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Manual of Nephrology
Pranaw Kumar Jha, Vijay Kher
CHAPTER 1:
Renal Anatomy and Physiology: A Clinical Perspective
INTRODUCTION
Gross Anatomy
Blood Supply
Nerve Supply
MICROSCOPIC ANATOMY: THE NEPHRON
Renal Corpuscle
Juxtaglomerular Apparatus
Renal Tubules
Proximal Convoluted Tubule
Henle's Loop
Distal Convoluted Tubule
Collecting Duct System
INTRODUCTION
GLOMERULAR FILTRATION RATE AND PRESSURE
TRANSPORT MECHANISMS
TUBULAR TRANSPORTS
Proximal Convoluted Tubule
Loop of Henle and the Countercurrent Mechanism
Distal Convoluted Tubule
Collecting Duct
AUTOREGULATION
SYMPATHETIC NERVOUS SYSTEM
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS)
ENDOCRINE FUNCTION OF KIDNEYS
SUMMARY
CHAPTER 2:
Basics of Renal Histopathology
INTRODUCTION
RENAL BIOPSY FIXATION AND PROCESSING
SPECIMEN ADEQUACY
LIGHT MICROSCOPIC EXAMINATION OF RENAL BIOPSY
Evaluation of Glomerular Compartment
Electron Microscopic Evaluation of Glomeruli
Common Glomerular Diseases
Evaluation of Tubular Compartment
Evaluation of Interstitial Compartment
Evaluation of Vascular Compartment
CONCLUSION
CHAPTER 3:
An Approach to Patient with Kidney Disease
INTRODUCTION
SIGNS AND SYMPTOMS OF KIDNEY DISEASE
ASYMPTOMATIC URINARY ABNORMALITY
URINARY TRACT INFECTION
HYPERTENSION
ACUTE KIDNEY INJURY
RAPIDLY PROGRESSIVE RENAL FAILURE
ACUTE NEPHRITIC SYNDROME
NEPHROTIC SYNDROME
Chronic Kidney Disease
CONGENITAL/GENETIC SYNDROMES
SUMMARY
CHAPTER 4:
Investigations in Renal Diseases
INTRODUCTION
URINE ANALYSIS
PROTEINURIA
BLOOD AND URINE BIOCHEMISTRY
Markers of Glomerular Function
Glomerular Filtration Rate and Renal Clearance
Plasma Urea and Urea Clearance
Serum Creatinine
Serum Cystatin C
Inulin
Radionuclide and Radiocontrast Markers of Glomerular Filtration Rate
Markers of Tubular Function
Proximal Tubular Function Tests
Distal Tubular Function Tests
Other Tubular Function Tests
Renal Calculi and Divalent Ions
Other Biochemical Tests in Specific Situations
SUMMARY
SUGGESTED READING
INTRODUCTION
METHOD OF COLLECTION OF URINE SAMPLE
URINE APPEARANCE
URINE ODOUR (TABLE 4.15)
SPECIFIC GRAVITY
CHEMICAL COMPOSITION OF URINE
Routine Dipstick Testing
URINE MICROSCOPY
Sample Collection for Urine Microscopy
Cells
Red Blood Cells
White Blood Cells (Leukocytes)
Epithelial Cells
Casts
Crystals
HEMATURIA
PROTEINURIA
SUMMARY
SUGGESTED READING
INTRODUCTION
RECOMMENDED IMAGING MODALITIES FOR KIDNEY DISEASES
PLAIN FILM OF THE ABDOMEN
INTRAVENOUS UROGRAPHY
RETROGRADE OR ANTEGRADE PYELOGRAPHY
CYSTOGRAPHY
ULTRASOUND
Basic Ultrasound Concepts
Anatomy of Kidney
DOPPLER ULTRASONOGRAPHY
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
Principle
Magnetic Resonance Angiogram
Magnetic Resonance Urogram
Magnetic Resonance Imaging for Evaluation of Renal Masses
SUMMARY
ACKNOWLEDGMENTS
SUGGESTED READING
INTRODUCTION
Principles of Radionuclide Renal Imaging
Radiopharmaceuticals
Techniques of Radionuclide Renal Imaging
Dynamic Renal Scintigraphy
Static Cortical Scintigraphy
Radionuclide Cystography
Radionuclide Techniques for Clearance Estimation
Clinical Applications
Urinary Tract Dilatation
Renovascular Hypertension
Transplant Kidney Evaluation
Glomerular Filtration Rate Estimation
Urinary Tract Infections
Vesicoureteric Reflux
SUMMARY
SUGGESTED READING
CHAPTER 5:
Acute Kidney Injury
INTRODUCTION
DEFINITION AND CLASSIFICATION
CLINICAL PRESENTATION
MAJOR CAUSES AND CLASSIFICATION OF AKI
EVALUATION
Imaging
Urinary Indices
MANAGEMENT
Volume Depletion
Volume Overload
Hyperkalemia
Metabolic Acidosis
Nutrition
Dialysis Therapy
PROGNOSIS
BIOMARKERS IN ACUTE KIDNEY INJURY
CHAPTER 6:
Chronic Kidney Disease
INTRODUCTION
DEFINITION OF CHRONIC KIDNEY DISEASE
STAGING/ESTIMATION OF GLOMERULAR FILTRATION RATE IN CHRONIC KIDNEY DISEASE
ETIOLOGY OF CHRONIC KIDNEY DISEASE
PROGRESSION OF CHRONIC KIDNEY DISEASE
Reciprocal of Serum Creatinine
Variable Rates of Progression of CKD
MANIFESTATIONS OF CHRONIC KIDNEY DISEASE
Fluid and Electrolyte Imbalance
Acid Base Abnormalities
Carbohydrate Intolerance
Calcium and Phosphate Abnormalities and Metabolic Bone Disease
Hematologic Abnormalities
Gastrointestinal Abnormalities
Dermatological Abnormalities
Neuromuscular Abnormalities
Chronic Kidney Disease and Cardiovascular Disease/Hypertension
MANAGEMENT OF CHRONIC KIDNEY DISEASE
PRINCIPLES OF MANAGEMENT OF CHRONIC KIDNEY DISEASE
Treatment of Reversible Causes of Renal Failure
Preventing or Slowing the Progression of Renal Disease
Early Interventions
Treatment of the Complications of Renal Failure
Later Interventions
PRE END-STAGE INTERVENTIONS
Referral to Specialist Care
Preparation for and Initiation of Renal Replacement Therapy
Conservative Management of ESRD
Timing the Initiation of Renal Replacement Therapy
Multidisciplinary CKD Clinic
Levels of Evidence
CHAPTER 7:
Electrolyte Disorders
INTRODUCTION
REGULATION OF SODIUM AND WATER BALANCE
ETIOLOGY AND CLASSIFICATION
Translocational Hyponatremia
Pseudohyponatremia
True Hyponatremia
Hypovolemic Hyponatremia
Hypervolemic Hyponatremia
Euvolemic Hyponatremia
CLINICAL MANIFESTATIONS OF HYPONATREMIA
DIAGNOSTIC APPROACH IN HYPONATREMIA (FLOW CHART 7.1)
TREATMENT OF HYPONATREMIA
ETIOLOGY AND CLASSIFICATION
Hypovolemic Hypernatremia
Hypervolemic Hypernatremia
Euvolemic Hypernatremia
DIABETES INSIPIDUS
Central Diabetes Insipidus
Treatment of Central Diabetes Insipidus
Nephrogenic Diabetes Insipidus
CLINICAL MANIFESTATION OF HYPERNATREMIA
TREATMENT OF HYPERNATREMIA
SUMMARY
SUGGESTED READING
INTRODUCTION
PATHOPHYSIOLOGY
ETIOLOGY
TREATMENT
Goals
APPROACH TO HYPERKALEMIA
Spurious Hyperkalemia
Excessive Potassium Retention
Renal Failure
Hypoaldosteronism
Defective Tubular Secretion
CLINICAL MANIFESTATIONS
TREATMENT
SUMMARY
SUGGESTED READING
INTRODUCTION
REGULATION OF CALCIUM BALANCE
FACTORS REGULATING CALCIUM HOMEOSTASIS
Parathormone
Regulation of Parathormone
Actions of Parathormone
Vitamin D
Calcitonin
Calcium-sensing Receptor
DEFINITION
ETIOLOGY
SYMPTOMS AND SIGNS
DIAGNOSIS
MANAGEMENT
Acute Hypocalcemia
Chronic Hypocalcemia
DEFINITION
ETIOLOGY
SYMPTOMS AND SIGNS
LABORATORY DIAGNOSIS
TREATMENT
SUMMARY
INTRODUCTION
PHOSPHORUS METABOLISM
PHOSPHATE HOMEOSTASIS
SIGNS AND SYMPTOMS OF HYPOPHOSPHATEMIA
CAUSES OF HYPOPHOSPHATEMIA
DIAGNOSIS AND TREATMENT
TREATMENT
EPIDEMIOLOGY
ETIOLOGY
SIGNS AND SYMPTOMS
LABORATORY STUDIES
TREATMENT
SUMMARY
CHAPTER 8:
Acid-base Disorders
INTRODUCTION
ACID HANDLING BY THE KIDNEY AND THE ROLE OF KIDNEY IN THE REGULATION OF PLASMA pH
COMPENSATORY MECHANISMS
PRACTICAL INTERPRETATION OF ABG: A STEP-WISE APPROACH
MANAGEMENT OF METABOLIC ACIDOSIS
RENAL TUBULAR ACIDOSIS
Proximal Renal Tubular Acidosis (Type 2)
Distal Renal Tubular Acidosis (Type 1)
SUMMARY
CHAPTER 9:
Urinary Tract Infection
INTRODUCTION
UTI TERMINOLOGY
UTI CLASSIFICATION
EPIDEMIOLOGY
ETIOLOGY
PATHOGENESIS
CLINICAL PRESENTATION
DIAGNOSIS
Microscopic Examination
Urine Culture and Sensitivity
Imaging Studies
MANAGEMENT
Antimicrobial Therapy
Treatment of Recurrent UTI
Treatment of Relapsing Infection
Treatment in Pregnancy
Treatment of UTI in Men
Catheter-associated UTI
SUMMARY
CHAPTER 10:
Contrast-induced Nephropathy
INTRODUCTION
CONTRAST MEDIA
PATHOPHYSIOLOGY
RISK FACTORS
CLINICAL FEATURES AND DIAGNOSIS
PREVENTING CONTRAST-INDUCED NEPHROPATHY
Intravenous Hydration with Normal Saline and Bicarbonate
Intravenous Hydration with Normal Saline and Forced Diuresis
Sodium Bicarbonate
Oral Hydration with Water
N-acetyl Cysteine
Prophylactic Hemodialysis or Hemofiltration
Other Emerging Preventive Measures
SUMMARY
CHAPTER 11:
Urology for Nephrologist
INTRODUCTION
TERMS USED FOR LOWER URINARY TRACT SYMPTOMS
COMMON INVESTIGATIONS IN THE EVALUATION OF LUTS
Uroflowmetry
Post-void Residual Urine
Urodynamics
Interpretation of the Urodynamics Graph
BENIGN PROSTATIC HYPERPLASIA
Incidence of Histological BPH
Static and Dynamic Component of BPH
Symptoms: The Americal Urological Association Symptom Score (AUASS) and “Bother” International Prostate and Symptom Score (IPSS)
Role of α Blockers
Role of 5α Reductase Inhibitors and Combination Therapy
Role of Antimuscarinics
Patient Selection for Surgery
ACUTE AND CHRONIC RETENTION
Acute Urinary Retention
Chronic Urinary Retention
URINARY TRACT OBSTRUCTION: OBSTRUCTIVE UROPATHY
Terminology and Impact
Diuretic Renal Scan
Principle of Diuretic Renal Scan
Interpretation of Diuretic Renal Scan
Management of Pain
Renal Drainage
Recovery of Renal Function after Drainage
Definitive Management of Obstructive Uropathy
STONE DISEASE
Small Renal Stones
Staghorn Renal Calculi
SUMMARY
CHAPTER 12:
Hypertension
INTRODUCTION
DEFINITION
EPIDEMIOLOGY
Indian Scenario
PATHOGENESIS
DIAGNOSTIC EVALUATION OF HYPERTENSION
TREATMENT
Goals of Treatment
Nonpharmacologic Treatment
Pharmacologic Treatment
Strategies to Dose Antihypertensive Drugs
SUMMARY
CHAPTER 13:
Nutrition in Renal Diseases
INTRODUCTION
PROTEIN ENERGY WASTING
MANAGEMENT OF NUTRITIONAL STATUS
Assessment of Nutritional Status
Diagnosis of Protein Energy Wasting
Goals of Nutritional Therapy
Nutrient Requirement
Nutritional Management in Predialysis Stage: Conservative Management
Nutritional Management in Chronic Kidney Disease Stage 5 Patients on Maintenance Dialysis
Protein Energy Management
Intradialytic Parenteral Nutrition
Peritoneal Dialysis
Phosphorus Management
Fluid Management
Water-soluble Vitamins
Role of Residual Renal Function
Reverse Epidemiology
Cachexia in Slow Motion or Malnutrition Inflammation Complex Syndrome
Obesity
Postrenal Transplant
Acute Kidney Injury
When to Initiate Nutritional Support
Enteral Feeding
Parenteral Nutrition
Control Hyperglycemia, Insulin Resistance and Hyperinsulinemia
SUMMARY
CHAPTER 14:
Drug Dosing in Renal Diseases
INTRODUCTION
VULNERABILITY OF KIDNEYS
AGE-RELATED DECLINE IN RENAL FUNCTION AND IMPORTANCE OF GLOMERULAR FILTRATION RATE
GLOMERULAR FILTRATION RATE IN RENAL DISEASES
MECHANISMS OF DRUG-INDUCED RENAL DAMAGE
Principles and Methods of Drug Dosing in Renal Failure
SUMMARY
CHAPTER 15:
Renal Replacement Therapy in Chronic Kidney Disease Patients
INTRODUCTION
RENAL REPLACEMENT THERAPY
Hemodialysis
Complications
Peritoneal Dialysis
Principle of Peritoneal Dialysis
Complications
Renal Transplantation
Indications
Contraindications
Pretransplant Assessment
Procedure
Immunosuppressive Regimens
Complications
SUMMARY
INDEX
TOC
Index
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