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Renal Disease—Prevention and Management—A Physician’s Perspective
OP Kalra
1:
Assessment of Renal Function
URINE ANALYSIS
I. Physical Features
II. Chemical Features
Detection of Proteinuria
Quantitative Evaluation of Proteinuria
Qualitative Evaluation of Proteinuria
Selectivity of Proteinuria
Microalbuminuria
Enzymuria
III. Urine Microscopy
CLINICAL ASSESSMENT OF RENAL FUNCTION
Measurement of Renal Blood Flow (RBF) and Renal Plasma Flow (RPF)
Glomerular Filtration Rate
Assessment of Functions of the Proximal Tubule
Assessment of Functions of the Distal Tubule
SUMMARY
2:
Assessment of Renal Reserve
SUMMARY
3:
Approach to a Patient with Proteinuria and Hematuria
PROTEINURIA (Fig. 1)
Bence Jones Proteinuria
Postural Proteinuria (Orthostatic Proteinuria)
Common Causes of Abnormal Proteinuria
Glomerular Proteinuria
Tubular Proteinuria
Overflow Proteinuria
Proteinuria in a Child / Young Adult
Proteinuria in Adults Between 25 to 55 years
Proteinuria in the Elderly
Proteinuria with Persistent Microscopic Hematuria
Heavy Proteinuria
HEMATURIA (Fig. 2)
Differentiating Characteristics of Glomerular and Non-glomerular Hematuria
Patterns of Hematuria
Causes of Hematuria
Glomerular Diseases
Vascular and Tubulo-interstitial Diseases
Renal Pelvis, Ureters, Urinary Bladder and Urethra
Systemic Disorders
Evaluation of Hematuria
Exercise Related Hematuria – ‘Jogger's Nephritis’
Hematuria in Children and Young Adults
Hematuria in Older Patients
Hematuria in Tropical and Developing Countries
Acute Macroscopic Hematuria with Proteinuria
Recurrent Macroscopic Hematuria, with or without Proteinuria
SUMMARY
4:
Approach to a Patient with Fluid and Electrolyte Imbalance
DISORDERS OF SODIUM BALANCE
Hyponatremia
Hypernatremia
DISORDERS OF POTASSIUM BALANCE
Hypokalemia5,9,10
Hyperkalemia
DISORDERS OF FLUID STATUS
Extracellular Fluid (ECF) Volume Excess
Extracellular Fluid (ECF) Volume Depletion
SUMMARY
5:
Approach to Acid Base Disorders
OXYGENATION
VENTILATION
ACID BASE STATUS
a. Buffers
b. Acid Base Disorders
STEPWISE APPROACH TO DIAGNOSING ACID BASE DISORDERS
SUMMARY
6:
Nephrotic Syndrome
CLINICAL PRESENTATION
ETIOLOGY
INVESTIGATIONS
MANAGEMENT
Dietary Sodium
Diuretics
Reduction of Proteinuria
SPECIFIC MANAGEMENT OF PRIMARY GLOMERULOPATHY
Childhood Onset Nephrotic Syndrome
Definitions
Focal Segmental Glomerulosclerosis (FSGS)
Membranous Glomerulonephritis (MGN)
Membranoproliferative Glomerulonephritis (MPGN)
Factors Heralding a Poor Prognosis in MPGN
COMPLICATIONS OF NEPHROTIC SYNDROME
Infections
Thromboembolic Complications
Dyslipidemia
Malnutrition
SUMMARY
7:
Acute Glomerulonephritis
ACUTE NEPHRITIC SYNDROME
Clinical Presentation
Outcome
Conditions Associated with Acute Nephritic Syndrome
Mechanisms of Glomerular Injury
Response to Glomerular Injury
Investigations
Morphological Patterns
1. Diffuse Proliferative GN
2. Focal Proliferative GN
3. Crescentic GN
4. Mesangial Proliferative GN
5. Membranoproliferative GN
Treatment
RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS
POST-INFECTIOUS GLOMERULONEPHRITIS
Epidemiology
Pathogenesis
Pathology
Clinical Aspects
Diagnosis
Treatment
Outcome
SUMMARY
8:
Rapidly Progressive Glomerulonephritis
EPIDEMIOLOGY
PROCESS OF CRESCENT FORMATION
CLINICAL FEATURES
CLASSIFICATION
Anti-glomerular Basement Membrane Disease
Immune Complex-mediated Crescentic Glomerulonephritis
Special Situations
Pauci-immune Crescentic Glomerulonephritis
SUMMARY
9:
Pregnancy and Renal Disease
ANATOMIC AND FUNCTIONAL CHANGES IN KIDNEY DURING PREGNANCY
Renal Hemodynamics
Acid Base Regulation
Water Metabolism
Volume Regulation
Blood Pressure Regulation
Mineral Metabolism
KIDNEY DISEASE IN PREGNANCY
CHRONIC KIDNEY DISEASE IN PREGNANCY
Kidney Diseases Associated with Systemic Illness
Diabetes Mellitus
Lupus Nephritis
Chronic Glomerulonephritis
Polycystic Kidney Disease
Urinary Tract Infection
Chronic Pyelonephritis
Kidney Diseases that Develop for the First Time during Pregnancy
Acute Kidney Injury
Thrombotic Microangiopathy
Bilateral Renal Cortical Necrosis
Acute Fatty Liver of Pregnancy
HYPERTENSIVE DISORDERS OF PREGNANCY
Classification
Pre-eclampsia
Management
Prevention
Chronic Hypertension
Gestational Hypertension
SUMMARY
10:
Preventive Strategies for Diabetic Nephropathy
EPIDEMIOLOGY
STAGES AND CLINICAL CHARACTERISTICS
SCREENING
PRIMARY PREVENTION (Normoalbuminuric Patients)
Control of Hyperfiltration
Strict Blood Glucose Control
Strict Blood Pressure Control
SECONDARY PREVENTION (Patients with micro- and macroalbuminuria)
Strict Blood Glucose Control
Choice of Antidiabetic Drugs
Strict Blood Pressure Control
Dual Blockade of RAAS
Role of Aldosterone Antagonists
Role of Diuretics
Role of Calcium Channel Blockers
Dietary Intervention
Dyslipidemia
Anemia
Role of Aspirin
Cessation of Smoking
Multifactorial Approach
Novel Therapeutic Strategies
SUMMARY
11:
Management of Hyperglycemia in Diabetic Nephropathy
INTRODUCTION
Effect of DN on Insulin Kinetics and Blood Glucose
Principles of Anti-diabetic Treatment In Dn and Renal Failure
SELECTION OF OADs IN DN
Sulfonylurea Compounds (Glipizide, Gliclazide)
Meglitinide Analogues (Repaglinide and nateglinide)
Thiazolidinediones (Pioglitazone and Rosiglitazone)
Biguanides (Metformin)
α-glucosidase Inhibitors (Acarbose)
Insulin Therapy in DN (Insulin and Insulin Analogues)
Role of Insulin Analogs in Diabetic Nephropathy
Risk of Hypoglycemic Episodes in DN
Monitoring of Blood Glucose Levels in DN
HbA1c Levels in DN and CRF
SUMMARY
12:
Chronic Tubulointerstitial Diseases
EPIDEMIOLOGY
PATHOGENESIS
PATHOLOGY
CLINICAL MANIFESTATIONS
TREATMENT
ETIOLOGICAL FACTORS
Hematopoietic Disorders
Heavy Metal Nephropathy
Vascular Diseases
Immunological Diseases
Metabolic Disorders
SUMMARY
13:
Drug Induced Renal Disease
SUMMARY
14:
Cystic Diseases of the Kidney
INTRODUCTION
DEVELOPMENT
AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD)
Epidemiology
Genetics and Pathophysiology
Pathology
Clinical Presentation
Renal Manifestations
Extrarenal Manifestations
Diagnosis
Imaging Techniques
Genetic Analysis
Future Directions
AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE (ARPKD)
Definition
Genetics
Pathology
Clinical Features
Diagnosis
Treatment
Counseling
MEDULLARY CYSTIC DISEASE AND NEPHRONOPHTHISIS
Nephronophthisis (NPH)
Medullary Cystic Kidney Disease (Mckd)
MEDULLARY SPONGE KIDNEY (MSK)
Etiology
Clinical Features
Pathology
Diagnosis
Treatment
TUBEROUS SCLEROSIS COMPLEX (TSC)
Introduction
Genetics
Clinical Features
Diagnosis
Treatment
SIMPLE CYSTS
Etiology
Clinical Features
Pathology
Diagnosis
Treatment
SUMMARY
15:
Approach to a Patient with Urinary Tract Infection
DEFINITIONS
A. Significant Bacteriuria
B. Recurrent Infection (Relapse, Reinfection, Treatment Failure)
C. Complicated and Uncomplicated UTI
ETIOLOGY
Bacterial Pathogens
Fungal Pathogens
Other Pathogens
PATHOGENESIS
LABORATORY DIAGNOSIS
A. Urine Culture
B. Microscopic Examination of Urine
C. Biochemical Tests for Bacteriuria
D. Localization of the Site of Infection
E. Special Investigations
TREATMENT OF UTI
A. Principles of Therapy and Follow up
B. Treatment of Asymptomatic Bacteriuria
C. Treatment of Uncomplicated Cystitis
D. Treatment of Acute Bacterial Pyelonephritis
E. Treatment of Prostatitis
F. Management of Recurrent Urinary Tract Infections
Recommendations for the Care of Urinary Catheters
Catheter-associated Infections
SUMMARY
16:
Urinary Infections in Diabetes Mellitus
CLASSIFICATION OF UTI
Based on Type of Infections
Based on Location of Infection
PATHOGENESIS OF UTI IN DM
Mechanisms that Predispose to UTI in Diabetes
Causative Micro-organisms
CHARACTERISTIC FEATURES OF UTI IN DM
CLINICAL FEATURES OF UTI IN DM
1. Asymptomatic Bacteriuria
2. Acute Pyelonephritis
3. Emphysematous Urinary Tract Disease
4. Renal Abscess
5. Renal Papillary Necrosis (RPN)
6. Perinephric Abscess
7. Urinary Tract Candidiasis
8. Mucormycosis
9. Renal Tuberculosis
10. Prostatic Abscess
TREATMENT
Upper UTI in DM
Lower UTI in DM
Treatment of Urinary Tract Infections in Patients With Impaired Renal function
UTI in Postmenopausal Women
Relapse of UTI
SUMMARY
17:
Tuberculosis in Patients with Chronic Kidney Disease
INTRODUCTION
IMMUNE ABNORMALITIES IN CKD
INCIDENCE
CLINICAL PRESENTATION
TREATMENT
TUBERCULAR PERITONITIS IN PATIENTS ON CHRONIC PERITONEAL DIALYSIS (CAPD)
CHEMOPROPHYLAXIS
SCREENING FOR TUBERCULOSIS
SUMMARY
18:
HIV and Renal Disease
INTRODUCTION
HIV AS A RISK FACTOR FOR RENAL DISEASE
Early Detection and Screening for HIV Renal Disease
Prevention: Tackling the Problems
HIV RELATED KIDNEY DISEASE IN THE HOSPITAL SETTING
Approach to HIV Renal Disease in the Hospital Setting
Indirect HIV Related Kidney Disease
Acute Tubular Necrosis
Acute Interstitial Nephritis
Urinary Tract Tuberculosis
Crystalluria
Direct HIV Related Renal Involvement
HIV-associated Nephropathy (HIVAN)
HIV Immune Complex Kidney Disease (HIVICK)
Other Glomerular Diseases in HIV
Dialysis and Transplantation in HIV Patients
SUMMARY
19:
Preventive Strategies for Acute Kidney Injury
ETIOLOGY
Pre-renal Causes
Post-renal Causes
Intrinsic Causes
Spectrum of AKI
PATHOGENESIS
CLINICAL FEATURES
DIAGNOSIS
Pre-renal Azotemia versus ATN
AKI versus Acute on Chronic Renal Failure
Urinalysis
Role of Renal Biopsy
PREVENTION
Volume Expansion
Role of Reno-protective Substances
MANAGEMENT
Fluid and Electrolyte Balance
Hyperkalemia
Metabolic Acidosis
Nutrition
Bleeding
Infection
Role of Dialysis
Role of Continuous Renal Replacement Therapy
PROGNOSIS
ACUTE CORTICAL NECROSIS
SUMMARY
20:
Acute Kidney Injury in Intensive Care Unit
CHANGING EPIDEMIOLOGY OF AKI
AKI IN CRITICALLY ILL PATIENTS ADMITTED TO THE ICU
Causes of AKI in ICU Versus non-ICU Patients
EFFECT OF INTENSIVE CARE ON RENAL FUNCTIONS
Renal Effects of Shock and Vasoactive Drugs
Effects of Mechanical Ventilation on Renal function
Effects of Sepsis on Renal function
EFFECTS OF RENAL FAILURE ON OTHER ORGANS IN CRITICALLY ILL PATIENTS
Physiologic Consequences of AKI on Critically Ill Patients
Water, Electrolytes and Acid-base Disturbance
Increased Inflammation and Decreased Immunity
Infection
PREVENTION OF ACUTE KIDNEY INJURY IN ICU
Maintenance of Adequate Intravascular Volume Status
Exposure to Nephrotoxins
Maintenance of Renal Perfusion and Role of Vasopressors
RENAL REPLACEMENT THERAPY FOR AKI IN ICU
Changing Approach of Dialysis in ICU
Modality of Renal Replacement Therapy
Peritoneal Dialysis
Intermittent Hemodialysis
Continuous Renal Replacement Therapy (CRRT)
Sustained Low-efficiency Dialysis or Extended Daily Dialysis
CRRT vs IHD vs SLED
SUMMARY
21:
Approach to a Patient with Acute on Chronic Renal Failure
RATE OF PROGRESSION OF CHRONIC RENAL INSUFFICIENCY
Relationship of Serum Creatinine and GFR
WHEN TO SUSPECT ACUTE ON CHRONIC RENAL FAILURE?
VARIOUS STIGMATA SUGGESTIVE OF CHRONICITY OF RENAL FAILURE INCLUDE
ROLE OF REVERSIBLE AGGRAVATING FACTORS
1. Extracellular Fluid Volume Depletion
2. Salt and Fluid Overload and Congestive Heart Failure
3. Accelerated Hypertension
4. Hypotension
5. Nephrotoxic Drugs
6. Radio-contrast Induced Nephropathy
7. Infections
8. Urinary Tract Obstruction
9. Renal Papillary Necrosis
10. Atheroembolic Disease
11. Renal Vein Thrombosis
12. Metabolic Disorders
13. Uremic Pericarditis and Cardiac Tamponade
14. Acute Interstitial Nephritis
15. Crescentic Conversion of Glomerulonephritis
MANAGEMENT DURING THE PHASEOF ACUTE EXACERBATION
SUMMARY
22:
Prevention of Progression of Chronic Kidney Disease
INTRODUCTION
MECHANISMS OF PROGRESSION
STRATEGIES FOR PREVENTION OF PROGRESSION
Control of Blood Pressure
Reduction of Proteinuria
Dietary Protein Restriction
Treatment of Dyslipidemia
Correction of Anemia
Other Measures To Retard or Prevent Progression
SUMMARY
23:
Staging of Chronic Kidney Disease
DEFINITION OF CKD
Ctriteria
MARKERS OF KIDNEY DAMAGE
Proteinuria
Other Markers of Kidney Damage
Estimation of GFR
EVALUATION AND TREATMENT OF CKD
SUMMARY
24:
Epidemiology of Chronic Kidney Disease in India
ASSESSMENT OF BURDEN OF DISEASE DUE TO CKD
1. Acceptance Rate of Renal Replacement Therapy
2. Incidence of CKD/ESRD
3. Prevalence of CKD/ESRD
ETIOLOGY OF CKD
SUMMARY
25:
Approach to a Patient with Hypertension
PREVALENCE
MEASUREMENT OF BLOOD PRESSURE
Circumstances
Cuff Size
Manometer
Number of Readings
Performance
CAUSES OF HYPERTENSION
PATHOGENESIS
EVALUATION
History
Physical Examination
Investigations
Hypertension during Pregnancy
HYPERTENSIVE CRISIS
TREATMENT
Lifestyle Modification
Drug Therapy
SUMMARY
26:
Hypertension in Chronic Kidney Disease
PATHOPHYSIOLOGY OF HYPERTENSION IN CKD
Salt, Fluid and Renin-angiotensin System
Other Mechanisms
TREATMENT
Treatment Goals
Non-pharmacological Approach
Pharmacological Approach
HYPERTENSION IN HEMODIALYSIS PATIENTS
REFRACTORY HYPERTENSION
HYPERTENSIVE EMERGENCIES
MONITORING
SUMMARY
27:
Management of Anemia in Patients with Chronic Kidney Disease
CONSEQUENCES OF ANEMIA IN CKD
TREATMENT OF ANEMIA IN CKD
Target Hematocrit/Hemoglobin
ESA Therapy
Newer Agents
Iron Therapy
Other Therapies
SUMMARY
28:
Coagulopathy in Chronic Kidney Disease
NORMAL COAGULATION PROCESS
CLINICAL MANIFESTATIONS OF ABNORMAL HEMOSTASIS
Laboratory Tests Revealing Abnormality of Hemostasis in Uremia
PATHOGENESIS OF HEMOSTATIC ABNORMALITY IN UREMIA
Abnormalities of Vessel-Platelet Interaction
Abnormalities in Platelet-Platelet Interaction
Basic Etiology of Platelet Dysfunction
Platelet Dysfunction at Receptor Level
Possible causes of Platelet Defect at Macromolecular Level
DREADED CONSEQUENCES OFHAEMOSTATIC DEFECT IN UREMIA
USE OF ASPIRIN IN CHRONIC KIDNEY DISEASE
ABNORMALITIES OF COAGULATION FACTORS IN UREMIA
CONSEQUENCES OF ABNORMALITIES IN COAGULATION FACTORS
Thrombotic Phenomenon
Disseminated Intravascular Coagulaton (DIC)
EFFECT OF HEMODIALYSIS (HD) AND PERITONEAL DIALYSIS (PD) ON HEMOSTATIC DEFECT
THERAPEUTIC MODALITIES IN UREMIC COAGULOPATHY
THERAPEUTIC GUIDELINES IN UREMIC COAGULOPATHY
SUMMARY
29:
Disturbances of Calcium and Phosphorus Metabolism and their Consequences in Chronic Kidney Disease
NORMAL CALCIUM METABOLISM
Functions of Extracellular Calcium
Normal Phosphorus Metabolism
Vitamin D
PARATHYROID GLANDS AND REGULATION OF PTH SECRETION
PTH Receptors
PTH and Calcium Relationship
Actions of Parathyroid Hormone (PTH)
NORMAL REGULATION OF SERUM CALCIUM AND PHOSPHORUS LEVELS
CHRONIC KIDNEY DISEASE AND DISTURBANCES IN CALCIUM PHOSPHORUS METABOLISM
CKD AND SECONDARY HYPERPARATHYROIDISM
Consequences of Secondary Hyperparathyroidism
Management of Secondary Hyperparathyroidism in CKD Stages 4 and 5
Management Of Hyperphosphatemia
MANAGEMENT OF HYPOCALCEMIA AND VITAMIN D DEFICIENCY IN CKD
Calcimimetics (CaSR Agonists) - Cinacalcet
SUMMARY
30:
Nutrition in Patients with Chronic Kidney Disease
ASSESSMENT OF NUTRITIONAL STATUS IN PATIENTS WITH CKD
Serum Albumin and Pre-albumin Level
Anthropometric Parameters
Bioelectrical Impedance Analysis
Dual-Energy X-ray Absorptiometry
Subjective Global Assessment
Dietary Recall Method
ROLE OF DIET THERAPY IN CKD
Dietary Intervention in Progression of Ckd
Goals for Dietary Therapy in CKD
SPECIAL SITUATIONS
Nephrotic Syndrome
Patients on Chronic Peritoneal Dialysis
Diabetic Nephropathy
MECHANISMS OF MALNUTRITION IN CKD AND THERAPY
Protein and Calories
Vitamins
Trace Elements
Calcium and Phosphorus
Iron
Peptides and Hormones
Carbohydrates
Lipids
INDIAN STUDIES ON NUTRITIONAL ADEQUACY IN CKD
SUMMARY
31:
Dyslipidemia in Chronic Kidney Disease
ALTERED LIPOPROTEIN PROFILE IN CKD
MECHANISMS OF DYSLIPIDEMIA
Abnormal HDL Metabolism
Hypertriglyceridemia
Lipoprotein(a)
PATHOPHYSIOLOGY
EPIDEMIOLOGY
EFFECTS OF DYSLIPIDEMIA
TREATMENT
RECOMMENDATIONS FROM NKF
SUMMARY
32:
Smoking and Renal Disease
SUMMARY
33:
Cardiovascular Disease in Chronic Kidney Disease
INTRODUCTION
SPECTRUM OF CVD IN CKD
EPIDEMIOLOGY
Epidemiology of CVD in CKD (Stages 1 to 4)
Epidemiology of CVD in ESRD
PATHOPHYSIOLOGY OF CVD IN CKD
Modifiable CVD Risk Factors in CKD
Hypertension
Left Ventricular Hypertrophy
Dyslipidemia
Anemia
Diabetes Mellitus
Other Risk Factors
Tobacco
Hyperhomocysteinemia
Oxidative Stress
Renal Impairment as a Risk Factor for CVD
TREATMENT OF CVD IN CKD
Coronary Revascularization and Management of Coronary Artery Disease28
SUMMARY
34:
Infections in Patients with Renal Disease
WHY ARE CKD PATIENTS PRONE TO INFECTION?
CLINICAL PRESENTATION
Skin and Mucosal Infection
Respiratory Tract Infection
Urinary Tract Infection
Peritonitis
CNS Infection
Tuberculosis
Other Infections
MANAGEMENT
SPECIAL GROUPS
Vascular Access Related Infections
Temporary Vascular Accesses
Patients on Chronic Peritoneal Dialysis
Peritonitis
Viral Hepatitis
Hepatitis B
Hepatitis C
Human Immunodeficiency Virus
Post-transplant Infections
SUMMARY
35:
Use of Vaccines in Patients of Chronic Kidney Disease
HEPATITIS B
STREPTOCOCCUS PNEUMONIAE
INFLUENZA
RECOMMENDATIONS REGARDING OTHER ROUTINE VACCINES
Live Attenuated Vaccines
Hepatitis A
Measles, Mumps, and Rubella Vaccine
Inactivated Vaccines and Toxoids
Oral Poliovirus Vaccine
Inactivated Poliovirus Vaccine
Haemophilus Influenza Type B Conjugate Vaccine
Diphtheria and Tetanus Toxoids and Pertussis Vaccine
Varicella Vaccine
Staphylococcus Aureus Vaccine
SUMMARY
36:
Use of Analgesics in Patients with Renal Disease
INTRODUCTION
PERIPHERALLY ACTING AGENTS
Acetaminophen
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS
NSAIDs and Nephrotoxicity
CENTRALLY ACTING ANALGESICS
Tramadol
Narcotics
Adjuvants
Anticonvulsants
Antidepressants
Other Agents
SUMMARY
37:
Modification of Drug Dosage in Patients with Renal Disease
DOSIMETRY IN RENAL DISEASE
Dialysis and Drug Dosing
SUMMARY
38:
Preoperative Evaluation and Optimization in Renal Disease
1. CARDIOVASCULAR RISK
2. HYPERTENSION
3. COAGULOPATHY
4. ANEMIA
5. PULMONARY STATUS
6. FLUID AND ELECTROLYTE BALANCE
Fluid Imbalance
Metabolic Acidosis
Potassium Balance
Hypermagnesemia
Hypomagnesemia
Calcium and Phosphate Balance
Hypophosphatemia
INDICATIONS FOR PRE-OPERATIVE DIALYSIS
Problems Associated with Dialysis
PREOPERATIVE MANOEUVRES AND PRECAUTIONS TO PRESERVE RENAL FUNCTION14
OTHER ANESTHESIA-RELATED EVALUATION AND PREPARATION
SUMMARY
39:
Medical Treatment of Urolithiasis
PATHOPHYSIOLOGY OF UROLITHIASIS
ROLE OF DIETARY FACTORS
Reduced Fluid Intake and Dehydration
High Animal Protein Intake
High Oxalate Intake
Reduced Intake of Potassium-rich Citrus Fruits
High Sodium Intake
Calcium Intake
ROLE OF METABOLIC RISK FACTORS
Hypercalciuria
Hypocitraturia
Hyperuricosuria
Gouty Diathesis
Hyperoxaluria
Anatomical/functional Abnormalities
DIAGNOSTIC WORK-UP OF UROLITHIASIS
History
Biochemical Investigations
TREATMENT OPTIONS TO PREVENT RECURRENT UROLITHIASIS
Dietary Modification
Pharmacologic Intervention
APPROACH TO PREVENTING RECURRENCE OF UROLITHIASIS
1. Initial Visit
2. Short-term Diet Modification
3. Repeat 24 hour Urinary Profile Following Short-term Diet Modification
4. Long-term Management
5. Causes and Treatment of Combined Disturbances
LIMITATIONS OF MEDICAL THERAPY
SUMMARY
40:
Medical Treatment of Benign Prostatic Enlargement
SYMPTOMS OF BPH
Differential Diagnosis of BPH
CLINICAL EVALUATION OF BPH
Physical Examination
LABORATORY INVESTIGATIONS
Further Laboratory Tests
MANAGEMENT OF BPH
Watchful Waiting
Drug Therapy of BPH
SUMMARY
41:
Therapeutic Options for a Patient with End Stage Renal Disease
PREVALENCE OF END STAGE RENAL DISEASE
ETIOLOGY OF END STAGE RENAL DISEASE
MANAGEMENT OF END STAGE RENAL DISEASE
INITIATION OF RENAL REPLACEMENT THERAPY
HEMODIALYSIS
Basic Principles
Complications During Hemodialysis
PERITONEAL DIALYSIS
Basic Principles
Access to the Peritoneal Cavity
Peritoneal Dialysis Fluid
Advantages of Peritoneal Dialysis over Hemodialysis
Complications of Peritoneal Dialysis
Peritoneal Membrane Characteristics
Renal Transplantation
ECONOMICS OF RENAL REPLACEMENT THERAPY IN INDIA
Hemodialysis
Continuous Ambulatory Peritoneal Dialysis
Renal Transplantation
SUMMARY
42:
Timely Referral to a Nephrologist
INTRODUCTION
CKD AND DELAYED REFERRAL ARE COMMON
DELAYED REFERRAL IS HARMFUL
Dialysis Patients
Non-dialysis Patients
THE ADVERSE IMPACT OF LR ON INITIATION OF RRT
LR Adversely Impacts RRT Modality Choice
Traditional Therapies are Underused in CKD
DISADVANTAGED POPULATIONS ARE MORE AFFECTED
Implications for Developing Nations
CKD MANAGEMENT CAN BE IMPROVED BY EARLY REFERRALS
CURRENT RECOMMENDATIONS ABOUT APPROPRIATE TIME OF REFERRAL
Aggressive Treatment of Cardiovascular Risk
Factors that Adversely Impact Referral Patterns
NOT ALL PATIENTS REQUIRE REFERRAL
Type of CKD Care After Referral
Better Co-ordination with General Physicians is Important
SUMMARY
43:
Role of Primary Care Physician in Prevention of Chronic Kidney Disease
INTRODUCTION
THE ECONOMIC REALITY
THE IMPORTANCE OF PREVENTION
THE PRIMARY CARE PHYSICIAN
A MODEL FOR PREVENTION OFCHRONIC KIDNEY DISEASE
The Survey
Confirmation of Diagnosis
Management
Follow-up and Support
Validation and Impact Assessment
Results
What have we achieved?
What is the impact?
Comment
Spin Offs
THE ROLE OF THE PRIMARY CARE PHYSICIAN AND SUGGESTED METHODOLOGY
For the Individual Physician
For the NGOs
At the Level of a Primary Health Center
Caveats
SUMMARY
INDEX
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