Manual of Clinical Nephrology of the Rogosin Kidney Center
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1. Evaluation of patients with renal disease.- 1. Introduction.- 2. Identifying Renal Disease.- 2.1. History.- 2.2. Family history.- 2.3. Physical examination.- 2.4. Urinalysis.- 2.5. The chemical data base.- 2.6. Radiologic techniques.- 2.7. Percutaneous renal biopsy.- 2.8. Risks and cost of procedures.- 3. Syndromes of Renal Disease.- 3.1. Acute renal failure.- 3.2. Chronic renal failure.- 3.3. Acute nephritic syndrome.- 3.4. Nephrotic syndrome.- 3.5. Urinary tract infection.- 3.6. Obstructive nephropathy.- 3.7. Renal tubular dysfunction.- 3.8. Nephrolithiasis.- 3.9. Accelerated hypertension...
1. Evaluation of patients with renal disease.- 1. Introduction.- 2. Identifying Renal Disease.- 2.1. History.- 2.2. Family history.- 2.3. Physical examination.- 2.4. Urinalysis.- 2.5. The chemical data base.- 2.6. Radiologic techniques.- 2.7. Percutaneous renal biopsy.- 2.8. Risks and cost of procedures.- 3. Syndromes of Renal Disease.- 3.1. Acute renal failure.- 3.2. Chronic renal failure.- 3.3. Acute nephritic syndrome.- 3.4. Nephrotic syndrome.- 3.5. Urinary tract infection.- 3.6. Obstructive nephropathy.- 3.7. Renal tubular dysfunction.- 3.8. Nephrolithiasis.- 3.9. Accelerated hypertension.- 4. Conclusion.- 2. Disorders of water, sodium and potassium metabolism.- 1. Maintenance of Osmotic Homeostasis.- 1.1. General considerations.- 1.2. Free-water clearance.- 1.3. Renal concentrating and diluting mechanisms.- 1.4. Antidiuretic hormone.- 1.5. Summary of requirements for maximum water diuresis $$\left( {{C_{{H_2}O}}} \right)$$.- 2. Clinical States Associated with Hypo-osmolality.- 2.1. True dilutional hyponatremia.- 2.2. Renal failure.- 2.3. Decreased delivery of filtrate to diluting segment of the nephron.- 2.4. Syndrome of inappropriate ADH (SIADH).- 2.5 Drugs associated with impaired free-water clearance.- 2.6. Endocrine deficiencies.- 2.7. Reset osmostat.- 2.8. Summary of the diagnostic approach to hyponatremia.- 3. Hypernatremia and Disorders of Urine Concentration.- 3.1. Low circulating levels of ADH.- 3.2. Renal tubular hyporesponsiveness to ADH (nephrogenic diabetes insipidus).- 3.3. Diagnostic approach to the patient with a disorder of urinary concentration.- 4. Disorders of Sodium Metabolism.- 4.1. Determinants of renal sodium excretion.- 4.2. Sodium retaining states (edema).- 4.3. Diuretic therapy.- 5. Disorders of Potassium Metabolism.- 5.1. Internal potassium balance.- 5.2. External potassium balance.- 5.3. Hyperkalemia.- 5.4. Hypokalemia.- 3. Acid-base disturbances.- 1. Introduction.- 1.1. Physiologic buffers.- 1.2. Respiratory control of pH.- 1.3. Renal control of H + excretion.- 1.4. Clinical definitions.- 1.5. Diagnostic approach.- 2. Metabolic Acidosis.- 2.1. Anion gap.- 2.2. Metabolic acidosis with an increased anion gap.- 2.3. Metabolic acidosis associated with a normal anion gap (hyperchloremic).- 2.4. Treatment of metabolic acidosis.- 3. Metabolic Alkalosis.- 3.1. Metabolic alkalosis associated with low urinary Cl -.- 3.2. Metabolic alkalosis associated with normal or increased urinary Cl -.- 3.3. Treatment of metabolic alkalosis.- 4. Respiratory Alkalosis.- 5. Respiratory Acidosis.- 6. Mixed Acid-Base Disorders.- 4. Glomerulonephropathies.- 1. Introduction.- 2. Asymptomatic Urinary Abnormalities.- 2.1. Hematuria.- 2.2. Asymptomatic proteinuria.- 2.3. Asymptomatic proteinuria and hematuria.- 3. Nephrotic Syndrome.- 3.1. Definition.- 3.2. Pathogenesis of proteinuria.- 3.3. Patient presentation and evaluation.- 3.4. Clinicopathological correlation.- 4. Acute Nephritic Syndrome.- 4.1. Definition.- 4.2. Patient presentation and evaluation.- 4.3. Clinicopathological correlation.- 4.4. Management of acute nephritic syndrome.- 4.5. Prognosis.- 5. Rapidly Progressive Glomerulonephritis (RPGN).- 5.1. Definition.- 5.2. Patient presentation and evaluation.- 5.3. Clinicopathological correlation.- 6. Chronic Nephritic Syndrome.- 6.1. Definition.- 6.2. Patient presentation and evaluation.- 7. Glomerulonephritis and Systemic Disease.- 7.1. Metabolic and inherited diseases.- 7.2. Hereditary nephritis.- 7.3. Infectious disease.- 7.4. Toxic nephropathy.- 7.5. Collagen vascular disease.- 7.6. Dysproteinemias.- 7.7. Pregnancy.- 5. Urinary tract infection and pyelonephritis.- 1. Prevalence.- 1.1. Overall incidence.- 1.2. Prevalence of urinary tract infection in children.- 1.3. Prevalence of urinary tract infection in adults.- 2. Clinical Significance of Bacteriuria.- 2.1. Pregnancy and urinary tract infection.- 2.2. Hypertension and urinary tract infection.- 2.3. Diabetes and urinary tract infection.- 2.4. Bacteriuria in non-pregnant women.- 2.5. Bacteriuria in children.- 2.6. Bacteriuria in men.- 2.7. Nosocomial urinary tract infections.- 3. Pathogenesis.- 3.1. Local barriers of invasion.- 3.2. Cervico-vaginal antibodies.- 3.3. Uroepithelial antibodies.- 3.4. Systemic antibody response.- 3.5. Other mechanisms.- 3.6. Vesicoureteral valve.- 4. Etiology.- 4.1. Bacterial infection.- 4.2. Fungal infections.- 4.3. Viral infection.- 5. Clinical Manifestations.- 6. Diagnosis.- 6.1. Urine collection.- 6.2. Microscopic examination.- 6.3. Localization.- 7. Management.- 7.1. Asymptomatic bacteriuria.- 7.2. Acute pyelonephritis.- 7.3. Recurrent infections.- 7.4. Antibiotics.- 7.5. Prophylaxis.- 6. Tubulo-interstitial nephritis.- 1. Hereditary Kidney Diseases.- 1.1. Medullary cystic disease.- 1.2. Medullary sponge kidney.- 1.3. Hereditary familial nephritis (Alport¿s syndrome).- 2. Metabolic Kidney Diseases.- 2.1. Hypercalcemia.- 2.2. Hypokalemia.- 2.3. Oxalate nephropathy.- 2.4. Gouty nephropathy.- 3. Hematologic Diseases.- 3.1. Hemolytic-uremic syndrome.- 3.2. Sickle cell anemia.- 4. Vascular Diseases.- 5. Neoplastic Diseases.- 6. Infections.- 7. Immunological Diseases.- 7.1. Antitubular basement membrane antibodies.- 7.2. Immune complex interstitial nephritis.- 7.3. Reflux nephropathy.- 7.4. Drug-related interstitial nephritis.- 7.5. Renal allografts.- 7.6. Sj¿gren¿s syndrome.- 8. Analgesic Nephropathy.- 8.1. Aspirin.- 8.2. Phenacetin.- 8.3. Pathology.- 8.4. Pathogenesis.- 8.5. Clinical manifestations.- 9. Heavy Metals.- 10. Balkan Nephropathy.- 11. Radiation Nephritis.- 7. Cystic diseases of the kidney.- 1. Introduction.- 2. Cystic Dysplasia.- 2.1. Renal aplasia.- 2.2. Congenital multicystic kidney.- 2.3. Pathology.- 2.4. Etiology and pathogenesis.- 2.5. Clinical presentation.- 2.6. Diagnosis.- 2.7. Prognosis and therapy.- 3. Polycystic Disease.- 3.1. Infantile polycystic disease.- 3.2. Adult polycystic disease.- 4. Medullary Cysts of the Kidney.- 4.1. Medullary sponge kidney.- 4.2. Medullary cystic disease.- 4.3. Renal-retinal dysplasia.- 5. Cysts of the Renal Cortex.- 6. Renal Cysts in Hereditary Syndromes.- 8. Urolithiasis.- 1. Introduction.- 2. Pathogenesis of Stone.- 3. Diagnosis of Stone Disease.- 3.1. History.- 3.2. Physical examination.- 3.3. Urinalysis.- 3.4. Radiography.- 4. Management of Stone Disease.- 4.1. General principles.- 4.2. Identification of anatomic or metabolic disorders.- 4.3. Fluid intake.- 4.4. Diet.- 4.5. Urinary tract infection.- 4.6. Classification of stone activity.- 5. Cystine Stones.- 6. Uric Acid Stones.- 7. Xanthine Stones.- 8. Calcium Stones.- 8.1. Hypercalciuria.- 8.2. Other causes of calcium stone formation.- 9. The Evaluation of the Recurrent Stone Former.- 10. Timing of Surgical Intervention.- 9. Drug-related nephropathy.- 1. Introduction.- 2. Acute Tubular Necrosis.- 2.1. Predisposing factors.- 2.2. Incidence.- 2.3. Clinical features.- 3. Tubulo-Interstitial Disease.- 3.1. Acute tubulo-interstitial disease.- 3.2. Chronic tubulo-interstitial disease.- 4. Glomerulonephritis, Nephrotic Syndrome and Vasculitis.- 4.1. Acute glomerulonephritis.- 4.2. Chronic glomerulopathy.- 4.3. Vasculitis.- 5. Hemolytic-Uremic Syndrome.- 6. Obstructive Uropathy.- 7. Fluid, Electrolyte and Acid-Base Disorders.- 7.1. Antidiuresis and dilutional hyponatremia.- 7.2. Diabetes insipidus.- 7.3. Potassium imbalance.- 7.4. Acid-base imbalance.- 10. Acute renal failure.- 1. Clinical Recognition of Acute Renal Failure.- 1.1. Urine volume.- 1.2. Azotemia.- 1.3. Urine sediment.- 1.4. Urine chemistries.- 1.5. Radiologic investigation.- 2. Management of ARF.- 2.1. Prevention.- 2.2. Established parenchymal ARF.- 3. The Recovery Phase.- 11. Chronic renal failure.- 1. Introduction.- 2. Pathophysiology of Chronic Renal Failure.- 2.1. Compensatory growth.- 2.2 Adaptive mechanisms.- 3. Uremia.- 3.1. Pathogenesis of uremia.- 3.2. Uremic complications.- 4. Preparation for Dialysis and Transplantation.- 12. Renal hypertension.- 1. Renovascular Hypertension.- 1.1. Renal artery stenosis.- 1.2. Hypertension in other forms of unilateral renal disease.- 2. Acute Renal Failure.- 2.1. Acute glomerulonephritis.- 2.2. Ischemic and nephrotoxic acute renal failure.- 2.3. Obstructive uropathy.- 3. Chronic Renal Failure.- 3.1. Sodium-volume factors.- 3.2. Vasoconstrictor factors.- 4. Transplantation.- 4.1. Persistence of pre-transplant hypertension¿The role of the recipient¿s kidneys.- 4.2. Acute rejection.- 4.3. Corticosteroids.- 4.4. Transplant renal artery stenosis.- 4.5. Hypercalcemia.- 4.6. Chronic rejection.- 5. Pharmacologic Therapy of Hypertension in Renal Disease.- 5.1. Diuretics.- 5.2. Beta-adrenergic blockers.- 5.3. Drugs acting on the central nervous system.- 5.4. Vasodilators.- 5.5. Parenteral drugs for hypertensive emergencies.- 13. Divalent ion metabolism and renal osteodystrophy.- 1. Introduction.- 2. Metabolism of Vitamin D.- 3. Pathogenesis of Abnormalities in Divalent Ion Metabolism in Chronic Renal Failure.- 3.1. Phosphate retention.- 3.2. Bone resistance to the calcemic effect of parathormone.- 3.3. Abnormalities in Vitamin D metabolism.- 4. Clinical Consequences of Abnormal Calcium and Phosphate Metabolism.- 4.1. Skeletal abnormalities.- 4.2. Non-skeletal complications.- 5. Management.- 5.1. General guidelines for therapy.- 5.2. Control of phosphorus.- 5.3. Vitamin D therapy.- 5.4. Calcium supplementation.- 5.5. Other medical therapy.- 5.6. Subtotal parathyroidectomy.- 6. Post-Transplant Mineral Homeostasis.- 7. Mineral Homeostasis in Acute Renal Failure.- 8. Mineral Replacement Therapy.- 8.1. Calcium and magnesium.- 8.2. Phosphorus.- 14. Dialysis treatment.- 1. Introduction.- 2. Hemodialysis.- 2.1. Principles of hemodialysis.- 2.2. Indications for dialysis.- 2.3. Type of dialyzer.- 2.4. Fluid delivery systems.- 2.5. Acute problems during dialysis treatment.- 2.6. Chronic problems in hemodialysis.- 2.7. Options in types of hemodialysis.- 2.8. General management of hemodialysis patients.- 2.9. Medication for dialysis patients.- 2.10. Acute hemodialysis.- 3. Peritoneal Dialysis.- 3.1. Peritoneal membrane characteristics.- 3.2. Peritoneal dialysate.- 3.3. Permanent peritoneal catheters.- 3.4. Automated peritoneal dialysis devices.- 3.5. Management of peritoneal dialysis patients.- 3.6. Complications of peritoneal dialysis.- 3.7. Continuous ambulatory peritoneal dialysis.- 4. Conclusion.- 15. Kidney transplantation.- 1. Introduction.- 2. Donors and Recipients.- 2.1. Living related donors.- 2.2. Cadaveric donors.- 2.3. Recipients.- 3. Immunological Aspects of Renal Transplantation.- 3.1. Human major histocompatibility complex.- 3.2. Genetic and inheritance patterns of the MHC.- 3.3. Identification of HLA- A, B, C antigens.- 3.4. Identification of DRw antigens.- 3.5. Mixed lymphocyte culture.- 3.6. Role of HLA antigens in renal transplantation.- 3.7. Role of ABO blood group antigens in renal transplantation.- 3.8. In vitro techniques to detect alloimmunity.- 4. Medical Management of the Transplant Recipient.- 4.1. Pre-transplant evaluation.- 4.2. Immunosuppressive therapy.- 4.3. Post-transplant management.- 4.4. Immunologic problems.- 4.5. Results and factors affecting transplantation.- 4.6. Immunologic monitoring of the renal allograft recipient.- 5. Complications.- 5.1. Primary non-function.- 5.2. Urinary leakage.- 5.3. Lymphocele.- 5.4. Infections.- 5.5. Hypertension.- 5.6. Lipid abnormalities.- 5.7. Gastrointestinal system.- 5.8. Bone disease.- 5.9. Malignancy.- 5.10. Recurrence of the original disease in renal grafts.- 5.11. Miscellaneous complications.- 6. Future Prospects.- 16. Dialysis and transplantation: dietary management.- 1. Dietary Management for Patients with Chronic Renal Failure Not Treated with Dialysis.- 1.1. General principles.- 1.2. Protein intake.- 1.3. Caloric supply.- 1.4. Fluid, sodium and potassium intake.- 1.5. Vitamin supplements.- 1.6. Mineral requirements.- 2. Dietary Management for Patients with Chronic Renal Failure Treated with Dialysis.- 2.1. Dietary protein intake for patients treated with hemodialysis.- 2.2. Dietary protein intake for patients treated with peritoneal dialysis.- 2.3. Caloric requirements during maintenance dialysis.- 2.4. Vitamin requirements during maintenance dialysis.- 2.5. Anabolic steroids.- 2.6. Management of inadequate protein and caloric intake.- 2.7. Evaluation of adequate dietary intake.- 3. Dietary Management for Patients with Acute Renal Failure.- 4. Parenteral Nutrition.- 17. Dialysis and transplantation: psychological management.- 1. Introduction.- 2. The Advent of Terminal Renal Failure.- 2.1. Minimization and denial.- 2.2. Hypervigilant behavior.- 3. The Meaning of Hemodialysis and its Impact upon Adaptation.- 4. The Process of Adaptation.- 5. Transplantation.- 6. Personality Types and Medical Management.- 6.1. The non-compliant denying patient and the need to accept limitations.- 6.2. The dependent clinging patient and the need to set limits.- 6.3. The entitled demanding patient and the need to allow the patient some control.- 7. Specific Clinical Syndromes and their Management.- 7.1. Painful feeling states.- 7.2. Organic brain syndrome and functional psychosis.- 18. Dialysis and transplantation: surgical management.- 1. Introduction.- 2. General Principles.- 2.1. Timing of surgery.- 2.2. Anemia.- 2.3. Hypertension.- 2.4. Corticosteroids.- 2.5. Operative and postoperative fluid management.- 2.6. Hemostasis.- 2.7. Postoperative dialysis.- 2.8. Wound healing.- 3. Anesthetic Management.- 3.1. General evaluation.- 3.2. Choice of agents.- 4. Surgical Aspects of Dialysis.- 4.1. Peritoneal dialysis.- 4.2. Hemodialysis.- 5. Surgical Considerations of Transplant Candidates.- 5.1. Indications for pre-transplant nephrectomy and ureterectomy.- 5.2. Indications for pre-transplant lower urinary tract corrective surgery.- 6. Cadaveric Kidneys.- 6.1. Cadaveric donors.- 6.2. Cadaveric nephrectomy.- 6.3. Cadaveric kidney storage.- 7. Surgical Aspects of Renal Transplantation.- 7.1. Transplant procedure.- 7.2. Surgical problems following transplantation.- 19. Drug metabolism and dose adjustment in patients with renal failure.- 1. Drug Metabolism in Uremia.- 1.1. Biotransformation.- 1.2. Effect of renal failure.- 1.3. Retention of active drug metabolites.- 1.4. Retention of inactive metabolites.- 2. Dose Adjustment in Renal Failure.- 2.1. Antimicrobial drugs.- 2.2. Urinary antiseptics.- 2.3. Antimycotic drugs.- 2.4. Antituberculosis drugs.- 2.5. Antimalarial drugs.- 2.6. Diuretics.- 2.7. Antihypertensive drugs.- 2.8. Drugs acting on the heart.- 2.9. Antiarthritic drugs.- 2.10. Analgesic drugs.- 2.11. Anticonvulsant drugs.- 2.12. Immunosuppressive drugs.- 2.13. Hypoglycemic drugs.- 2.14. Anticoagulants.- 3. Dialysis of Drugs and Poisons.- Appendices.- 1. Composition of Electrolyte and Colloid Solutions.- 2. Normal Arterial Blood Pressure.- 3. Nomogram for Estimation of Endogenous Creatinine Clearance.- 4. Nomogram for Calculating the Body Surface Area of Adults.- 5. Conversion Tables.- Temperature.- Weight.- Height.- 6. WHO Nomenclature for Factors of the HLA System.- 7. Elements and Atomic Weights.- 8. Normal Chemical Values of Body Fluids.
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