Essentials of Clinical Nephrology (Shorouk Press, Cairo, 2000, ISBN ...

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PART IV: VASCULITIS • Classification ......................................................................................... 113 • Polyarteritis nodosa ............................................................................. 114 • Wegener's granulomatosis ................................................................ 117 • Churg-Strauss syndrome .................................................................. 118 • Temporal arteritis ................................................................................. 120 • Takayasu's arteritis .............................................................................. 121 • Relapsing polycondritis ....................................................................... 121 • Goodpasture's syndrome .................................................................... 122 • ANCA and vasculitis .......................................................................... 125 PART V: THROMBOTIC MICROANGIOPATHY................................. 127 PART VI: ACUTE RENAL FAILURE ........................................................ 133 PART VII: CHRONIC RENAL FAILURE: • Definitions ............................................................................................. 147 • Etiology ................................................................................................. 148 • Pathophysiology ................................................................................. 150 • Clinical features .................................................................................. 158 • Investigations ....................................................................................... 164 • Management ........................................................................................ 164 • Dialysis .................................................................................................. 169 • Transplantation .................................................................................... 1 PART VII: RENAL TUBULAR DISORDERS • Renal glycosuria ................................................................................ 185 • Amino acids tubular transport defects ........................................... 186 • Renal tubular acidosis (RTA) .......................................................... 187 • Nephrogenic diabetes insipidus ...................................................... 193 • Water retention .................................................................................. 195 • Cystinosis ............................................................................................ 195 • Wilson's disease ............................................................................... 196 • Oxalosis ............................................................................................... 196 • Bartter's syndrome ............................................................................ 197 • Vitamin D resistent rickets ............................................................. 197 • Pseudohypoparathyroidism ............................................................ 198 • Fanconi syndrome ............................................................................ 198
PART IX: TUBULAR AND INTERSTITIAL DISEASES • Interstitial nephritis............................................................................. 201 • Analgesic nephropathy....................................................................... 205 • Reflux nephropathy............................................................................. 209 • Pyelonephritis...................................................................................... 212 • Urinary tuberculosis ........................................................................... 218 PART X: RENAL CYSTIC DISEASES • Classification of renal cystic diseases ........................................ 231 • Autosomal dominant polycystic kidney diseases ....................... 231 • Autosomal recessive polycystic kidney diseases....................... 234 • Medullary cystic kidney diseases .................................................. 236 • Medullary sponge kidney ................................................................ 236 • Acquired renal cystic diseases ...................................................... 238 • Tuberous sclerosis ............................................................................ 239 • Von Hipple-Lindau syndrome ......................................................... 239 • Simple renal cysts............................................................................. 239 PART XI: RENAL STONE DISEASES ................................................ 241 PART XII: WATER AND ELECTROLYTE DISORDERS • Disorders of plasma osmolality ...................................................... 247 • Disturbances of plasma sodium concentration .......................... 253 • Disturbances of plasma potassium concentration...................... 256 • Disturbances of plasma calcium concentration.......................... 260 PART XIII: DISORDERS OF ACID-BASE BALANCE • Physiology of acid-base system ..................................................... 265 • Metabolic acidosis ............................................................................. 266 • Respiratory acidosis .......................................................................... 269 • Metabolic alkalosis ............................................................................. 270 • Respiratory alkalosis .......................................................................... 271 PART XIV: HYPERTENSION AND THE KIDNEY • Etiology and classification ................................................................ 273 • Essential hypertension ...................................................................... 274 • Renovascular hypertension .............................................................. 286 • Ischaemic nephropathy ..................................................................... 291
Page 1 and 2: ESSENTIALS OF CLINICAL NEPHROLOGY E
Page 3 and 4: Essentials of Clinical Nephrology T
Page 5 and 6: Dedication To the soul of my dear f
Page 7 and 8: FOREWARD Although this country is p
Page 9: CONTENTS Forward ..................
Page 13 and 14: RENAL FUNCTIONS AND STRUCTURE KIDNE
Page 15 and 16: Juxtaglomerular apparatus Liver Ren
Page 17 and 18: 3. Prostanoids (Prostaglandins) (Fi
Page 19 and 20: B- Peptide hormones degraded by the
Page 21 and 22: main action is on the late distal t
Page 23 and 24: - Renal venous system follows the s
Page 25 and 26: (Fig. 1.6) Diagrammatic illustratio
Page 27 and 28: Figure 8 shows a cross section of t
Page 29 and 30: (Fig. 1.8d) Electron micrograph (X
Page 31 and 32: ANATOMIC PHYSIOLOGY (FUNCTION OF DI
Page 33 and 34: Concentration And Dilution Of Urine
Page 35 and 36: (Fig. 1.9) Countercurrent mechanism
Page 37 and 38: INVESTIGATIONS FOR KIDNEY DISEASES
Page 39 and 40: (Fig. 2.2a) An Illustration of Urin
Page 41 and 42: II. RENAL FUNCTION TESTS: These inc
Page 43 and 44: progressive decrease in urine volum
Page 45 and 46: C. IMMUNOLOGICAL TESTS FOR DIAGNOSI
Page 47 and 48: B-mode U.S. imaging is the usual ex
Page 49 and 50: (Fig. 2.4c) It shows a longitudinal
Page 51 and 52: Duplex ultrasonography shows the st
Page 53 and 54: (Fig. 2.8) Intravenous urography (I
Page 55 and 56: (Fig. 2.9): The grading system adop
Page 57 and 58: (Fig. 2.10b) IA-DSA of left kidney
Page 59 and 60: excreted, either by glomerular filt
Page 61 and 62:
(Fig. 2.14) Diuretic Renogram (obst
Page 63:
Suggested Readings: - Wilcox CS: Is
Page 66 and 67:
B. Extrinsic antigens include bacte
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5. Neutrophils: have an important r
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2. Collagen disease (e.g. SLE, poly
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(Fig. 3.3b) The same case in Fig. 3
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(III) Clinical manifestations of gl
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1. Hypoalbuminaemia results in a de
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4. Manifestations of the etiologic
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7. Corticosteroids are given when t
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5. Serum creatinine is usually high
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MCN is more common in male (male to
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MGN could be primary or secondary t
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. Autoimmune disease as SLE and cry
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monocytes), later become fibrous. G
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SECONDARY GLOMERULAR DISEASES In ma
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(Fig. 3.9d) Immunofluorescence stai
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10- Immunologic disorders (positive
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(Fig. 3.10c) Immunofluorescent stai
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Clinical features: Clinical manifes
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e responsible for the alterations i
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When renal failure manifests, suppo
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(Fig 3.14) Photograph showing the c
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In patients with bacterial endocard
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Schistosomal Nephropathy Introducti
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in the pathogenesis of local tissue
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well-documented in an extensive exp
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Glomerulopathy Secondary To Virus I
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8- Autoimmune thyroiditis. 9- Polya
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TREATMENT OF GLOMERULONEPHRITIS The
Page 122 and 123:
term, but an effect may be obtained
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Suggested Readings: - Woo KT: Recen
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Polyarteritis Nodosa Incidence: Pol
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Clinical features of PAN: 1- Consti
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Immunofluorescence microscopy is al
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Renal pathology: • Glomeruli show
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larynx. Vasculitis in this disease
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(Fig. 4.4b) Immunofluorescen staine
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Suggested Readings: - Griffith ME,
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(Fig. 5.1a) H & E stained section(X
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There are 5 outstanding features fo
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ACUTE RENAL FAILURE (ARF) Definitio
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Acute Tubular Necrosis Acute tubula
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Tumour Specific Syndromes: Tumour l
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2. Renal Ultrasonography and echo-d
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If the case proved to be pre-renal,
Page 155 and 156:
In case of contrast media, the foll
Page 157:
Suggested Readings: - McCarthy JT:
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year, while in Egypt and some devel
Page 162 and 163:
PATHOPHYSIOLOGY OF CHRONIC RENAL FA
Page 164 and 165:
(Fig. 7.1) Disturbances of Acid-bas
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(Fig. 7.2a) Disturbances of calcium
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Calcified papillae shown in plain f
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Eye CNS • Malaise, lethergy • c
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• Iatrogenic causes as frequent b
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• Uraemic amaurosis (rare): which
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INVESTIGATIONS OF A CASE WITH CHRON
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c. Postrenal factors: Causing obstr
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Step 4. RENAL REPLACEMENT THERAPY (
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solutes that can pass easily throug
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(C) Nausea and Vomiting: The aetiol
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(C) Arrhythmia: Arrhythmias during
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3- Recent thoracic or abdominal sur
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KIDNEY TRANSPLANTATION Definition:
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2- Cadaveric donors: These are pers
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. Complications due to individual d
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- Ter Wee PM, et al: Dietary protei
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B) Amino acids tubular transport de
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distal RTA, more HCO 3 and chloride
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2. Hypokalemia due to defective han
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4. Autoimmune disease • Sjogren's
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5. Miscellaneous • Amyloidosis
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WILSON'S DISEASE Characterized by a
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Treatment: 1. Vitamin D (either the
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TUBULAR AND INTERSTITIAL DISEASES T
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(Fig. 9.1a) Cross section of a kidn
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The etiologic cause is unknown, pos
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3. Vascular sclerosis: Affecting sm
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5. Pregnancy and gonadal manifestat
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VUR is genetically determined. It h
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3. Obstruction of the urinary tract
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Symptoms: Fever, malaise, aches, dy
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2. Hypertension. 3. Insidious onset
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d) Direct infection : From epididym
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Symptoms: 1- Asymptomatic 2- Consti
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Cystoscopy - May show ulcers or con
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Rationale of short antituberculous
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Drug Route of Dose in GFR GFR GFR n
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Disadvantages: - Needs experience a
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CYSTIC RENAL DISEASES Renal cyst is
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tricuspid valve incompetence and le
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Pathology: 1. Both kidneys are enla
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IVU- medullary sponge kidney demons
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Management 1. Patients under dialys
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RENAL STONE DISEASES Renal stone di
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6. Xanthinuria It is a very rare me
Page 257:
Suggested Readings: - Jaeger O: Gen
Page 260 and 261:
solutes which could affect plasma o
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2. Volume receptors are mainly in t
Page 264 and 265:
• Essential hyponatraemia: Occurs
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saline and in severe cases, small a
Page 268 and 269:
III. DISTURBANCES IN PLASMA POTASSI
Page 270 and 271:
B- Increase renal excretion of K +
Page 272 and 273:
(Fig. 12.1) Extensive vacuolization
Page 274 and 275:
3- Gastrointestinal manifestations
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DISORDERS OF ACID-BASE BALANCE Phys
Page 279 and 280:
HCo 3 -. Since these substances are
Page 281 and 282:
B- Gastrointestinal causes of metab
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• Cushing's syndrome • Bartter'
Page 285 and 286:
HYPERTENSION AND THE KIDNEY The val
Page 287 and 288:
2- Secretion of hormone which cause
Page 289 and 290:
(Fig. 14.2b) Hx&E stained kidney se
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pressure is released gradually (2cm
Page 293 and 294:
2- Vasodilators: This group include
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the angiotensin II. There are three
Page 297 and 298:
Secondary Hypertension A- Renal Hyp
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A-Two-kidney-one-clip (2K/1C) model
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(Fig. 14.5 ) An angiogram showing a
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PTCA will be tried as example in yo
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Suggested Readings: - Stanley JC: D
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MISCELLANEOUS PROTEINURIA Proteinur
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a. Strenuous exercise b. Fever c. O
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4. Casts such as proteinuria. 5. Bl
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VALUE OF URINE EXAMINATION IN MEDIC
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3. Colour: - Normal: umber yellow -
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• Direct microscopic examination
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7. Chemicals: Determination of 24 h
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RENAL MANIFESTATIONS OF SYSTEMIC DI
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2- Nephrogenic diabetes insipidus.
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Gout and Kidney Patient with gout m
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RENAL DISEASES IN HEPATIC PATIENTS
Page 329 and 330:
• Elevated plasma endothelin (E)
Page 331 and 332:
• Orthotopic liver transplantatio
Page 333 and 334:
MALIGNANCY AND THE KIDNEY The spect
Page 335 and 336:
Multiple myeloma. Case of light cha
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POEMS Syndrome (P= polyneuropathy,
Page 339 and 340:
2- Minimal change glomerulonephriti
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Prevention of tumour lysis syndrome
Page 343 and 344:
• Non Hodgkin's lymphoma, and Kap
Page 345 and 346:
DRUGS AND THE KIDNEY In this chapte
Page 347 and 348:
• Uremia may reduce drug metaboli
Page 349 and 350:
• It's usual dose is 1gm / 8hrs.
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• Digoxin is not dialyzable • Q
Page 353 and 354:
• Renal prostaglandins (PGE 2 , P
Page 355 and 356:
(D) Diuretic treatment of nephrotic
Page 357 and 358:
KIDNEY AND THE HEART This issue cou
Page 359 and 360:
Suggested Readings: - Leschke M, et
Page 361 and 362:
• The renal vessels may show inti
Page 363 and 364:
Suggested Readings: - Lindeman RD,
Page 365 and 366:
Renal pathology: Glomeruli show swe
Page 367 and 368:
- Treatment of sudden acute renal f
Page 369 and 370:
Pregnancy In Dialysis Patients: •
Page 371 and 372:
ENVIRONMENTALLY-INDUCED KIDNEY DISE
Page 373 and 374:
Lead containing inclusion bodies wi
Page 375 and 376:
Radiation injury It may be defined
Page 377:
Suggested Reading: - Sobh M: Enviro
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