Clinical Nephrology

The following sections are included:

• Preface

• Acknowledgements

• Contents

The following sections are included:

• ANATOMY OF THE KIDNEYS

• FUNCTIONS OF THE KIDNEYS
  • Renal Handling of Sodium
  • Renal Handling of Potassium
  • Kidney Regulation of Acid-Base Balance
  • Acidification of the Urine and Excretion of H⁺
    • In Metabolic Acidosis
    • In Metabolic Alkalosis
    • Adequacy of Gradient-Generating and Acid-Excreting Ability
  • Concentration of Urine
  • Hormones and the Kidneys

The following sections are included:

• HISTORY TAKING

• PHYSICAL EXAMINATION OF THE RENAL MASS
  • An Enlarged Kidney or a Spleen?

• KIDNEY DISEASES IN SINGAPORE

• URINE EXAMINATION
  • Further Remarks on Haematuria
    • Symptoms and Diagnosis
    • Time of Haematuria

The following sections are included:

• URINE EXAMINATION
  • Urinary Red Blood Cells (RBC)
  • Leukocytes
  • Casts

• QUANTITATIVE MEASUREMENT OF PROTEINURIA

• GLOMERULAR FUNCTION
  • Blood Urea Level
  • Factors Affecting Serum Creatinine
  • Glomerular Filtration Rate (GFR)
  • Measurement of GFR
    • Inulin Clearance
    • Creatinine Clearance
    • Chromium⁵¹-EDTA
    • Estimation of GFR by Radiopharmaceuticals
    • Estimation of GFR Using Beta 2 Microglobulin

• TUBULAR FUNCTION
  • Proximal Tubular Function
    • Amino Acids
    • Urate
    • Phosphate
    • Glycosuria
  • Urinary Concentration Ability
    • Maximal Osmolar Concentration
  • Impaired Urinary Concentration
  • Dilution Test
  • Urinary Acidification
  • Short Test of Wrong and Davis

• RENAL FUNCTION WITH INCREASING AGE

The following sections are included:

• ACUTE NEPHRITIC SYNDROME

• RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS (CRESCENTERIC GLOMERULONEPHRITIS)

• ASYMPTOMATIC HAEMATURIA AND PROTEINURIA
  • History
  • Physical Examination
  • Investigations
  • Indications for Renal Biopsy
  • Renal Biopsy
  • Factors Influencing the Progression of IgA Nephritis
  • How does glomerulonephritis come about?
  • Renal Biopsy
    • What investigations are usually performed on a patient who is suspected of having Glomerulonephritis?
    • Significance of Repeatedly Passing Blood in the Urine (Visible Blood or Gross Haematuria)
    • Significance of finding a small amount of blood and protein in the urine on routine medical examination

• REFERENCES

The following sections are included:

• MINIMAL CHANGE DISEASE

• FOCAL AND SEGMENTAL GLOMERULO SCLEROSIS (FSGS)

• MESANGIAL PROLIFERATIVE GLOMERULONEPHRITIS

• MEMBRANOUS GLOMERULONEPHRITIS

• MESANGIOCAPILLARY GLOMERULONEPHRITIS (MCGN)

• HEREDITARY NEPHRITIS AND DEAFNESS(ALPORT'S SYNDROME)

• REFERENCES

The following sections are included:

• INTRODUCTION
  • Pathogenesis
• Defective Clearance of Immune Complexes
• Role of Cytokines
• The Propensity for IgA Deposition in IgA Nx
• Mechanism by which Mesangial Deposits Initiate Glomerular Injury
  • Therapeutic Strategies
• Ways to Limit Amounts of Mesangial Deposits
• A Pathophysiologic Approach
• Future Therapeutic Strategies
• Therapy of IgA Nephritis: Present Status

• CONCLUSION

• REFERENCES

The following sections are included:

• Renal Involvement in Systemic Lupus Erythematosus (SLE)
• Assessment of the Patient at Presentation
• Investigations
• Renal Biopsy
• WHO Classification of Lupus Nephritis
• Indices of Activity and Chronicity
• Active Lesions (Potentially Reversible)
• Chronic Lesions (Irreversible)
• Renal Histopathology and Survival (Baldwin 1977)
• Serologic Parameters (Balow)
• Correlation between Serologic Markers and Disease Activity (Hayslett)
• Assessment of a Patient for Therapy
• Assessment for Pregnancy
• Pregnancy In Women with SLE
• Treatment of Lupus Nephritis
• Increased Risk of Mortality
• Predictors of Mortality
• Prognosis

The following sections are included:

• Mid Stream Urine

• Suprapubic Aspiration

• Catheterised Specimen

• CONCLUSION

• REFERENCES

The following sections are included:

• RELATIONSHIP BETWEEN SEXUAL INTERCOURSE AND RENAL DISEASE

• HONEYMOON CYSTITIS
  • What can be done for women prone to recurrent Urinary Infections?
  • Anal Intercourse and Urinary Infection in a Male
  • Oral Intercourse and Urinary Infection
  • Urinary Tract Infection in Sexy Young Males
    • In a woman who has repeated bruising to the urethral opening following Sexual Intercourse what could be done?
  • Significance of Blood Stained Semen
  • Impotency
  • Causes of Impotency

The following sections are included:

• CAUSES OF HYPERTENSION

• RENAL EFFECTS OF HYPERTENSION

• INVESTIGATION OF THE PATIENT WITH HYPERTENSION
  • History
  • Physical Examination
  • Investigation
  • Special Investigations

• TREATMENT OF RENAL ARTERY STENOSIS
  • Medical Management of Hypertension
  • Drugs Used in Emergency Treatment of Hypertension

• ROLE OF SODIUM AND POTASSIUM IN HYPERTENSION
  • Story of Evolution
  • Sodium and Blood Pressure
  • How does Salt Raise Blood Pressure?
  • Does Salt Restriction Lower Blood Pressure?
  • Role of Potassium
  • Essential Hypertension: A Renal Perspective

The following sections are included:

• Thiazides
  • Side Effects of Thiazide Diuretic

• Loop Diuretic (Frusemide, Ethacrynic Acid, Bumetamide)

• Spironolactone (Aldactone)

• Indapamide (Natrilix)

• Diuretic Therapy and Vascular Disease

• Beta Blockers and Cardiac Protection

• Comparison of Beta Blocker and Diuretic

• Current Role of Diuretics in Hypertension

• Treatment of Renal Hypertension

• Treatment of Essential Hypertension

• Tailor Treatment to Patient

The following sections are included:

• THE INCIDENCE OF STONE DISEAS

• FACTORS WHICH PREDISPOSE TO STONE FORMATION

• THE DIFFERENT TYPES OF STONES

• SYMPTOMS OF STONES IN THE URINARY TRACT

• INVESTIGATION OF PATIENTS WITH STONES

• TREATMENT OF PATIENT WITH RENAL STONES
  • Newer Techniques of Stone Removal

• GOUT
  • What Triggers Off an Attack of Gout?
  • Treatment of Gout
  • Renal Complications of Gout

• DIETARY FACTORS AND CALCIUM NEPHROLITHIASIS
  • High Level of Dietary Protein
  • Other Factors
  • Dietary Therapy

• REFERENCE

The following sections are included:

• Natural History of Diabetic Nephropathy

• Role of Glycemic Control in Diabetic Nephropathy

• Role of Hypertension in Diabetic Nephropathy

• Role of Angiotensinogen Converting Enzyme Inhibitors

• RENAAL Trial

• The Role of Dietary Protein Restriction in DiabNx

• The Role of Hyperlipidemia in Diabetic Nephropathy

• Indications for Referral of a Patient with Diabetes Mellitus to a Nephrologist

• IN CONCLUSION

• REFERENCES

The following sections are included:

• SODIUM AND WATER

• SODIUM (Na⁺)
  • Distribution
  • Symptoms of Hyponatraemia
  • Symptoms of Hypernatraemia
  • Hyponatraemia
  • Hypermatraermia with Expansion of Body Fluids
  • Hypernatremia with Contraction of Body Fluids
  • Oedema
  • Idiopathic (Cyclical) Oedema
  • Natriuretic Hormone (NH)
  • Atrial Natriuretic Peptide (ANP)
  • Syndrome of Inappropriate Secretion of ADH
  • Causes of SIADH
  • Treatment of Salt Loss
  • Calculation of Sodium Deficit

• POTASSIUM
  • K⁺ Depletion
  • Effects of K⁺ Depletion
  • Hyperkalemia
  • Treatment of Hyperkalaemia
  • Effects of Hyperkalaemia

• MAGNESIUM
  • Function
  • Mg Deficiency

The following sections are included:

• PATHOGENESIS OF METABOLIC ACIDOSIS

• NET ENDOGENOUS ACID PRODUCTION

• PHYSIOLOGICAL RESPONSE TO METABOLIC ACIDOSIS OF EXTERNAL ORIGIN

• RENAL RESPONSE TO METABOLIC ACIDOSIS OF EXTRARENAL ORIGIN

• CONSEQUENCES OF METABOLIC ACIDOSIS

• CAUSES OF METABOLIC ACIDOSIS

• LACTIC ACIDOSIS (COHEN AND WOODS)

• SYMPTOMS OF LACTIC ACIDOSIS

• TREATMENT OF LACTIC ACIDOSIS

• TREATMENT OF METABOLIC ACIDOSIS

• METABOLIC ALKALOSIS

• SYMPTOMS OF METABOLIC ALKALOSIS

• CAUSES OF METABOLIC ALKALOSIS

• PATHOGENESIS OF METABOLIC ALKALOSIS

• GENERATION OF METABOLIC ALKALOSIS

• MAINTENANCE OF METABOLIC ALKALOSIS

• TREATMENT OF METABOLIC ALKALOSIS

• THE ROLE OF CHLORIDE DEFICIENCY IN METABOLIC ALKALOSIS

• BARTTER'S SYNDROME

The following sections are included:

• QUESTION
  • Question 1
  • Question 2
  • Question 3
  • Question 4
  • Question 5
  • Question 6
  • Question 7
  • Question 8
  • Question 9
  • Question 10
  • Question 11
  • Question 12

• ANSWERS
  • Answer 1
  • Answer 2
  • Answer 3
  • Answer 4
  • Answer 5
  • Answer 6
  • Answer 7
  • Answer 8
  • Answer 9
  • Answer 10
  • Answer 11
  • Answer 12

• Additional Notes

The following sections are included:

• TYPE I RTA

• TYPE II RTA

• TYPE III RTA

• TYPE IV RTA

• INVESTIGATIONS
  • Ammonium Chloride Loading Test
  • Maximal Osmolar Concentration

• TYPE I OR DISTAL RTA (Classic or Gradient RTA)
  • Clinical Features of Type I RTA

• TYPE II OR PROXIMAL RTA (Bicarbonate Wasting or Rate RTA)
  • Clinical Features of Type II or Proximal RTA

• TREATMENT OF RTA

• PRACTICE POINTS

The following sections are included:

• CYSTINURIA

• CYSTINOSIS

• MEDULLARY SPONGE KIDNEY

• MEDULLARY CYSTIC KIDNEYS

• DIABETES INSIPIDUS (DI)

• PSEUDOHYPOPARATHYROIDISM

• URAEMIC ACIDOSIS

• INTERSTITIAL NEPHRITIS

The following sections are included:

• RENAL VASCULITIS
  • Clinical Features
  • Investigation
  • Renal Lesions
  • Treatment

• SYSTEMIC LUPUS ERYTHEMATOSUS

• POLYARTERITIS NODOSA

• WEGENER'S GRANULOMATOSIS

• SCLERODERMA

• RHEUMATOID ARTHRITIS

• MULTIPLE MYELOMA

• AMYLOIDOSIS

• CRYOGLOBULINAEMIA

• MACROGLOBULINAEMIA

• RENAL TUBULAR ACIDOSIS

• SARCOIDOSIS

• NEPHROTIC SYNDROME AND MALIGNANCY

• RENAL COMPLICATIONS OF LYMPHOMA

• GOUT

• SUBACUTE BACTERIAL ENDOCARDITIS

• XANTHOGRANULOMATOUS PYELONEPHRITIS

• DIABETES MELLITUS

• HENOCH˜SCHONLEIN NEPHRITIS

• FUNCTIONAL RENAL FAILURE ASSOCIATED WITH LIVER DYSFUNCTION

• FALCIPARUM MALARIA

• QUARTAN MALARIA

• REFERENCE

The following sections are included:

• PRECAUTIONS DURING PREGNANCY

• PREGNANCY AND SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

• PREGNANCY IN A PATIENT ON DIALYSIS OR WITH A KIDNEY TRANSPLANT

• PREGNANCY IN A PATIENT WITH INHERITED RENAL DISORDERS

The following sections are included:

• HYPERNEPHROMA

• WILMS' TUMOUR

• ADENOMA OF THE KIDNEY

The following sections are included:

• PATTERNS OF INHERITANCE OF DISEASE

• POLYCYSTIC KIDNEY
  • Inheritance of Polycystic Kidneys
  • Infantile Polycystic Kidneys

• MEDULLARY SPONGE KIDNEY

• INHERITED RENAL STONES

• HEREDITARY GLOMERULONEPHRITIS

• FABRY'S DISEASE (ANGIOKERATOMA CORPORIS DIFFUSUM)

• CONGENITAL MALFORMATION AND DEVELOPMENTAL ANOMALIES

The following sections are included:

• THE EFFECTS OF DRUGS ON THE KIDNEYS

• PRACTICE POINTS

• DRUGS WHICH REQUIRE CAUTION AND ALTERATION OF DOSAGE IN RENAL FAILURE
  • Renal Transplant: Drugs to avoid

The following sections are included:

• DEFINITION

• DIAGNOSTIC APPROACH AND INVESTIGATION
  • Exclude Obstruction (Post Renal Failure)

• INVESTIGATIONS

• INTRINSIC RENAL FAILURE
  • Vasomotor Nephropathy or Acute Tubular Necrosis
  • Glomerulonephritis, Vasculitis
  • Interstitial Nephritis, Drugs
  • Renal Vascular (Arterial Thrombosis, Embolism)
  • Acute Exacerbation of Chronic Renal Disease

• CLINICAL COURSE OF ACUTE RENAL FAILURE
  • Onset Phase
  • Oliguric Phase
    • Acute Uraemic Syndrome

• Diuretic Phase
  • Oliguric Phase
  • Diuretic Phase
  • Post Diuretic Phase

• PROGNOSIS

The following sections are included:

• DEFINITION

• AETIOLOGY

• CLINICAL PRESENTATION
  • Central Nervous System
  • Ophthalmic Changes
  • Gastrointestinal
  • Dermatological
  • Cardiovascular System
  • Haematological System
  • Respiratory System
  • Renal Osteodystrophy

• MANAGEMENT
  • Dietary Treatment
    • Low Protein Diet
    • 20 gm Protein Diet
    • 0.8 gm/kg BW Protein Diet
    • Hyperfiltration and Relevance of Low Protein Diet (0.8 gm/kg BW)
    • Keto Acid Analogues
    • Maintaining Internal Environment
    • Hyperkalaemia
    • Anaemia
    • Phosphate Binders
    • Calcium, Vitamin D Supplements
    • Blood Pressure Control
    • Vitamins
  • Investigations
  • Sympathy

The following sections are included:

• SELECTION

• CENTRE DIALYSIS

• HOME DIALYSIS

• SELF DEPENDENCY DIALYSIS CENTRES
  • Medical Problems still present in Patients on Dialysis

• PRINCIPLES INVOLVED IN HAEMODIALYSIS

• HAEMOFILTRATION
  • Vascular Access and How It is Made Possible
  • Types of Dialysers (Artificial Kidneys)

• DIALYSATE
  • The Tap Water Used for Haemodialysis

• EQUIPMENT REQUIRED FOR HAEMODIALYSIS
  • Functions of the Monitoring System in the Dialysis Machine

• THE EFFECT OF HAEMODIALYSIS ON THE PATIENT

• DIETARY RESTRICTIONS FOR A PATIENT ON HAEMODIALYSIS

• THE PSYCHOLOGICAL EFFECTS ON THE DIALYSIS PATIENT

• HALLMARKS OF A WELL DIALYSED PATIENT

• PRINCIPLES OF PERITONEAL DIALYSIS
  • The Tenckhoff Catheter
  • Dialysate used for Patients on Peritoneal Dialysis
  • Continuous Ambulatory Peritoneal Dialysis (CAPD)
  • Automated Peritoneal Dialysis

• SUBSIDY FOR DIALYSIS

• PROGNOSIS FOR PATIENTS ON DIALYSIS

The following sections are included:

• LIVING RELATED DONOR

• CADAVER DONOR

• TISSUE TYPING

• PATTERN OF INHERITANCE OF HLA TYPES

• ABO BLOOD GROUPING IN KIDNEY TRANSPLANT

• THE MIXED LYMPHOCYTE REACTION

• FITNESS TO DONATE A KIDNEY
  • Is it safe for a parent or sibling to donate a kidney? Will it do any harm? What about people who do heavy work? Can young women marry and have children after giving away one kidney?
  • Complications of Live Kidney Donation
  • Social Pressure on a Relative to Donate Kidney
    • The stand of kidney doctors with regard to living related donor transplantation and what they tell potential donors
  • Spouse to Spouse Renal Transplant
  • Assessment of Donor for Living Related Transplantation
  • Potential Cadaver Kidney Donors
  • Brain Death
  • Kidney Transplant Legislation
  • Preparation of the Patient for Renal Transplant
  • The Transplant Operation
  • What Happens to the Patient (Recipient) After the Operation?
  • The Donor Nephrectomy on a Live Donor
  • Immunosuppressive Drugs

• COMPLICATIONS OF KIDNEY TRANSPLANTATION
  • Transplant Rejection

• ADVANTAGES OF TRANSPLANTATION

The following sections are included:

• APPENDIX: ATRA Therapy in IgA Nephritis

• Index