Clinical Companion in Nephrology

249 Pages·2015·13.56 MB·English

by  Mark Findlay, Christopher Isles (auth.)

Mark Findlay
Christopher Isles
Clinical Companion
in Nephrology
123
Clinical Companion in Nephrology

Mark Findlay (cid:129) C hristopher Isles
Clinical Companion
in Nephrology
Mark Findlay Christopher Isles
Institute of Cardiovascular and Medical Dumfries and Galloway Royal Infi rmary
Sciences Dumfries
University of Glasgow UK
Glasgow
UK
ISBN 978-3-319-14867-0 ISBN 978-3-319-14868-7 (eBook)
DOI 10.1007/978-3-319-14868-7
Library of Congress Control Number: 2015938307
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2015
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Pref ace
We have written this clinical companion for medical students and junior doc-
tors who have told us over the years that renal medicine is ‘too diffi cult’ and
not always well covered in textbooks. We suspect this may be a consequence
of a tendency to concentrate on mechanisms as a prerequisite for understand-
ing disease and we have made a conscious decision to avoid this approach.
Renal physiology and pathophysiology are undoubtedly interesting but they
are also complex and a detailed knowledge of what happens inside the renal
tubule is probably not necessary to assess, investigate and manage a patient
with acute kidney injury or chronic kidney disease.
We have also made a conscious decision to divide the text into bite size
chunks using a Q and A format. We have done this partly because we have
found this approach works when teaching and partly because there is so much
more to learn than there was 20–30 years ago. With this approach in mind we
have divided our material into six sections. We start with the physiology that
it helps to know and go on to assess GFR, proteinuria and haematuria. We
include a section on electrolyte and acid-base disorders next as nephrologists
are frequently asked for help in these areas. We devote considerable space to
AKI and CKD because these topics are most likely to be encountered by
general medical trainees. We then describe a miscellaneous group of renal
topics including urinary tract infection and renal stones before tackling renal
replacement therapy in a way that we hope will make clearer to non-
nephrologists exactly what goes on inside dialysis and transplant units. We
conclude with a series of appendices. We have always taught students that
there are some things they need to know and some things they need to look
up. The appendices are where medical students and junior doctors will fi nd
material they don’t always need to carry in their heads.
We are grateful to a number of colleagues who have reviewed chapters for
us, helped with illustrations or provided us with slides. In particular we would
like to thank Alison Almond, Zeyad Bayaty, Lynn Carson, Louise Clark,
Fiona Gardiner, Fiona Green, David Kipgen, Thalakunte Muniraju, Calum
Murray, Sue Robertson, Subrata Saha, Ranjit Thomas, Abdul Wahab and
Wayne Wrathall. We also acknowledge many other colleagues, especially
John Firth and Roger Greenwood, whose lectures have stimulated us to
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vi Preface
consider different ways of approaching and teaching a particular topic. Last
but by no means least we thank our wives, Maytal and Karen, for their toler-
ance and patience during the many evenings we spent drafting and redrafting
this book.
Glasgow , U K Mark Findlay
Dumfries , UK Christopher Isles
Contents
Part I Physiology and Assessment
1 Structure and Function of the Kidney. . . . . . . . . . . . . . . . . . . . 3
2 Assessment of GFR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3 Proteinuria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4 Haematuria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Part II Disorders of Renal Metabolic Function
5 Hyponatraemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
6 Hypokalaemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
7 Hypocalcaemia and Hypercalcaemia. . . . . . . . . . . . . . . . . . . . . 33
8 Hypophosphataemia and Hypomagnesaemia. . . . . . . . . . . . . . 37
9 Disorders of Acid Base Balance . . . . . . . . . . . . . . . . . . . . . . . . . 39
Part III Acute Kidney Injury
10 Causes of Acute Kidney Injury. . . . . . . . . . . . . . . . . . . . . . . . . . 45
11 Rhabdomyolysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
12 Cardiorenal Failure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
13 Hepatorenal Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
14 HUS/TTP in Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
15 Myeloma and the Kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
16 Investigation, Management and Outcome
of Acute Kidney Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
17 Fluid Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
18 Hyperkalaemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
19 Rapidly Progressive Glomerulonephritis. . . . . . . . . . . . . . . . . . 95
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Part IV Chronic Kidney Disease
20 Overview of Chronic Kidney Disease. . . . . . . . . . . . . . . . . . . . . 101
21 Glomerular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
22 Renal Disease and Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
23 Renovascular Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
24 Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
25 Antihypertensive Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
26 Polycystic Kidney Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
27 Renal Anaemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
28 Mineral Metabolism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
29 Nutrition in Renal Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Part V Miscellaneous Renal
30 Gout and the Kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
31 Urinary Tract Infection in Adults. . . . . . . . . . . . . . . . . . . . . . . . 161
32 Renal Stone Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
33 Managing Pain in Chronic Kidney Disease. . . . . . . . . . . . . . . . 171
34 Pregnancy and Renal Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . 177
35 Blood Borne Viruses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
36 Rarer Renal Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Part VI Renal Replacement Therapy
37 Haemodialysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
38 Peritoneal Dialysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
39 Renal Transplantation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
40 Hypertension and Fluid Balance in Dialysis Patients. . . . . . . . 215
41 Tunnelled Dialysis Catheters. . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
42 Catheter Related Blood Stream Infection . . . . . . . . . . . . . . . . . 225
43 The Challenges of Renal Replacement Therapy
in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Abbreviations
1y Primary
2y Secondary
3y Tertiary
AonCKD Acute on chronic kidney disease
ABPM Ambulatory blood pressure monitor
ACE Angiotensin converting enzyme
ACEi Angiotensin converting enzyme inhibitor
ACR Albumin:creatinine ratio
ADH Anti-diuretic hormone
ADPKD Autosomal dominant polycystic kidney disease
AIDS Acquired immunodefi ciency syndrome
AKI Acute kidney injury
ANA Anti-nuclear antibody
ANCA Anti-neutrophil cytoplasmic antibody
ANP Atrial natriuretic peptide
Anti-GBM Anti-glomerular basement membrane
APD Automated peritoneal dialysis
ARB Angiotensin II receptor blocker
ARVD Atherosclerotic reno-vascular disease
ATN Acute tubular necrosis
AV Arterio-venous
BBV Blood borne viruses
BC Blood culture
bd bis die (twice daily)
BJP Bence Jones proteinuria
BP Blood pressure
Ca Calcium
CAPD Continuous ambulatory peritoneal dialysis
CCB Calcium channel blocker
CCD Cortical collecting duct
CJD Creutzfeldt-Jakob disease
CK Creatine kinase
CKD Chronic kidney disease
CM Conservative management
CMV Cytomegalo virus
CNI Calcineurin inhibitor
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