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

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Bowman's capsule Glomerulus -3- Epithelial cells (renin granules) Afferent arteriole Sympathetic nerve ending (B2 adrenergic) -1- Macula densa cells Tubular lumen Distal tubule Efferent arterioles -2- Juxtaglomerular (lacis) cells Mesangial cells and matrix (Fig. 1.7) The Juxtaglomerular apparatus. Note: (1) Macula densa of distal tubule. (2) Juxtaglomerular (lacis) cells. (3) Granular renin-secreting epithelial cells of afferent arterioles. The glomerulus (renal corpuscle): The renal corpuscle is formed essentially of two modified structures of different embryonic origins: A. The first is the Bowman's capsule which is present at the beginning of the proximal convoluted tubule and is formed of a space lined by basement membrane and flat epithelial cells. B. The second is modification of the end of the afferent arteriole, which divides into several primary branches. These in turn give rise to several lobules of capillaries (tuft of capillaries). The other end of this capillary tuft gives rise to the efferent arteriole. Each capillary is lined with basement membrane, lined from inside by endothelial cells and from outside by epithelial cells which lie on the capillary basement membrane by foot process (so it is called podocyte). The capillary tuft will invaginate and occupy the Bowman's capsule to form the renal corpuscle.
Figure 8 shows a cross section of the glomerulus which is composed of: 1. Bowman's capsule with its outer (parietal) layer lined by flat epithelial cells, and inner visceral layer in contact with capillary tuft lined with visceral epithelial cells (podocytes). Between the two layers there is a space called urinary space. 2. Glomerular capillaries are lined by basement membrane which is covered from inside with endothelial cells and from outside by epithelial cells (podocytes). The capillary wall basement membrane is chemically formed of type IV collagen and negatively charged glycosaminoglycans. By electron microscopy, the basement membrane is formed of three layers, inner layer (lamina rara interna), outer layer (lamina rara externa) and in between the lamina densa. The thin cytoplasm of the endothelial cells show multiple open fenestrae, and the outer epithelial cells show elongated foot processes which rest on the outer surface of the glomerular basement membrane. These foot processes interdigitate with those of nearby epithelial cells and in between we can see slit pores. The fenestrae of endothelial cells and slit pores of epithelial cell foot processes are of great value in glomerular filtration. Fig. (1.8a) Electron Photomicrograph Of Renal COPPUSCLE, X1100 Pa=Partial Epithelium Nucleus U= URINARY SPACE Ca=PODOCYTE (Visceral Epithelium) NUCLEUS En=Endothelium Nucleus M= Mesangial Cell nucleus A= Afferent Arteriole E= Efferent Arteriole J= Juxataglomerular Cell D= Macula Densa Of Distal Tubule (Tangentially Cut) P= Proximal Tubules
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 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: (Fig. 1.6) Diagrammatic illustratio
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
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1. Hypoalbuminaemia results in a de
Page 78 and 79:
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
Page 92 and 93:
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
Page 108 and 109:
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
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
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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
Page 184 and 185:
(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:
Page 192 and 193:
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
Page 213 and 214:
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
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
Page 311 and 312:
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
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7. Chemicals: Determination of 24 h
Page 321 and 322:
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
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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