Handbook of Renal Therapeutics

ISBN-13: 9781468472622 / Angielski / Miękka / 2012 / 568 str.

Manuel Martinez-Maldonado

Opis

This book started out as a "Manual. " The idea was to offer straightforward instruction on how to handle patients in whom renal function is altered by intrinsic as well as systemic or extrarenal disease. While we have attempted to provide simple approaches to most conditions, we have gone beyond that and offer here more detailed description of pathophysiology, diagnosis and therapy. Thus, the "Manual" has become a Handbook. In so doing we hope we have widened the audience for which the book may be useful. As it now stands, we envision that students, house staff, nephrology trainees, nephrologists, primary-care physicians, and nurses of specialized units, interested in kidney-related disturbances and in alterations of the composi- tion of the extracellular fluid, will benefit from reading the Handbook. While providing a rational background for the treatments outlined, each author has attempted to narrate the reasons why such therapy is utilized. Frequently, the information is provided in tables and figures to which ready reference can be made. The flow-chart approach has also been utilized to illustrate pathophysiological sequence or steps in therapy. In most instances, the discussion of pathophysiology has been limited to what is widely ac- cepted rather than treading into anything controversial, unless the nature of the problem or the nature of our knowledge is ambiguous.

Spis treści

1. Fluid and Electrolyte Disturbances: Hypo- and Hypernatremia.- I. Normal Physiology of Urinary Dilution.- II. Etiology of Hyponatremia.- A. Factitious Hyponatremia.- B. Redistribution of Water.- C. Hyponatremia with Increased Total Body Salt and Water Content.- D. Hyponatremia with Decreased Total Body Salt and Water Content.- E. Hyponatremia and “Normal” Total Body Salt and Water Content.- F. Acute Water Intoxication.- III. Treatment of Hyponatremia.- A. Duration of Hyponatremia.- B. Hyponatremia and Diminished Extracellular Fluid Volume.- C. Assessment of Extracellular Fluid Volume and Sodium Deficit.- D. Hyponatremia and Expanded Extracellular Fluid Volume.- E. Inappropriate ADH Secretion.- F. Hypokalemia-Associated Hyponatremia.- IV. Clinical Disorders of Hypernatremia.- A. Sodium Gain.- B. Water Loss.- C. Water Loss in Excess of Sodium Loss.- D. Reset Osmostat.- V. Clinical Manifestations of Hypernatremia.- VI. Treatment of Hypernatremia.- A. Treatment of Hypernatremia Resulting from Sodium Gain.- B. Treatment of Hypernatremia Resulting from Pure Water Loss.- 2. Fluid and Electrolyte Disturbances: Hypo- and Hyperkalemia.- I. Postassium Distribution.- II. Renal Regulation of Potassium Excretion.- III. Extrarenal Potassium Homeostasis.- IV. Clinical Disorders of Hyperkalemia.- A. Factitious Hyperkalemia.- B. Acidemia.- C. Increased Potassium Intake or Release from Cells.- D. Inadequate Distal Delivery of Sodium and Fluid.- E. Renal Failure.- F. Impaired Renin-Aldosterone Axis.- G. Renal Tubular Secretory Defect.- H. Abnormal Potassium Distribution.- V. Treatment of Hyperkalemia.- A. Clinical Manifestations.- B. Acute Treatment of Hyperkalemia.- C. Treatment of Chronic Hyperkalemia.- VI. Hypokalemia: Estimation of Potassium Deficit.- VII. Clinical Manifestations.- A. Cardiac Toxicity.- B. Neuromuscular Manifestations.- C. Renal-Metabolic.- VIII. Etiology and Specific Therapy of Hypokalemia.- A. Diuretics.- B. Other Forms of Renal Losses.- IX. General Treatment of Hypokalemia.- A. Oral Potassium Replacement.- B. Intravenous Potassium Replacement.- C. Antagonists of Potassium Secretion.- 3. Fluid and Electrolyte Disturbances: Hypo- and Hypercalcemia.- I. Physiological Role of Calcium.- A. Physicochemical Aspects.- B. Functions in the Body.- C. Calcium Homeostasis.- II. Hypocalcemia.- A. Causes and Mechanisms.- B. Consequences.- III. Hypercalcemia.- IV. Treatment of Hypo- and Hypercalcemia.- A. Hypocalcemia.- B. Hypercalcemia.- 4. Fluid and Electrolyte Disturbances: Hypo- and Hypermagnesemia.- I. Physiological Role of Magnesium.- A. Physicochemical Aspects.- B. Functions in the Body.- C. Magnesium Homeostasis.- D. Interaction with Other Ions.- II. Hypomagnesemia.- A. Causes.- B. Consequences of Hypomagnesemia.- III. Hypermagnesemia.- A. Causes.- B. Consequences.- IV. Treatment of Hypo- and Hypermagnesemia.- A. Treatment of Magnesium Excess.- B. Treatment of Magnesium Deficiency.- 5. Fluid and Electrolyte Disturbances: Treatment of Hypophosphatemia and Phosphate Depletion.- I. Hypophosphatemia.- A. Relationship to Alcohol.- B. Role of Antacid.- C. Burns.- D. Role of Nutrients.- E. Diabetes Mellitus.- F. Nutritional Recovery Syndrome.- G. Acid-Base Alteration.- II. The Consequences of Acute Hypophosphatemia.- A. Rhabdomyolysis.- B. The Red Cell in Hypophosphatemia.- C. Myocardial Dysfunction.- D. Leukocyte Function during Hypophosphatemia.- E. Platelet Function during Hypophosphatemia.- F. Effects of Hypophosphatemia on the Central Nervous System.- G. Metabolic Acidosis.- H. Osteomalacia.- I. Unproved Consequences of Hypophosphatemia.- J. Mechanism of Cellular Injury in Hypophosphatemia.- III. Treatment of Acute Severe Hypophosphatemia.- A. Clinical Evidence.- B. Experimental Evidence.- IV. Therapeutic Considerations.- 6. Acid-Base Disturbances: Metabolic and Respiratory Acidoses.- I. Introductory Terms and Concepts.- A. Acidity.- B. Acidosis, Alkalosis, Acidemia, Alkalemia.- C. Bicarbonate Space.- D. The Acid-Base Equation.- E. Compensation, the Anion Gap, and Simple and Mixed Disorders.- II. The Acidoses.- A. Effects of Metabolic and Respiratory Acidoses.- B. Metabolic Acidosis.- C. Respiratory Acidosis.- 7. Acid-Base Disturbances: Metabolic and Respiratory Alkaloses.- I. Effects of Alkalosis.- II. Metabolic Alkalosis.- A. Pathogenesis.- B. Pathophysiology.- C. Differential Diagnosis.- D. Management.- III. Respiratory Alkalosis.- A. Pathogenesis.- B. Pathophysiology.- C. Diagnosis.- D. Management.- 8. Disturbances of Uric Acid Metabolism.- I. Introduction.- II. Regulation of Purine Metabolism in Man.- III. Origin of Uric Acid in Man.- A. Exogenous.- B. Endogenous.- IV. Disposition of Uric Acid.- A. Extrarenal.- B. Renal Handling of Uric Acid in Man.- V. Evaluation of Hyperuricemic States.- A. Etiology of Hyperuricemia.- B. Work-up for Hyperuricemia.- VI. Renal Complications of Hyperuricemia.- A. Chronic Gouty Nephropathy.- B. Uric Acid Nephropathy.- VII. Therapy of Hyperuricemic States.- A. Asymptomatic Hyperuricemia.- B. Uric Acid Nephrolithiasis.- C. Acute Uric Acid Nephropathy.- VIII. Hypouricemic States.- A. Decreased Production of Uric Acid.- B. Increased Excretion of Uric Acid.- 9. Management of Glomerulonephritis and Nephrotic Syndrome.- I. Pathogenesis of Glomerulonephritis.- II. Pathophysiology of Nephrotic Syndrome.- A. Proteinuria.- B. Hypoproteinemia.- C. Edema.- D. Hyperlipemia.- E. Lipiduria.- III. General Management of Nephrotic Syndrome and Glomerulonephritis.- A. Edema.- B. Hypoalbuminemia.- C. Hyperlipemia.- D. Drug Metabolism in the Nephrotic Syndrome.- E. Vitamin D, Thyroid, and Iron.- F. Thrombosis.- G. Infection.- H. Proteinuria.- I. Hypertension and Renal Failure.- J. Renal Biopsy.- IV. Treatment of Glomerular Diseases.- A. Minimal-Lesion Nephrosis.- B. Focal Segmental Glomerular Sclerosis.- C. Membranous Nephropathy.- D. Membranoproliferative Glomerulonephritis (Mesangiocapillary Glomerulonephritis, Chronic Hypocomplementemic Glomerulonephritis, MPGN).- E. Rapidly Progressive Glomerulonephritis.- F. Acute Proliferative Glomerulonephritis.- G. Mesangial Proliferative Glomerulonephritis [Including IgA Nephropathy (Berger’s Disease), Benign Hematuria, and Some Varieties of Hereditary Glomerular Nephritis].- V. Conclusion.- 10. Drugs and the Kidney: Renal Contribution to Handling of Drugs.- I. Introduction.- II. Determinants of the Relationship between the Dose of a Drug and Its Concentration in Blood.- A. Absorption.- B. Distribution.- C. Elimination.- D. Dosing Interval.- III. Effect of the Kidney on the Distribution of Drugs to Tissues.- IV. Effect of Renal Function on Sensitivity to Drugs.- 11. Drugs and the Kidney: Adjusting Drug Regimens in Patients with Renal Disease.- I. Introduction.- II. Terminology.- III. Quantitative Dose Adjustment.- A. Determination of Creatinine Clearance as an Index of Renal Function.- B. Choice of an Appropriate Dosing Regimen with Selection of Dose and Dosing Interval.- IV. Conclusions.- 12. Infections and Antibiotic Usage in Patients with Renal Diseases.- I. Introduction.- II. The Predisposition to Infection.- A. Renal Failure and Dialysis.- B. Renal Transplant Recipients and Other Patients with Renal Disease Receiving Immunosuppressive Medications.- C. Other Renal Diseases with a Predisposition to Infection.- D. Pathogenesis of Urinary Tract Infections.- III. The Diagnosis of Infections in Patients with Renal Disease.- A. Skin, Mucosal, and Soft Tissue Infections.- B. Respiratory Infections.- C. Endovascular Infections.- D. Gastrointestinal Infections.- E. Urinary Tract Infections.- F. Central Nervous System Infections.- G. Other Sites of Infection.- IV. General Guidelines to Antibiotic Use In Patients with Renal Disease.- A. Pharmacodynamic Principles.- B. Route of Administration: Pharmacological and Drug Interactions.- C. Method of Drug Administration and Serum Concentrations.- V. Clinical Use of Antibiotics in Patients with Renal Disease.- VI. Therapy of Urinary Tract Infections.- A. Uncomplicated Acute Urinary Tract Infections.- B. Symptomatic Female Patient with No Bacteria Seen on Urinary Gram Stain.- C. Pyelonephritis, Upper Tract Disease.- D. Asymptomatic Bacteriuria.- E. Prophylaxis.- 13. Management of Hypertension: Management of Essential and Secondary Hypertension.- I. Introduction.- II. Mechanisms of Essential Hypertension.- III. Management of Essential Hypertension.- A. Nonpharmacological Treatment.- B. Dietary Restriction of Sodium.- C. Antihypertensive Drugs.- IV. Secondary Forms of Hypertension.- A. Oral Contraceptive Use.- B. Hypertension Associated with Renal Parenchymal Disease.- C. Renovascular Hypertension.- D. Primary Aldosteronism.- E. Pheochromocytoma.- F. Miscellaneous Causes.- 14. Management of Hypertension: Hypertensive Emergencies.- I. Introduction.- II. Accelerated and Malignant Hypertension.- A. Clinical Features.- B. Management.- III. Hypertensive Encephalopathy.- A. Clinical Features.- B. Management.- IV. Severe Hypertension Associated with Cerebrovascular Accidents.- V. Acute Aortic Dissection.- A. Clinical Features.- B. Physical Findings.- C. Initial Management.- D. Angiography.- E. Definitive Therapy.- VI. Acute Left Ventricular Failure.- VII. Severe Hypertension Associated with Ischemic Heart Disease.- VIII. Miscellaneous Causes.- A. Pheochromocytoma Crisis.- B. Clonidine Withdrawal Syndrome.- C. Hypertensive Crisis Associated with Drug and Food Interactions.- D. Postoperative Hypertensive Crisis.- E. Severe Hypertension Associated with Burns.- F. Hypertensive Crises in Quadriplegic Patients.- IX. Drugs Used in the Treatment of Hypertensive Crisis.- A. Diazoxide.- B. Nitroprusside.- C. Trimethaphan.- D. Phentolamine.- E. Other Agents.- F. Transition to Oral Therapy.- X. General Approach to the Management and Conclusions.- 15. Hypertension and Renal Disease during Pregnancy.- I. Physiological Changes in Pregnancy.- A. Blood Volume and Arterial Pressure.- B. Humoral Alterations.- C. Renal Blood Flow.- D. Glomerular Filtration Rate.- E. Renal Tubular Function.- F. Acid-Base Balance in Pregnancy.- G. Urinary Concentration and Dilution in Pregnancy.- H. Serum Tonicity during Pregnancy.- II. Anatomic Changes of the Urinary Tract.- III. Renal Disease and Pregnancy.- A. Acute Renal Diseases.- B. Chronic Renal Diseases.- C. Renal Diseases Associated with Systemic Disease.- D. Hereditary Renal Diseases.- E. Renal Calculi.- F. Hemodialysis during Pregnancy.- G. Pregnancy following Renal Transplantation.- IV. Diagnosis of Renal Disorders during Pregnancy.- A. Proteinuria.- B. Hematuria.- C. Pyuria.- D. Renal Biopsy.- E. Other Laboratory Studies.- V. Hypertension during Pregnancy.- A. Essential Hypertension.- B. Primary Aldosteronism (Conn’s Syndrome).- C. Renal Artery Stenosis.- D. Coarctation of the Aorta.- E. Pheochromocytoma.- VI. Antihypertensive Drugs.- A. Diuretics.- B. Adrenergic Blocking Drugs.- C. ?- and ?-Adrenergic Blockers.- D. Arteriolar Dilators.- 16. Nutrition in Renal Disease.- I. Introduction.- II. Dietary Protein.- A. Minimum Requirements.- B. Deviations from Minimal Requirements.- III. Nitrogen Metabolism.- A. Nitrogen Balance.- B. Urea.- C. Urea Appearance Rate.- D. Urea Appearance and Nitrogen Balance.- E. Steady-State SUN.- F. Urea Degradation.- IV. Metabolism of Creatine and Creatinine.- A. Creatine Conversion to Creatinine.- B. Other Determinants of Creatinine Production.- C. Chronic Renal Failure.- D. Daily Creatinine Production.- V. Other Nitrogen Waste Products.- A. Ammonia.- B. Uric Acid.- C. Proteinuria.- D. Intestinal Nitrogen Losses.- E. Nonurea Nitrogen.- VI. Importance of Calories.- A. Consequence of Anorexia.- B. Energy Requirements.- VII. Metabolic and Endocrine Abnormalities.- A. Glucose Intolerance.- B. Insulin Metabolism.- C. Hypertriglyceridemia.- D. Treatment of Hypertriglyceridemia.- VIII. Minerals and Electrolytes.- A. Body Fluid Volumes.- B. Sodium.- C. Dietary Salt.- D. Potassium.- E. Divalent Ions.- IX. Vitamins and Trace Metals.- A. Folic Acid and Vitamin C.- B. Pyridoxine and B Vitamins.- C. Vitamin A.- D. Iron.- E. Zinc and Copper.- X. Design of the Diet.- A. Protein Restriction.- B. Representative Diet.- XI. Progression of Renal Insufficiency.- A. Serum Urea Nitrogen Concentration.- B. Serum Creatinine Concentration.- C. Creatinine Clearance.- D. Reciprocal of the Serum Creatinine Concentration.- XII. Nutritional Therapy and Progression of Chronic Renal Failure.- 17. Diagnosis and Therapy of Nephrolithiasis.- I. Introduction.- II. Diagnostic Considerations.- A. Heterogeneity of Chemical Composition of Calculi.- B. Metabolic Classification of Nephrolithiasis.- III. Pathogenesis of Different Causes of Nephrolithiasis.- A. Hypercalciuria.- B. Hyperuricosuria.- C. Hyperoxaluria.- D. Inhibitor Deficiency.- E. Uric Acid Stones.- F. Cystine Stones.- G. Infection Stones.- H. No Metabolic Abnormality.- IV. Diagnosis of Different Causes of Nephrolithiasis.- A. History and Physical Examination.- B. Stone Analysis and Roentgenologic Examination.- C. Description of Ambulatory Diagnostic Protocol.- D.Diagnostic Criteria.- V. Therapeutic Considerations.- A. Mechanism of Action of Therapeutic Modalities.- B. Selective Treatment Programs.- C. General Treatment Measures.- 18. Bone and Mineral Disturbances in Renal Insufficiency.- I. Introduction.- II. Pathogenesis of Renal Osteodystrophy.- A. Secondary Hyperparathyroidism.- B. Phosphate Retention.- C. Alterations in Vitamin D Metabolism.- D. Skeletal Resistance to the Action of Parathyroid Hormone.- E. Impaired Degradation of PTH Secondary to Reduced Renal Function.- F. Altered Feedback Regulation between Ionized Calcium and the Secretion of Parathyroid Hormone.- G. Osteomalacia.- H. Clinical and Biochemical Features of Altered Divalent Ion Metabolism.- I. Bone Histology.- J. X-Ray Features of Secondary Hyperparathyroidism.- K. Radiographic Features of Osteomalacia.- L. Extraskeletal Calcifications.- M. Miscellaneous Determinations of Bone Mineral Content.- III. Prevention and Treatment.- A. Control of Phosphate.- B. Control of Calcium.- C. Use of Vitamin D.- D. Subtotal Parathyroidectomy.- E. Other Treatment Considerations.- 19. Therapy of the Acute Renal Failure Syndrome.- I. Introduction.- II. Prerenal Failure.- A. Evaluation.- B. Diagnostic Challenge.- III. Postrenal Failure.- IV. Renal Failure.- A. Initiating Phase.- B. Oliguric Phase.- C. Diuretic Phase.- D. Recovery Phase.- V. Treatment of Specific Types of Acute Renal Failure.- A. Myoglobinuric Acute Renal Failure.- B. Radiocontrast-Induced Acute Renal Failure.- C. Acute Uric Acid Nephropathy.- D. Multiple Myeloma.- 20. Care of the Chronic Hemodialysis Patient.- I. Introduction.- II. Organ System Disturbances in Chronic Dialysis Patients.- A. Cardiovascular Disturbances.- B. Immunologic Disturbances.- C. Nutrition.- D. Hematological and Coagulation Disturbances.- E. Gastrointestinal Disturbances.- F. Nervous System and Psychiatric Disturbances.- G. Bone and Joint Involvement.- H. Other Endocrine and Metabolic Disturbances.- I. Dermatological Complications.- J. Special Problems.- III. Acute Complications of Hemodialysis.- A. General.- B. Mechanisms of Acute Complications during Hemodialysis.- C. Specific Symptoms.- D. Accidents during Dialysis.- 21. Care of the Patient on Acute and Chronic Peritoneal Dialysis.- I. Introduction.- II. Peritoneal Membrane.- A. Anatomy.- B. Transport.- III. Access to the Peritoneal Cavity.- A. Catheter for Acute Dialysis.- B. Chronic Indwelling Catheters.- C. Complications of Catheter Insertions.- IV. Peritoneal Dialysate Solutions, Accessories, and Machines.- A. Composition of Solutions.- B. Manual Drainage Systems.- C. Automated Peritoneal Dialysis Delivery Systems.- V. Acute Peritoneal Dialysis.- A. Indications.- B. Contraindications.- C. Patient Management during Acute Peritoneal Dialysis.- VI. Chronic Intermittent Peritoneal Dialaysis.- VII. Continuous Ambulatory Peritoneal Dialysis.- A. Definition.- B. Patient Selection.- C. Training and Follow-up.- D. Some Aspects of Medical Management on CAPD.- VIII. Peritonitis and Catheter Tunnel Infections.- A. Incidence.- B. Diagnosis.- C. Cultures and Gram Stains.- D. Treatment.- IX. Complications of Peritoneal Dialysis.- X. Summary.- 22. Care of the Transplant Recipient.- I. Introduction.- II. Preparation of the Transplant Recipient.- A. Immunologic Preparation.- B. Prophylactic Measures against Infectious Complications.- C. Prophylaxis against Gastrointestinal Complications.- D. Bilateral Nephrectomy, Ileal Bladder.- E. Pretransplant Hemo- and Peritoneal Dialysis.- III. Evaluation of the Donor.- A. The Living Related Donor.- B. The Cadaver Donor.- IV. Management of Immediate Posttransplant Complications.- A. Acute Renal Failure.- B. Surgical Complications.- V. Immunosuppression and Rejection.- A. Prophylactic Immunosuppression.- B. Antirejection Therapy.- VI. Infectious Complications.- A. General Causes and Timing of Infections.- B. Viral Infections.- C. Bacterial Infections.- D. Fungal Infections.- E. Protozoan and Parasitic Infections.- VII. Infections—Organ System Involvement.- A. Pulmonary Infection.- B. Central Nervous System Involvement.- C. Oropharynx and the Gastrointestinal Tract.- D. Bacteremia.- E. Hepatitis.- F. Urinary Tract Infections.- G. Skin.- VIII. Intermediate Surgical Problems.- A. Vascular.- B. Renal.- C. Gastrointestinal.- IX. Long-Term Complications.- A. Vascular Complications and Hypertension.- B. Infections.- C. Liver Disorders.- D. Neoplasms.- E. Suicide.- F. Other Medical Problems.- G. Late Loss of the Transplanted Kidney.- H. Return to Dialysis.- I. Causes of Death.