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

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ACKNOWLEDGEMENT Professor Jacob Churg, USA and IGAKU-SHOIN Medical Publishers, Inc Japan are acknowledged for granting a permission to reproduce some of their histopathology figures. Also, Novartis, Egypt, is acknowledged for facilitating the permission to reproduce some of Frank Netter's illustrations (The Netter Collection of Medical Illustrations, Vol. 6, illustrated by M.D. all rights reserved). The gratitude is for Dr. Fatma El-Husseini, professor of pathology for providing some of her pathology figures. Dr. Tarek El-Diasty, consultant radiologist, is acknowledged for providing the radiology figures. The valuable help provided by Dr. M. Ashraf Foda, Dr. Ahmed Donia and Dr. Mahmoud Mohasseb is highly appreciated. The clever secretarial work of Mrs. Hend Sharaby and Heba Zaher are greatly acknowledged.
FOREWARD Although this country is plagued by the highest prevalence of renal disease worldwide, only very few Egyptian nephrologists have attempted to write a book on renal medicine. The dream has always been there, but the major barrier was the pain it takes to produce a work that competes with the plethora of excellent international textbooks and monographs. No wonder that Mohamed Sobh pioneered the challenge, as he has always done. I have admirably witnessed this young man's progress over the years since he had made one of his earliest contribution in the first Egyptian Society of Nephrology in 1980. His star continued to shine in the horizons of renal medicine until he became one of the best known in Africa and the Arab world, while at home he became the Professor and Chief of Nephrology in renowned Mansoura University. He published a lot on basic renal physiology, schistosomal nephropathy and renal transplantation among many other topics. In addition, he was the author or co-author of a number of excellent monographs published in Egypt and abroad. He made outstanding presentations in a lot of local and international conferences, and received many awards of great honor. Despite his academic interests, Professor Sobh has a vast clinical experience, which enriches this book. In over 400 pages he intelligently mixes theory with practice, bench with bedside, and international with local experience. He offer the post-graduate student the long-waited practical an applicable concise guide in nephrology. I confidently promise the reader a most enjoyable cruise through the very well written and carefully illustrated chapters of the book. Professor Rashad Barsoum MD, FRCP, FRCPE Professor and Head of Department of internal Medicine, Cairo University. President of The Egyptian Society of Nephrology and the Arab Society of Nephrology and Renal Transplantation. Secretary General of the International Society of nephrology
Page 1 and 2: ESSENTIALS OF CLINICAL NEPHROLOGY E
Page 3 and 4: Essentials of Clinical Nephrology T
Page 5: Dedication To the soul of my dear f
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 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
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
Page 80 and 81:
7. Corticosteroids are given when t
Page 82 and 83:
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
Page 88 and 89:
. 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
Page 104 and 105:
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
Page 110 and 111:
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
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
Page 138 and 139:
Suggested Readings: - Griffith ME,
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(Fig. 5.1a) H & E stained section(X
Page 142 and 143:
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
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
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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
Page 178 and 179:
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
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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
Page 198 and 199:
B) Amino acids tubular transport de
Page 200 and 201:
distal RTA, more HCO 3 and chloride
Page 202 and 203:
2. Hypokalemia due to defective han
Page 204 and 205:
4. Autoimmune disease • Sjogren's
Page 206 and 207:
5. Miscellaneous • Amyloidosis
Page 208 and 209:
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
Page 229 and 230:
2. Hypertension. 3. Insidious onset
Page 231 and 232:
d) Direct infection : From epididym
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Symptoms: 1- Asymptomatic 2- Consti
Page 235 and 236:
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
Page 245 and 246:
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
Page 266 and 267:
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
Page 315 and 316:
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.
Page 325 and 326:
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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