The Kidney Book : A Practical Guide on Renal Medicine

Contents
Epigraph
Dedication
Contributors in Order of Presentation
Foreword
Preface
General Nephrology
Chapter 1 Pebbles From the Grand Round
Introduction
Reference
Chapter 2 Assessment of Kidney Function
Introduction
Assessment of GFR
Glomerular filtration rate
Estimation of GFR
Limitations of creatinine-based eGFR
References
Chapter 3 Haematuria and Proteinuria
Introduction
Proteinuria
Measurement of proteinuria
Spot urine measurements
Clinical Significance of Different Types of Proteinuria
Management of proteinuria
Haematuria
Macroscopic haematuria
Microscopic haematuria
Management of haematuria
References
Chapter 4 Imaging of the Kidney and Urinary Tract
Introduction
Diagnostic Imaging
Plain radiograph
Ultrasound
Contrast-enhanced ultrasound
Doppler ultrasound
Computed Tomography
Magnetic Resonance Imaging
Nephrogenic systemic fibrosis
Nuclear renal scans or renal scintigraphy
References
Chapter 5 Sodium Disorders
Introduction
Sodium Balance
Water Balance
Hyponatraemia
Definition
Classification
Step-by-step approach
Management
Hypernatraemia
Definition
Classification
Step-by-step approach
Management
References
Chapter 6 Potassium Disorders
Potassium Balance
Hypokalaemia
Approach
Management
Hyperkalaemia
Definition
Principles
Step-by-step approach
Management
References
Chapter 7 Calcium Disorders
Calcium Balance
Parathyroid Hormone
Vitamin D
Hypocalcaemia
Introduction
Diagnosis
Management
Hypercalcaemia
Aetiology of hypercalcaemia
Diagnosis
Management
References
Chapter 8 Magnesium Disorders
Magnesium Balance
Intestinal Absorption
Kidney Absorption
Hypomagnesaemia
Diagnosis
Management
Hypermagnesaemia
References
Chapter 9 Acid-Base Disorders
Introduction
Step-by-step Approach to Acid-base Disorders
Compensation Formulas
Anion gap
High Anion Gap Acidosis
Low/negative Anion Gap
The utility of the urinary NH4+ excretion
Renal tubular acidosis
Metabolic Alkalosis
References
Chronic Kidney Disease
Chapter 10 Diagnostic Approach to Chronic Kidney Disease
Introduction
Definition
Epidemiology
Approach
History
Physical Examination
Investigations
Guide for Referral to a Nephrologist
References
Chapter 11 Slowing Progression of Chronic Kidney Disease
Introduction
Approach
Treat underlying cause of chronic kidney disease
Prevent acute kidney injury
Renin-angiotensin System (RAS) Blockade
Sodium-glucose Cotransporter-2 Inhibitor (SGLT-2i)
Mineralocorticoid Receptor Antagonists
Blood Pressure Control
Diabetic Control (In Patients with Diabetes Mellitus)
Correction of Acidosis
Dietary and Lifestyle Interventions
CKD Monitoring Frequency
References
Chapter 12 Fluid Overload in Chronic Kidney Disease
Introduction
Causes
Diagnosis
Management
Chapter 13 Anaemia of Chronic Kidney Disease
Introduction
Management
Reference
Chapter 14 Hypertension in Chronic Kidney Disease
Introduction
Measurement of Blood Pressure
Evaluation of Hypertension in Chronic Kidney Disease
Target Blood Pressure in Chronic Kidney Disease
Non-pharmacological Management of Hypertension in Chronic Kidney Disease
Pharmacological Management of Hypertension in Chronic Kidney Disease
References
Chapter 15 Kidney Mineral Bone Disease
Introduction
Management of Chronic Kidney Disease Mineral Bone Disease
Control phosphate
Avoid calcium loading
Vitamin D and PTH
Parathyroidectomy
References
Chapter 16 Parathyroidectomy
Introduction
Total Parathyroidectomy vs. Subtotal Parathyroidectomy vs. Total Parathyroidectomy with Auto Implantation
Hungry Bone Syndrome
Treatment of hungry bone syndrome
References
Chapter 17 Hypertensive Emergencies
Introduction
Hypertensive Urgencies
Hypertensive Emergencies
Evaluation of hypertensive emergencies
Management of hypertensive emergencies
References
Chapter 18 Renovascular Hypertension
Introduction
Clinical Clues that Suggest Renovascular Hypertension
Screening and Diagnostic Tests
Management
Medical therapy
Percutaneous revascularisation
Surgical Revascularisation
References
Chapter 19 Autosomal Dominant Polycystic Kidney
Disease
Introduction
Clinical Manifestations
Renal
Extra-renal
Screening for Intra-cranial Aneurysms
Diagnosis
Screening of Asymptomatic Individuals Suspected to be at Risk of ADPKD
Monitoring of ADPKD
Management
Disease-Modifying Drugs to Reduce Disease Progression
Poor Prognostic Factors
End-stage Kidney Disease in ADPKD
Family Planning
References
Chapter 20 Tubulointerstitial Nephritis
Introduction
Diagnosis of Tubulointerstitial Nephritis
Management of Acute Tubulointerstitial Nephritis
Management of Chronic Tubulointerstitial Nephritis
Prognosis
References
Chapter 21 Contrast-Induced Acute Kidney Injury
Introduction
Diagnosis
Nephrotoxicity of Iodinated Contrast Media
Risk Factors
Prevention of CA-AKI and CI-AKI
References
Chapter 22 Urinary Tract Infections in the Non-Transplant Setting
Introduction
Definitions
Diagnosis
Modalities of Urine Examination for the Assessment of Urinary Tract Infections
Urine dipstick
Urine microscopy
Urine cultures
Microbiology
UTIs in Special Populations
UTIs in males
UTIs in older adults
Catheter-associated UTIs
UTIs in diabetic patients on sodium glucose co-transporter-2 (SGLT2) inhibitors
Management of UTIs
Acute uncomplicated cystitis
Mild to moderate uncomplicated pyelonephritis
Complicated urinary tract infections
Recurrent UTIs
Test of cure
Candida in the urine
Specific Complicated UTIs
Emphysematous pyelonephritis
Infections in patients with polycystic kidney disease
References
Chapter 23 Assessment of Patients With Advanced Chronic Kidney Disease for Dialysis or Transplant
Introduction
Timing of Initiation of KRT
Haemodialysis
Reference
Glomerulonephritis
Chapter 24 Nephrotic Syndrome
Introduction
Causes
Evaluation of Nephrotic Syndrome
History
Physical examination
Laboratory investigation
Management
References
Chapter 25 Nephritic Syndrome and Rapidly Progressive Glomerulonephritis
Introduction
Aetiology
Pathophysiology
Clinical Suspicion of RPGN
Evaluation
Urinalysis
Urine phase contrast
Management
Treatment approach principles
General supportive treatment
Disease-specific therapies
Reference
Chapter 26 Principles of Immunosuppression in Glomerular Diseases
Introduction
Evaluation Prior to Immunosuppression Therapies
Adjunctive Therapies
Anticoagulation
Anti-microbial surveillance and prophylaxis
Vaccinations
Gastroprotection
Bone protection
Chapter 27 Common Glomerulonephritis and Their Treatment
Haemodialysis
Chapter 28 Concepts and Modalities of Haemodialysis
Introduction
Conventional HD
Sustained Low-efficiency Dialysis
Isolated UF
Sequential HD
Haemodiafiltration (HDF)
References
Chapter 29 Initiation and Prescription of Haemodialysis
Indication of Dialysis Initiation
Haemodialysis Prescription
Dialysis Disequilibrium Syndrome
References
Chapter 30 Assessment of Adequacy of Haemodialysis
Introduction
Dialysis Dose
Approach to Inadequate Haemodialysis
References
Chapter 31 Fluid Overload in Haemodialysis Patients
Introduction
Diagnosis of Fluid Overload
Management of Fluid Overload
References
Chapter 32 Hypertension in Haemodialysis Patients
Introduction
Diagnosis and Monitoring
Pathogenesis
Management
Pharmacological treatment
Resistant Hypertension
Intradialytic Hypertension
References
Chapter 33 Intradialytic Hypotension
Introduction
Pathophysiology of Intradialytic Hypotension
Clinical Features of Intradialytic Hypotension
Complications of Intradialytic Hypotension
Cardiovascular events and mortality
Cerebral ischaemia
Other organ ischaemia
Loss of residual kidney function
Vascular access thrombosis
Management
Acute management
Prevention
References
Interventional Nephrology
Chapter 34 Vascular Access for Haemodialysis
Introduction
Arteriovenous Fistula
Arteriovenous Graft
Haemodialysis Catheter
References
Chapter 35 Haemodialysis Catheter Complications
Post-insertion Bleeding
Vascular Injuries
Air Embolism
Cardiac Arrhythmia
Catheter Malposition
Haemodialysis Catheter-related Infections
Catheter-related Bloodstream Infection
Septic Work-up for CRBSI
Empirical Antibiotic Therapy
Removal of Haemodialysis Catheter
Response to Blood Culture Results
Exit Site Infection
Tunnel Tract Infection
Haemodialysis Catheter Dysfunction
Early Haemodialysis Catheter Dysfunction
Late Haemodialysis Catheter Dysfunction
References
Chapter 36 Insertion and Removal of Haemodialysis Catheter
Indications for Non-tunnelled Haemodialysis Catheter Insertion
Sites of Insertion
Insertion of Right IJV Non-tunnelled Haemodialysis Catheter
Removal of Tunnelled Haemodialysis Catheter
References
Chapter 37 Arteriovenous Dialysis Access Complications
Introduction
Arteriovenous Access Flow Dysfunction
Failure to Mature
Stenosis of AV Access
Central Vein Stenosis
Thrombosis of AV Access
AV Access Infection
Medical Treatment
Surgical Treatment
AV Access Aneurysm
AV Access Steal
High-flow AV Access
References
Peritoneal Dialysis
Chapter 38 Basic Concepts in Peritoneal Dialysis
Introduction
Anatomy of PD
Physiology of PD
Processes in Peritoneal Dialysis
Solute clearance
Sodium sieving
Fluid removal
Reference
Chapter 39 Initiation and Prescription of Peritoneal Dialysis
Introduction
Types of Peritoneal Dialysis
Components of PD Prescription
General Considerations for PD Prescription
Types of PD Solutions
Urgent-start PD
Incremental PD
Implementing Incremental PD
References
Chapter 40 Assessment and Management of Peritoneal Dialysis Adequacy
Introduction
Mineral Bone Disease
Anaemia
Volume Status Assessment and Management
Small Solute Clearance
Total Kt/V urea = Peritoneal Kt/V urea + Renal Kt/V urea
Total CrCl = Peritoneal CrCl + Renal CrCl
Metabolic and Glycaemic Control
Dialysis related symptom complication
Conclusion
References
Chapter 41 Peritoneal Dialysis Catheter Malfunction and Flow Pain
Diagnosis of Peritoneal Dialysis Catheter Malfunction
Prevention and Management of Peritoneal Dialysis Catheter Malfunction
Pain During Inflow and Outflow of Peritoneal Dialysis Fluid
Reference
Chapter 42 Fluid Management in Peritoneal Dialysis Patients
Introduction
Causes of Fluid Overload in Peritoneal Dialysis Patients
Assessment of Fluid Status
Approach to Fluid Overload
Investigations for Fluid Overload in Peritoneal Dialysis Patients
Management of Fluid Overload in Peritoneal Dialysis Patients
Acute management
Chronic management
Peritoneal Equilibration Test
References
Chapter 43 Peritoneal Dialysis-Related Peritonitis
Introduction
Diagnosis
Assessment
Management of PD-Related Peritonitis
Prevention of PD-Related Peritonitis
References
Chapter 44 Peritoneal Dialysis Catheter-Related Infections
Introduction
Pathogenesis
Risk Factors
Diagnosis
Exit site infection
Tunnel infection
Severity Classification of Peritoneal Dialysis Catheter Exit Site Infection
Management (Figure 44.3)
Prevention of ESI
Treatment of ESI
Refractory exit site infection
References
Critical Care Nephrology
Chapter 45 Acute Kidney Injury
Introduction
Diagnosis
Types of Acute Kidney Injury
Pre-renal AKI
Intrinsic renal vascular disease
Post-renal disease
Approach to Evaluating a Patient with Acute Kidney Injury
Overview of the Management of Acute Kidney Injury in Adults
Initial management
Subsequent management
Specific Causes of AKI
Sepsis-associated AKI
Rhabdomyolysis
Tumour lysis syndrome
References
Chapter 46 Kidney Replacement Therapy for Patients with Critical Illness and Acute Kidney Injury
Introduction
Timing for Initiation of Kidney Replacement Therapy
Modality Selection for Kidney Replacement Therapy in Patients with Critical Illness
Vascular Access for Continuous Kidney Replacement Therapy (Table 46.3)
Effluent Dose of Continuous Kidney Replacement Therapy
Modality of CKRT
Anticoagulation Choice in CKRT
Fluid Management During CKRT
Drug Dosing and Nutrition Management During CKRT
Monitoring During CKRT
References
Chapter 47 Extracorporeal Therapies in Acute Kidney Injury and Critically Ill Patients
Introduction
References
Chapter 48 Extracorporeal Treatment for Poisoning and Drug Overdoses
Introduction
Indications for Extracorporeal Removal Treatments
Characteristics of Xenobiotics Removed b yExtracorporeal Removal Treatments
Haemodialysis
Continuous Kidney Replacement Therapies
Charcoal Haemoperfusion
Plasma Exchange
References
Transplantation
Chapter 49 Evaluation for Kidney Transplantation
Introduction
Evaluation of the Potential Kidney Transplant Candidate
Evaluation of Primary Kidney Disease
Malignancy Evaluation
Infective Evaluation
Cardiac Evaluation
Surgical Evaluation
Psychosocial Evaluation
References
Chapter 50 Histocompatibility Assessment in Kidney Transplantation
Introduction
Determination of ABO Compatibility
Matching of Donor and Recipient HLA
Panel-reactive Antibodies
Detection of donor-specific antibodies
Cross-reactive Groups
Assessing Overall Immunological Risk
References
Chapter 51 Assessment of Deceased Donor
Introduction
Assessment of a deceased donor
References
Chapter 52 Evaluation for Living Kidney Donation
Introduction
Evaluation of the potential kidney donor
Evaluation of kidney function
Evaluation of pre-donation albuminuria
Evaluation of pre-donation microscopic haemturia
Evaluation of pre-donation hypertension
Evaluation of pre-donation history for nephrolithiasis
Malignancy Evaluation
Infective Evaluation
Cardiac Evaluation
Surgical Evaluation
Psychosocial Evaluation
Risks Post-donation
Post-donation follow up
References
Chapter 53 Immunosuppression for Kidney Transplant
Introduction
Induction immunosuppression
IL-2 receptor antagonists
Antilymphocyte antibodies
Anti-CD20 monoclonal antibodies
Maintenance immunosuppression
Corticosteroids
Calcineurin inhibitors
Mycophenolic acid analogues
Azathioprine
Mammalian target of rapamycin inhibitors
Drug interactions with immunosuppression
Drug interactions with azathioprine
References
Chapter 54 Early Post-operative Management of a Kidney Transplant Recipient
Introduction
Immediate post-operative care
Post-operative fluid management
Post-operative Hypotension
Post-operative Hypertension
Post-discharge care
Reference
Chapter 55 Acute Kidney Injury in Kidney Transplantation
Introduction
Causes of acute kidney injury in kidney transplants
Diagnostic evaluation of acute kidney injury in kidney transplants
Delayed graft function
Clinical presentation
Prevention
Management of delayed graft function
T-cell mediated rejection
References
Chapter 56 Post-Transplant Urinary Tract Infections
Introduction
Assessment of UTI
Prevention of UTI
Management of UTI
Management of Asymptomatic Bacteriuria
Management of Recurrent UTI
References
Chapter 57 Cytomegalovirus
Introduction
Definitions
Pre-transplant screening
Post-transplant screening
CMV preventive strategies
Treatment of asymptomatic CMV infection
Treatment of CMV disease
Refractory CMV
Ganciclovir-resistant CMV
Very low CMV DNAaemia
Emerging CMV therapies where further studies are required
References
Chapter 58 BK Virus
Introduction
Screening
Diagnosis
Management
Approaches to reduction of immunosuppression
Intravenous Immunoglobulin
BKV-specific T-cell therapy
Resumption of immunosuppression following the clearance of BKV infection
Prognosis
References
Chapter 59 Long-Term Management of the Kidney Transplant Recipient
Introduction
Cardiovascular disease
Post-transplant diabetes mellitus
Hypertension
Dyslipidaemia
Malignancy
Hyperuricaemia and gout
References
Special Patients and Care
Chapter 60 Pregnancy in Patients with Chronic or End-stage Kidney Disease
Structural changes in the kidney and urinary tract during pregnancy
Functional changes in the kidney and urinary tract during pregnancy
Pregnancy in patients with chronic kidney disease
Principles of management
Medications in Pregnancy
References
Chapter 61 Pregnancy in Kidney Transplantation
Pre-pregnancy
Pregnancy
Labour and delivery
Lactation
References
Chapter 62 Management of the Patient with a Failing Kidney Transplant
Introduction
Diagnosis and management of the underlying causes(s) of the failing allograft
Optimising CKD care and associated risk factors
Planning for alternative kidney replacement therapy
Management of immunosuppression following kidney transplant failure
Graft Intolerance Syndrome
Graft nephrectomy
Re-transplantation
References
Chapter 63 Kidney Diseases in Cancer Patients
Introduction
Acute kidney injury
Chronic kidney disease
Glomerular diseases and electrolyte disorders
Reference
Chapter 64 Kidney Supportive Care
Introduction
Prognostication
Recognising dialysis patients at risk of deterioration
Goals of care discussion
Principles of symptom assessment and management in advanced CKD
Symptom assessment
Management of symptoms
When to refer to a specialist palliative care team
References
Chapter 65 Approach to Drug Dosing in Patients with Kidney Disease
Introduction
Pharmacokinetic Changes
Approach to dosing regimen adjustment
References
Chapter 66 Nutritional Care in Chronic Kidney Disease
Introduction
Nutrition assessment
Nutrition assessment tools
Nutrition diagnosis
Nutrition intervention for CKD (non-dialysis) haemodialysis and peritoneal/dialysis
Nutrition intervention for kidney transplantation
Nutrition monitoring and evaluation
References
Chapter 67 Common Dermatological Manifestations of Kidney Disease
(1) Pruritus
Pathophysiology
Clinical features (Figure 67.1)
Treatment (Table 67.1)
(2) Xerosis
Pathophysiology
Clinical features (Figure 67.2)
Treatment
(3) Acquired Perforating Dermatosis
Pathophysiology
Clinical features (Figure 67.3)
Treatment (Table 67.2)
(4) Calciphylaxis
Pathophysiology
Clinical features (Figure 67.4)
Treatment (Table 67.3)
(5) Pseudoporphyria
Pathophysiology
Clinical features (Figure 67.5)
Workup and treatment
References
Chapter 68 Psychosocial Considerations in Kidney Disease
Patient’s journey along the kidney disease illness trajectory
Understanding the impact of kidney disease through the Biopsychosocial-spiritual model
Psychosocial considerations for the different modalities of kidney replacement therapies
References
Chapter 69 Ethical Issues in Nephrology
The four meta-principles of bioethics
Case illustrations on the four bioethical principles
The four-box approach
Applying “The Four-Box” approach
Mental capacity
The 5 statutory principles of Mental Capacity Act (2008)
When to assess for mental capacity?
Who can assess mental capacity?
Practical issues related to mental capacity assessment
Best interests principle
References
Chapter 70 Kidney Biopsy
Introduction
General approach to preparing a patient for biopsy
Post-biopsy management and follow-up
References
Chapter 71 Therapeutic Plasma Exchange
Introduction
Principles
Types of therapeutic plasma exchange procedures
Indications for therapeutic plasma exchange
Prescription of therapeutic plasma exchange
References
Index