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

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occurs by increasing its reabsorbsorption which will then lead to increase of H + in the blood through the reaction H 2 CO 3 → H + + HCO 3 -. Also formation of ammonia and secretion of titratable acids by renal tubules will decrease. This results in retention of H + in blood and tissue fluids with correction of alkalosis. In states of acidosis, in a patient with normal kidney, urine will be maximally acidic (less than 5.5) and in state of alkalosis the urine will be alkalotic. 3. HEMOPOIETIC FUNCTION: Kidney has an important role in erythropioesis in the bone marrow through secretion of erythropoietin. Erythropoietin is a hormone of glycoprotein nature which regulates red blood cell development in the bone marrow. Ninety percent of erythropoietin is produced in renal cortex (by interstitial, tubular or endothelial cells). The main stimulus for erythropoietin secretion is tissue hypoxia, other stimuli are androgens, PGE, thyroid hormone and B-adrenergic agonists. Inability to secrete sufficient amount of erythropoietin as in chronic renal failure results in anaemia. In contrary, in conditions as renal artery stenosis, cystic kidney diseases and renal cell carcinoma, erythropoietin is secreted in excess resulting in polycythaemia (Erythrocytosis). Human recombinant erythropoietin is now commercially available for the treatment of anaemia in uraemic patients. 4. ENDOCRINE FUNCTIONS OF THE KIDNEY: Many hormones and vasoactive substances are either formed, activated, or degraded by the kidney. Examples of these functions are:- A- Hormones synthesized by the kidney:- 1. Renin (Fig. 1.1): This is secreted by cells of the iuxta-glomerular apparatus (see page 18). Renin will act on a circulating protein (angiotensinogen) changing it into angiotensin I which is then converted by converting enzyme into angiotensin II which has a vasopressor activity and also stimulates suprarenal gland to secrete aldosterone. This system (Renin- Angiotensin- Aldosterone) is of great importance for the control of blood pressure and body fluid and electrolyte balance.
Juxtaglomerular apparatus Liver Renin Angiotensinogen (Renin substrate) Low blood pressure, salt depletion etc. Angiotensin I (10 AAs) Angiotensin II (8 AAs) Angiotensin converting enzyme (Lung kidney, brain) Adrenal cortex Brain Vascular smooth muscle Vasoconstriction Thirst Aldosterone Kidney Sodium retention Potassium excretion Rise in blood volume Rise in blood pressure (Fig. 1.1) The renin-angiotensin system and its interactions 2. Activation of vitamin D (Fig. 1.2): Vitamin D reaching the body through oral intake or formed subcutaneously (by exposure to sun or ultraviolet rays) is biologically inactive. The activation of this vitamin occurs through hydroxylation (OH). The first step of hydroxylation occurs in the liver (25-OH- Vitamin D), whereas the second step occurs in the kidney (1, 25- (OH) 2 Vitamin D). The 1,25-dihydroxy vitamin D is 100 times as active as 25-hydroxy vitamin D.
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 and 12: PART IX: TUBULAR AND INTERSTITIAL D
Page 13: RENAL FUNCTIONS AND STRUCTURE KIDNE
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
Page 68 and 69:
5. Neutrophils: have an important r
Page 70 and 71:
2. Collagen disease (e.g. SLE, poly
Page 72 and 73:
(Fig. 3.3b) The same case in Fig. 3
Page 74 and 75:
(III) Clinical manifestations of gl
Page 76 and 77:
1. Hypoalbuminaemia results in a de
Page 78 and 79:
4. Manifestations of the etiologic
Page 80 and 81:
7. Corticosteroids are given when t
Page 82 and 83:
5. Serum creatinine is usually high
Page 84 and 85:
MCN is more common in male (male to
Page 86 and 87:
MGN could be primary or secondary t
Page 88 and 89:
. Autoimmune disease as SLE and cry
Page 90 and 91:
monocytes), later become fibrous. G
Page 92 and 93:
SECONDARY GLOMERULAR DISEASES In ma
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(Fig. 3.9d) Immunofluorescence stai
Page 96 and 97:
10- Immunologic disorders (positive
Page 98 and 99:
(Fig. 3.10c) Immunofluorescent stai
Page 100 and 101:
Clinical features: Clinical manifes
Page 102 and 103:
e responsible for the alterations i
Page 104 and 105:
When renal failure manifests, suppo
Page 106 and 107:
(Fig 3.14) Photograph showing the c
Page 108 and 109:
In patients with bacterial endocard
Page 110 and 111:
Schistosomal Nephropathy Introducti
Page 112 and 113:
in the pathogenesis of local tissue
Page 114 and 115:
well-documented in an extensive exp
Page 116 and 117:
Glomerulopathy Secondary To Virus I
Page 118 and 119:
8- Autoimmune thyroiditis. 9- Polya
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TREATMENT OF GLOMERULONEPHRITIS The
Page 122 and 123:
term, but an effect may be obtained
Page 124 and 125:
Suggested Readings: - Woo KT: Recen
Page 126 and 127:
Polyarteritis Nodosa Incidence: Pol
Page 128 and 129:
Clinical features of PAN: 1- Consti
Page 130 and 131:
Immunofluorescence microscopy is al
Page 132 and 133:
Renal pathology: • Glomeruli show
Page 134 and 135:
larynx. Vasculitis in this disease
Page 136 and 137:
(Fig. 4.4b) Immunofluorescen staine
Page 138 and 139:
Suggested Readings: - Griffith ME,
Page 140 and 141:
(Fig. 5.1a) H & E stained section(X
Page 142 and 143:
There are 5 outstanding features fo
Page 145 and 146:
ACUTE RENAL FAILURE (ARF) Definitio
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Acute Tubular Necrosis Acute tubula
Page 149 and 150:
Tumour Specific Syndromes: Tumour l
Page 151 and 152:
2. Renal Ultrasonography and echo-d
Page 153 and 154:
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:
Page 160 and 161:
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
Page 166 and 167:
(Fig. 7.2a) Disturbances of calcium
Page 168 and 169:
Calcified papillae shown in plain f
Page 170 and 171:
Eye CNS • Malaise, lethergy • c
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• Iatrogenic causes as frequent b
Page 174 and 175:
• Uraemic amaurosis (rare): which
Page 176 and 177:
INVESTIGATIONS OF A CASE WITH CHRON
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c. Postrenal factors: Causing obstr
Page 180 and 181:
Step 4. RENAL REPLACEMENT THERAPY (
Page 182 and 183:
solutes that can pass easily throug
Page 184 and 185:
(C) Nausea and Vomiting: The aetiol
Page 186 and 187:
(C) Arrhythmia: Arrhythmias during
Page 188 and 189:
3- Recent thoracic or abdominal sur
Page 190 and 191:
KIDNEY TRANSPLANTATION Definition:
Page 192 and 193:
2- Cadaveric donors: These are pers
Page 194 and 195:
. Complications due to individual d
Page 196 and 197:
- 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
Page 210 and 211:
Treatment: 1. Vitamin D (either the
Page 213 and 214:
TUBULAR AND INTERSTITIAL DISEASES T
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(Fig. 9.1a) Cross section of a kidn
Page 217 and 218:
The etiologic cause is unknown, pos
Page 219 and 220:
3. Vascular sclerosis: Affecting sm
Page 221 and 222:
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
Page 237 and 238:
Rationale of short antituberculous
Page 239 and 240:
Drug Route of Dose in GFR GFR GFR n
Page 241 and 242:
Disadvantages: - Needs experience a
Page 243 and 244:
CYSTIC RENAL DISEASES Renal cyst is
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tricuspid valve incompetence and le
Page 247 and 248:
Pathology: 1. Both kidneys are enla
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IVU- medullary sponge kidney demons
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Management 1. Patients under dialys
Page 253 and 254:
RENAL STONE DISEASES Renal stone di
Page 255 and 256:
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
Page 262 and 263:
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
Page 277 and 278:
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
Page 283 and 284:
• 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
Page 291 and 292:
pressure is released gradually (2cm
Page 293 and 294:
2- Vasodilators: This group include
Page 295 and 296:
the angiotensin II. There are three
Page 297 and 298:
Secondary Hypertension A- Renal Hyp
Page 299 and 300:
A-Two-kidney-one-clip (2K/1C) model
Page 301 and 302:
(Fig. 14.5 ) An angiogram showing a
Page 303 and 304:
PTCA will be tried as example in yo
Page 305 and 306:
Suggested Readings: - Stanley JC: D
Page 307 and 308:
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
Page 313 and 314:
VALUE OF URINE EXAMINATION IN MEDIC
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3. Colour: - Normal: umber yellow -
Page 317 and 318:
• Direct microscopic examination
Page 319 and 320:
7. Chemicals: Determination of 24 h
Page 321 and 322:
RENAL MANIFESTATIONS OF SYSTEMIC DI
Page 323 and 324:
2- Nephrogenic diabetes insipidus.
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Gout and Kidney Patient with gout m
Page 327 and 328:
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
Page 337 and 338:
POEMS Syndrome (P= polyneuropathy,
Page 339 and 340:
2- Minimal change glomerulonephriti
Page 341 and 342:
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.
Page 351 and 352:
• 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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