
Liver Function Tests  275;  Renal Function Tests  275;  CSF Studies  276;
Other Investigations  276;  Serological Methods  276;  Differential Diagnosis  277;  Prevention  277;
Management 277; Prognosis 277
26. Drug Dosing in Renal Disease 279
Shiv K Seth, Megan M Bond
Estimation of Glomerular Filtration Rate  279;  Pharmacokinetic Terms  280;
Bioavailability 280; Volume of Distribution 281; Protein Binding 281;
Elimination Coefficient and Half-Life  282;  Metabolism  282;  Calculation of Loading Dose  284;
Drug Dosage Adjustment in Renal Failure 284; Dialysis 284; Diffusion 284;
Convection and Ultrafiltration  287;  Continuous Renal Replacement Therapy  287;
Continuous Ambulatory Peritoneal Dialysis  288;  Drug-induced Nephrotoxicity  291;
Aminoglycosides  291;  Angiotensin-Converting Enzyme (ACE) Inhibitors  291;
Amphotericin B  291;  Nonsteroidal Anti-inflammatory Agents  292;  Cisplatin  293;
Cyclosporine  293;  Radiographic Contrast Media  293;
Drug-induced Crystal Formation and Nephrolithiasis  293
xx Textbook of Nephrology
SECTION 4: HYPERTENSION
27. An Approach to a Patient with Hypertension 297
Anil K Mandal
Classification of High Blood Pressure  297;  Outcome of Undetected and Uncontrolled Hypertension  297;
Systematic Approach to a Patient with Hypertension  300;  Focus  305;  Key Points  312
28. Pregnancy-related Renal Diseases and Hypertension 315
R Kasi Visweswaran, Jacob George
Hypertensive Diseases in Pregnancy  316;  Pathophysiology of Preeclampsia/Eclampsia  317;
Acute Renal Failure in Pregnancy 322; Urinary Tract Infections in Pregnancy 323;
Pregnancy in Pre-existing Renal Disease  324;  Pregnancy and Dialysis  326;
Pregnancy following Renal Transplantation  326
29. Renovascular Disease 329
Ricardo Paz-Fumagalli
Pathophysiology  329;  Epidemiology  331;  Diagnostic Testing  331;
Management of Renovascular Disease 335; Fibromuscular Dysplasia 340; Key Points 340
SECTION 5: GLOMERULAR DISEASE
30. Poststreptococcal Glomerulonephritis 345
JP Tiwari, Kedareshwar PS Narvencar
Pathogenesis  345;  Pathology  346;  Clinical Features  346;
Differential Diagnosis 347; Key Points 347
31. Nephrotic Syndrome 349
JP Tiwari, Kedareshwar PS Narvencar
Pathogenesis  349;  Classification  352;  Clinical Features  353;
Treatment  353;  Who Develops Renal Disease?  362
32. Tuberculosis of the Kidney 365
Jai Prakash, Biplab Ghosh
Etiologic Agent  365;  Epidemiology  365;  Pathogenesis  366;  Pathology  367;
Clinical Features  368;  Diagnosis  369;  Imaging  371;  Differential Diagnosis  371;
Management 372; Key Points 374
SECTION  6: STONE DISEASE
33. Urinary Stones 379
Anil K Agarwal, Christopher Valentine
Pathophysiology of Stone Formation  379;  Diagnosis  382;  Management  384
SECTION 7: DIALYSIS AND TRANSPLANTATION
34. Technique, Practice and Complications of Hemodialysis 393
Yijuan Sun, Karen S Servilla and Antonios H Tzamaloukas
Principles and Technique of Hemodialysis  393;  Hemodialysis Practice  397;
Complications of Hemodialysis  398
Contents xxi
35. Principles of Peritoneal Dialysis: Management and Complications 406
Jose A Diaz-Buxo, Rainer Himmele
Physiology of the Peritoneal Membrane  406;  Peritoneal Solute and Water Transport  407;
Assessment of Peritoneal Membrane Characteristics 407; Peritoneal Dialysis Access 408;
Peritoneal Dialysis Solutions  409;  Modalities of Peritoneal Dialysis  409;
Adequacy and Measurement of Dialysis Dose  411;  Dialysis Prescription  412;
Complications of Peritoneal Dialysis 413; Clinical Outcome 417
36. Immunologic Concepts of Renal Transplantation 423
Sanjay K Agarwal
Protein and Related Substances 423; Immunoglobulins 424;
The Major Histocompatibility Complex  425;  B-Cell Receptor and Antibody  426;
T-Cell Receptor (TCR)  426;  T-Cell Triggering  427;  Specific Immune Responses of T Cells and B Cells  430;
The Adhesion Molecules 431; Endothelial Cells 431; IFN-g Production and Regulation 431;
Target Injury; 432; Outcome of Allograft 432; Rejection 432; Graft Adaptation 433;
Drug Modification of Immune Response  434;  Azathioprine  435;
Prodrugs of Mycophenolic Acid (MPA)  435;  Leflunomide  435;  Key Points  436
37. Diagnosis and Management of Post-transplant Medical and Surgical Complications 438
Vinay Malhotra, Pankaj Beniwal
Surgical Complications 438; Vascular Complications 438; Urologic Complications 440;
Hematuria 441; Gastrointestinal Complications 441; Infectious Complications 441;
Common Infections Post-transplant 442; Hypertension 447; Metabolic Complications 447;
Hematologic Disorders  448;  Bone Metabolism and Disease  449;  Malignancies  449;
Key Points 450; List of Abbreviations 452
38. Postrenal Transplantation Late Complications Including Rejection 453
Todd E Pesavento
Immunosuppressive Agents 453; Acute Rejection 457; Chronic Allograft Dysfunction 458;
Transplantation of Incompatible Recipients  459;  Hypertension  460;  Diabetes Mellitus  461;
Post-transplant Bone Loss  462;  Infectious Complications  463;  Polyomavirus  464;
Post-transplant Lymphoproliferative Disorders  465;  Key Points  466
SECTION 8: PEDIATRIC POPULATION
39. Management of Urinary Tract Infection in Pediatrics 469
Udai K Kala
Classification of Urinary Tract Infection  469;  Pathogenesis  470;
Clinical Features of Urinary Tract Infection 471; Management of Urinary Tract Infection; 472;
Key Points 475
Index 479