Third Edition
Editor Anil K Mandal MBBS FACP FASN FICP (Honorary)
Fulbright Scholar Consultant Nephrologist Northeast Florida Area Hospitals Courtesy Clinical Professor of Medicine University of Florida in Gainesville,
Florida, USA E-mail: amandal@med-spec.com
Associate Editor Jai Prakash MD FASN
Professor of Nephrology Banaras Hindu University Institute of Medical Sciences Department of Nephrology
Varanasi, Uttar Pradesh, India Email: jpojha555@hotmail.com jprakash53@gmail.com
Foreword KK Malhotra
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© Anil K Mandal, Jai Prakash
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Textbook of Nephrology
First Edition: 1993
Second Edition: 2004
Third Edition: 2014
9789350905326
Printed at
5Dedicated to
Those who are inspirational in my daily work;
Atashi Mandal
Huntington Beach, California, USA
Karen Kidwell
Saint Augustine, Florida, USA
Shriram Marathe
Saint Augustine, Florida, USA
The entire office staff of Medical Specialists of Northeast Florida
Moustafa Eldick
Palatka, Florida, USA
JP Tiwari
Goa, India
Linda Hiebert
Saskatoon, Canada
Rajendra Bhimma
Caronisha Bhimma
Durban, South Africa
7List of Contributors
- Anil K Agarwal md facp fasn
- Professor of Medicine
- Director of Interventional Nephrology
- The Ohio State University
- Columbus, Ohio, USA
- E-mail: anil.agarwal@osumc.edu
- Preferred E-mail: aagarwal@pol.net
- Anil K Mandal mbbs facp fasn ficp
- Consultant Nephrologist
- Northeast Florida Area Hospitals
- Courtesy Clinical Professor of Medicine
- University of Florida, Gainesville
- St Augustine, Florida, USA
- E-mail: amandal@med-spec.com
- Antonios H Tzamaloukas md
- Professor of Medicine
- University of New Mexico, School of Medicine
- Chief, Renal Section
- New Mexico VA Healthcare System
- Raymond G Murphy Veterans Affairs Medical Center
- Albuquerque, New Mexico, USA
- E-mail: Antonios.Tzamaloukas@med.va.gov
- Arnold J Felsenfeld md
- Professor of Medicine
- Nephrology Section 111L
- Veterans Administration
- Greater Los Angeles Healthcare System
- Los Angeles, California, USA
- E-mail: afelsenf@ucla.edu
- Aswini Patnaik md
- Department of Medicine and Nephrology
- South Eastern Railway Hospital
- Kolkata, India
- E-mail: aswini_p@hotmail.com
- Biplab Ghosh md md
- Senior Resident in Nephrology
- Medical Superspecialty Hospital
- India
- Christopher Valentine md
- Assistant Professor of Medicine
- The Ohio State University
- Columbus, Ohio, USA
- E-mail: Christopher.Valentine@osumc.edu
- Jacob George md dm
- Professor of Nephrology
- Medical College
- Trivandrum, India
- E-mail: drjacobgeo@rediffmail.com
- Jai Prakash md fasn
- Professor of Nephrology
- Banaras Hindu University
- Institute of Medical Sciences
- Department of Nephrology
- Varanasi, India
- E-mail: jpojha555@hotmail.com
- Jose A Diaz-Buxo md facp
- Senior Vice-President
- Chief Medical and Regulatory Affairs Officer
- Fresenius Medical Care, North America
- Renal Therapies Group
- Charlotte, North Carolina, USA
- E-mail: jose.diaz-buxo@fmc-na.com
- JP Tiwari md
- Professor of Nephrology
- Department of Medicine
- Goa Medical College
- Bambolim, Goa, India
- E-mail: jptiwari@sancharnet.in
- Karen S Servilla md facp
- Professor of Medicine
- Director, Renal Fellowship Program
- University of New Mexico School of Medicine
- Staff Nephrologist
- Raymond G Murphy VA Medical Center
- Albuquerque, New Mexico, USA
- E-mail: karen.servilla@va.gov
- Kedareshwar PS Narvencar md
- Assistant Professor in Medicine
- Department of Medicine
- Goa Medical College
- Bambolim, Goa, India
- E-mail: kedarnarvenkar@yahoo.com
- Linda M Hiebert phd
- Professor
- Department of Veterinary Biomedical Sciences
- University of Saskatchewan
- Saskatoon, Saskatchewan, Canada
- E-mail: linda.hiebert@usask.ca
- Megan M Bond pharmd
- Clinical Pharmacist, Internal Medicine
- The Ohio State University Medical Center
- Columbus, Ohio, USA
- E-mail: megan.bond@osumc.edu
- Nabil J Haddad md
- Assistant Professor of Medicine
- Division of Nephrology
- The Ohio State University
- Columbus, Ohio, USA
- E-mail: nabil.haddad@osumc.edu
- Pankaj Beniwal mbbs md
- Senior Resident
- Department of Nephrology
- SMS Medical College and Associated Hospitals
- Jaipur, Rajasthan, India
- E-mail: pankajbeniwal@yahoo.co.in
- R Kasi Visweswaran md dm
- Retired Professor of Nephrology and Vice-Principal
- Medical College
- Trivandrum, India
- E-mail: rkasivis@yahoo.com
- Rainer Himmele md
- Director, Medical Information and Communication
- Renal Therapies Group
- Fresenius Medical Care, North America
- Charlotte, North Carolina, USA
- E-mail: Rainer.Himmele@fmc-na.com
- Rajendra Bhimma md
- Professor
- Department of Pediatrics and Child Health
- Nelson R Mandela School of Medicine
- University of Kwa Zulu-Natal
- Congella, South Africa
- E-mail: bhimma@ukzn.ac.za
- Ricardo Paz-Fumagalli md
- Associate Professor of Radiology
- Mayo College of Medicine
- Department of Radiology
- Mayo Clinic, Florida
- Jacksonville, Florida, USA
- E-mail: Paz.Ricardo@mayo.edu
- Sanjay K Agarwal md frcp (edin) fasn fams
- Professor and Head
- Department of Nephrology
- Commonwealth Fellow UK (Manchester)
- All India Institute of Medical Sciences
- New Delhi, India
- E-mail: skagarwal58@yahoo.co.in
- Shalini Sundar md
- Fellow, Nephrology Section
- VA Greater Los Angeles Healthcare System
- Los Angeles, California, USA
- E-mail: shalinidoc@yahoo.com
- Shiv K Seth rph phd
- Clinical Assistant Professor
- The Ohio State University Medical Center
- Columbus, Ohio, USA
- E-mail: seth-1@medctr.osu.edu
- Soni Dhanireddy md
- Fellow
- Division of Nephrology
- The Ohio State University
- Columbus, Ohio, USA
- E-mail: soni.dhanireddy@osumc.edu
- Todd E Pesavento md
- Associate Professor of Clinical Nephrology
- Division of Nephrology
- Ohio State University
- Columbus, Ohio, USA
- E-mail: pesavento.2@osu.edu
- Udai K Kala md
- Associate Professor of Pediatrics
- Chris Hani Naragwanath Hospital
- University of Witwaterstrand
- Johannesburg, South Africa
- E-mail: udai.kala@wits.ac.za
- Uday Nori md
- Assistant Professor of Clinical Medicine
- Division of Nephrology
- The Ohio State University
- Columbus, Ohio, USA
- E-mail: uday.nori@osumc.edu
- Vinay Malhotra mbbs md dm dnb
- Associate Professor
- Department of Nephrology
- SMS Medical College and Associated Hospitals
- Jaipur, Rajasthan, India
- E-mail: tanvin91@gmail.com
- Yijuan Sun md
- Assistant Professor of Medicine
- University of New Mexico School of Medicine
- Staff Nephrologist
- Raymond G Murphy VA Medical Center
- Albuquerque, New Mexico, USA
- E-mail: yijuan.sun@va.gov
Nephrology has made great strides during the last decade and demand for renal services has grown considerably throughout the world. A book highlighting practical and clinical aspects of nephrology fills an important gap on the subject. The last edition of the book was very well received and there was an urgent demand for revision of the book. All the chapters have been extensively revised and some new chapters have been added. Four new chapters dealing with Diabetes and Kidney have been included. Professor Mandal has large practical experience in this area of nephrology and has highlighted his observations in these chapters. The book has been supplemented with figures, tables and graphs. This makes it more readable. Professor Anil K Mandal and his co-authors deserve appreciation for the hard work they have done in preparing this book. I am sure this will serve the specific purpose for which it has been written.
KK Malhotra mbbs md isn fams fapi ficn
Director, Clinical Research, and Senior Consultant, Nephrology
Pushpawati Singhania Research Institute
For Liver, Renal & Digestive Diseases
New Delhi, India
11Foreword to the First Edition
This textbook, written very largely by people from the Asian-Pacific area, many of whom are now working in other parts of the world, is likely to fill a particular need for Asian-Pacific physicians. The chapters contain practical information giving formulas to assist the physician in making judgements on things like electrolyte disturbances and other practical problems which arise in nephrological practice. The chapter on dialysis is a useful one written for physicians rather than nephrologists and explaining the techniques in simple and practical terms.
The Editor, Anil K Mandal, is a distinguished and energetic nephrologist and nephro-pathologist who has managed to persuade a number of very talented academics to participate in this new venture. This textbook written for a specific purpose for Asian-Pacific physicians promises to be both a popular and useful text.
Priscilla Kincaid-Smith
Department of Pathology
University of Melbourne
Parkville, Victoria
Australia
13Preface to the Third Edition
Third edition is an update of the second edition with addition of several new chapters on diabetes: what does high glucose higher than normal levels (70–99 mg/dL or 3.8 to 5.5 mmol/L) do to body function?, diabetes and sexual dysfunction and a logical approach to management of diabetes with a goal to prevention of complications. Diabetes-associated renal disease may not be due to diabetes as written by Professor Jai Prakash from Varanasi, India. The reason being Type 2 diabetes is not a well-defined entity, due to lack of assessment by 2-hour postprandial glucose level or glucose tolerance test. Therefore, some of these patients with so-called Type 2 diabetes may not have diabetes.
Nevertheless, diabetes has constituted a big part of nephrology practice with the intention to reduce proteinuria hence reducing the risk of end-stage renal disease (ESRD) and dialysis therapy. This intention was not accomplished as more and more diabetes patients are entering into dialysis programs. In the editor's practice, diabetes patients do not enter into dialysis, because editor pays total attention to glycemic control and does not prescribe reninangiotensin inhibitor drugs or discontinues these drugs for patients who were receiving them at the time of first office visit. Diabetes is a self-care disease. Well-motivated patients understand that diabetes is a serious disease and do their best to keep sugar under control so that they do not develop the horrible complications such as foot ulcer, gangrene and kidney failure. Professionals should do everything to prevent renal failure and resulting dialysis treatment. It is with those goals in mind that the new chapters were added. Diabetes is the most common cause of sexual dysfunction in men and women and a major cause of family turmoil. This is an uncultivated and uninformed area. Thus, with the addition of this chapter, the editor feels that professionals may be alerted to the importance of the discussion of sexual function with their diabetes patients.
The focus of the third edition is a conservative nephrology practice clear of dialysis and transplantation. However, the chapters on dialysis and transplantation are retained to help trainees and those practitioners who are more interested in those two areas than others. The chapters are written based on observations and application of methods of diagnosis and management plans which work well for the patients. Thus, this book is a practical one to appropriately tackle problems pertaining to renal disease, hypertension, and diabetes. This book is not evidencebased resulting from clinical trials which are not helpful when it comes to direct patient care. Style of the book is succinct and lucid and is free of commercial interest. Finally, the editors are pleased to express a deep appreciation to all of the authors for their contribution to the enrichment of this third edition.
Anil K Mandal
15Preface to the First Edition
The purpose of developing a volume in nephrology entitled Textbook of Nephrology for the Asian-Pacific Physicians is neither a gesture to crowd the publishing market with another nephrology book nor an intention to compete with any of the existing volumes in the medical books market. The purposes of developing a volume of nephrology for the Asian-Pacific physicians are discrete and do not overlap with those of any of the existing nephrology textbooks.
These purposes are: (1) There is a wide margin of difference in the currency exchange between the Western world and the Asian-Pacific countries. This currency difference makes books published in the Western world less or non-affordable to most practicing physicians including nephrologists in the Asian-Pacific countries. (2) Except in Japan and Australia, there are very few trained nephrologists in the Asian-Pacific countries. For example, there are hardly 240 trained nephrologists for an 800 million population in India, giving a ratio of 0.3 nephrologist per million or barely 1 nephrologist for every 3 million. The international directory of nephrology indicates that a similar or a lower ratio of the nephrologists per million population exists in many of the Asian-Pacific countries. (3) The system of continuous medical education in nephrology is also rather tenuous in the Asian-Pacific countries. Therefore, the practicing physicians in these countries have few or no avenues to obtain information or seek assistance while dealing with their patients who have major renal problems. In addition, I have consistently observed that the non-nephrologist physicians become more apprehensive by the findings of acidosis, rising serum potassium and blood urea nitrogen than other laboratory abnormalities in their patients. These purposes were embedded in the mind of the editors for sometime, and thus this book was conceived.
I have a hope that this Textbook of Nephrology would become affordable to most of the physicians in the Asian-Pacific countries.
This book is not complete due to the lack of inclusion of some other topics in nephrology; nonetheless, this text has covered major areas of nephrology to facilitate nephrology care in the Asian-Pacific countries. In addition, rather than not having a volume at all, this initial edition, at best, may serve as a forum to address the issues and the needs so that the next edition can be developed in a more comprehensive fashion.
The encouragement, support and contributions made by my distinguished colleagues from the USA and the Asian-Pacific countries for the completion of this volume are immeasurable. My special gratitude goes to Dr H Verdain Barnes, Professor and Chair, Department of Medicine, Wright State University, for providing me with the facilities that are conducive for this type of tedious work. My special thanks go to Mrs Chris Wert, Senior Secretary, Department of Medicine, Wright State University, whose dedicated work has turned this volume into reality. I am also very thankful to all the secretaries of the word processing satellite of the Wright State University, Medical Sciences Division, Dayton, Ohio, for consistently working with me to complete this volume. I am thankful to my elder daughter, Aditi Mandal, for her time and effort in the editorial work. Finally, I am very appreciative of Shri Jitendar P Vij of Jaypee Brothers Medical Publishers, New Delhi, for his keen interest in publishing this nephrology volume.
AK Mandal
Anil K Agarwal