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

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(Fig. 2.2b) ILLUSTRATION OF DIFFERENT TYPES OF CRYSTALS WHICH MAY BE FOUND IN URINARY SEDIMENT (Upper are mainly seen in alkaline urine while lower are mainly seen in acidic urine). For more details on value of urine examination in medical diagnosis see page 301.
II. RENAL FUNCTION TESTS: These includes tests for glomerular and tubular functions. A. TESTS FOR GLOMERULAR FUNCTION These include test for serum creatinine, blood urea nitrogen and glomerular filtration rate (GFR). 1- Serum creatinine: In routine practice serum creatinine level is the best indicator of kidney function (normally is 0.6-1.2 mg/dl or 53-106 µmol/L). It is higher in male than in female and in those with bulky muscles than cachectic ones. Creatinine is normally released with stable level from the muscles (unless there is a muscle disease) and is secreted by the kidney. 2- Plasma urea and Blood Urea Nitrogen (BUN) :Unlike creatinine, urea is affected by protein diet, liver disease (because liver changes ammonia to urea), and dehydration (excessively reabsorbed from proximal convoluted tubules giving higher level in blood out of proportion to renal dysfunction). The normal value of blood urea is 15-40 mg/dl (2.5-7.0 mmol/L). Its production is increased by infection, trauma, surgery and corticosteroid intake. However, blood urea is considered a less reliable measure for kidney function. Still, measuring serum creatinine and urea together may give useful clinical information. For example, if urea concentration is out of proportion to that of creatinine it suggests a state of salt and water depletion, gastrointestinal haemorrhage, increased protein intake, diuretic therapy, infection or, corticosteroid therapy. Serum creatinine is out of proportion to plasma urea in cases of rhabdomyolysis and muscle diseases. Blood urea nitrogen (BUN) is sometimes used as a test for kidney function. Normal value is 8-13 mg/dl (2.9-8.2 mmol/L). 3- Glomerular Filtration Rate (GFR): This is measured by studying the clearance of a substance which is ideally freely filtered through the glomerulus; and not reabsorbed or excreted by the renal tubules (e.g. inulin). In practice, we use endogenous creatinine which is filtered through the glomerulus but some excretion occurs by the renal tubules, so creatinine clearance slightly overestimates GFR. Clearance (C) of a substance is a measure of volume of plasma cleared by the kidneys of this substance per time unit (e.g. minute or second). Thus C= UXV P
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 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: (Fig. 2.2a) An Illustration of Urin
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
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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
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
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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
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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
Page 270 and 271:
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
Page 281 and 282:
B- Gastrointestinal causes of metab
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• Cushing's syndrome • Bartter'
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HYPERTENSION AND THE KIDNEY The val
Page 287 and 288:
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
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
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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
Page 305 and 306:
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)
Page 331 and 332:
• 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,
Page 339 and 340:
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
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
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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
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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
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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