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

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• Conn's syndrome .............................................................................. 291 • Pheochromocytoma .......................................................................... 292 PART XV: MISCELLANEOUS • Proteinuria............................................................................................ 295 • Haematuria .......................................................................................... 298 • Value of urine in medical diagnosis ................................................ 301 • Polyuria and oliguria .......................................................................... 302 • Renal manifestations of systemic diseases..................................... 309 • Renal diseases in hepatic patients .............................................. 315 • Malignancy and the kidney .............................................................. 321 • Drugs and the kidney ........................................................................ 333 • Kidney and the heart ......................................................................... 345 • Kidney and the lung ......................................................................... 348 • Renal diseases in the elderly ......................................................... 348 • Kidney in pregnancy........................................................................... 352 PART XVI: ENVIRONMENTALLY-INDUCED KIDNEY DISEASES ................................................................................... 359
RENAL FUNCTIONS AND STRUCTURE KIDNEY FUNCTIONS: The function of the kidney is to keep the internal environment (internal milieu) of the body stable within the physiologic limits. This is achieved through the following functions: 1. EXCRETORY FUNCTION AND PRODUCTION OF URINE: The production of urine from the blood perfusing the kidney occurs in two steps: the first is filtration of plasma in the glomerulus; and the second is selective reabsorption or excretion of various substances in the renal tubules. Through urine production there are: 1. elimination of wasts (metabolic products, ingested toxins such as drugs). 2. control of water balance (maintenance of total body water and plasma osmolarity), and 3. control of electrolyte balance (sodium, chloride, calcium, phosphate, potassium, acidbase, magnesium and others). For more detail see anatomic physiology of the nephron, page 20. 2. REGULATION OF THE ACID-BASE BALANCE OF THE BODY: When excess acids are released into the circulation (e.g. through metabolic process, acid intake, or respiratory failure), the kidney prevents acidosis (accumulation of H + and drop in pH) through different mechanisms such as: a. Excessive proximal tubular reabsorption of bicarbonate filtered from blood through the glomeruli. This reabsorbed bicarbonate will go through the blood and acts as a buffer to neutralize excess H + in the circulation (H + + HCO 3 ∅ H 2 CO 3 ∅ H 2 O + CO 2 ). b. Excessive consumption and excretion of H + by the renal tubules through the increase in the formation of ammonia and titratable acids (phosphates, sulphates and phenols). In case of alkalosis (low H+ concentration pH of body fluids), the kidney will compensate by increasing bicarbonate loss in urine. This compensation
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 and 10: CONTENTS Forward ..................
Page 11: PART IX: TUBULAR AND INTERSTITIAL D
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
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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
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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,
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In case of contrast media, the foll
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Suggested Readings: - McCarthy JT:
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year, while in Egypt and some devel
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PATHOPHYSIOLOGY OF CHRONIC RENAL FA
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(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
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Suggested Readings: - Jaeger O: Gen
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solutes which could affect plasma o
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2. Volume receptors are mainly in t
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• Essential hyponatraemia: Occurs
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saline and in severe cases, small a
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III. DISTURBANCES IN PLASMA POTASSI
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B- Increase renal excretion of K +
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(Fig. 12.1) Extensive vacuolization
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3- Gastrointestinal manifestations
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DISORDERS OF ACID-BASE BALANCE Phys
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HCo 3 -. Since these substances are
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B- Gastrointestinal causes of metab
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• Cushing's syndrome • Bartter'
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HYPERTENSION AND THE KIDNEY The val
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2- Secretion of hormone which cause
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(Fig. 14.2b) Hx&E stained kidney se
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pressure is released gradually (2cm
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2- Vasodilators: This group include
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the angiotensin II. There are three
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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
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• Elevated plasma endothelin (E)
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• Orthotopic liver transplantatio
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MALIGNANCY AND THE KIDNEY The spect
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Multiple myeloma. Case of light cha
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POEMS Syndrome (P= polyneuropathy,
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2- Minimal change glomerulonephriti
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Prevention of tumour lysis syndrome
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• Non Hodgkin's lymphoma, and Kap
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DRUGS AND THE KIDNEY In this chapte
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• Uremia may reduce drug metaboli
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• It's usual dose is 1gm / 8hrs.
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• Digoxin is not dialyzable • Q
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• Renal prostaglandins (PGE 2 , P
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(D) Diuretic treatment of nephrotic
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KIDNEY AND THE HEART This issue cou
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Suggested Readings: - Leschke M, et
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• The renal vessels may show inti
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Suggested Readings: - Lindeman RD,
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Renal pathology: Glomeruli show swe
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- Treatment of sudden acute renal f
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Pregnancy In Dialysis Patients: •
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ENVIRONMENTALLY-INDUCED KIDNEY DISE
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Lead containing inclusion bodies wi
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Radiation injury It may be defined
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Suggested Reading: - Sobh M: Enviro
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