Renal Pathophysiology: The Essentials Fifth edition Dr. Helmut G. Rennke MD, Dr. Bradley M. Denker MD

Renal pathophysiology can be a difficunt subject even for the most advanced medical students. This Fifth Edition of Renal Pathophysiology: The Essentials provides an easy-to-read, case-based approach to learning the mechanisms of renal disease. Each chapter focuses on a mechanism of kidney disease and includes an opening case, learning objectives, integrated open-ended questions, and chapter-ending summaries. Updated with the latest clinical advances and research, this edition also features full-color illustrations and photomicrographs, suggested readings, and online and in-book Q&As. Updated chapter-opening Case Presentations (with Summary and Case Discussion at the end of chapter) introduce real-life clinical situations and allow students to apply what they’ve learned. New illustrations and clinical images clarify key concepts, key terms are now bolded, and a new appendix lists formulas and lab values for easy reference. Open-ended and multiple-choice questions stimulate critical thinking and allow students to gauge their mastery of the information. Separate Summary and Case Discussion boxes provide at-a-glance, bulleted information for easy review. eBook available for purchase. Fart, smart, and convenient, today’s eBooks can transform learning. These interactive, fully searchable tools offer 24/7 access on multiple devices, the ability to highlight and share notes, and more Preface CHAPTER 1 Review of Renal Physiology Introduction Relationship between Filtration and Excretion General Mechanism of Transtubular Sodium Reabsorption Tight Junctions and Membrane Polarity Segmental Sodium Reabsorption Proximal Tubule Loop of Henle Distal Tubule Calcium Transport Collecting Ducts Water Transport Countercurrent Mechanism Glomerular Filtration Rate Determinants of Glomerular Filtration Arteriolar Resistance and Glomerular Filtration Rate Clinical Estimation of Glomerular Filtration Rate Creatinine Clearance Plasma Creatinine Concentration and Glomerular Filtration Rate Blood Urea Nitrogen and Glomerular Filtration Rate CHAPTER 2 Regulation of Salt and Water Balance Introduction Physiologic Role of Osmotic Pressure Osmotic Pressure and Distribution of Body Water Relationship between Plasma Osmolality and Sodium Concentration Osmoregulation and Volume Regulation Hormonal Role in Water and Sodium Balance Osmoregulation Volume Regulation Antidiuretic Hormone, Thirst, and Maintenance of Water Balance Actions Vascular Resistance Renal Prostaglandins Control of Antidiuretic Hormone Secretion Osmoreceptors Thirst Volume Receptors Interactions of Osmotic and Volume Stimuli Hormonal Regulation of Sodium Excretion Definition of Effective Circulating Volume Renin–Angiotensin System Actions Aldosterone Actions Control of Aldosterone Secretion Maintenance of Sodium and Potassium Balance Atrial Natriuretic Peptide Actions Control of Atrial Natriuretic Peptide Secretion Physiologic Role of Atrial Natriuretic Peptide Other Atrial Natriuretic Peptide-like Hormones Pressure Natriuresis Steady State Role of Impaired Renal Excretion in Electrolyte Disorders Time Course of Diuretic Action CHAPTER 3 Disorders of Water Balance: Hyponatremia, Hypernatremia, and Polyuria Determinants of Plasma Sodium Concentration Clinical Importance of Osmoregulation Osmolytes and Cell Volume Regulation Implications for Symptoms and Treatment Hyponatremia Etiology Congestive Heart Failure Syndrome of Inappropriate Antidiuretic Hormone Reset Osmostat Diagnosis Plasma Osmolality Urine Osmolality Urine Sodium Concentration Basic Principles of Therapy Hypernatremia Etiology Diagnosis Treatment Water Deficit Concept of Free Water Clearance Polyuria Diagnosis Primary Polydipsia Central Diabetes Insipidus Nephrogenic Diabetes Insipidus Treatment CHAPTER 4 Edematous Conditions and the Use of Diuretics Pathophysiology of Edema Formation Capillary Hemodynamics Starling’s Law Capillary Hydraulic Pressure Interstitial Oncotic Pressure Normal Values in Different Organs Edema Formation Renal Sodium Retention Primary Renal Sodium Retention Compensatory Response to Effective Circulating Volume Depletion Compensated State Renal Disease and Nephrotic Syndrome Nephrotic Syndrome Congestive Heart Failure Hepatic Cirrhosis and Ascites Splanchnic Vasodilatation Physical Examination and Site of Edema Formation Site of Edema Formation Diuretics and Treatment of Edema Diuretic Potency Diuretic Dose Quantity of Sodium Reabsorbed at the Diuretic-Sensitive Site Increased Reabsorption in Other Nephron Segments Diuretic-Induced Side Effects Excess Fluid Removal Potassium Balance Metabolic Alkalosis Hyperuricemia CHAPTER 5 Acid–Base Physiology and Metabolic Alkalosis Introduction Acids and Bases Law of Mass Action Bicarbonate–Carbon Dioxide System Acidosis and Alkalosis Response to the Daily Acid Load Buffering Renal Acid Excretion Cell Model for Proximal Bicarbonate Reabsorption and Hydrogen Secretion Regulation of Renal Acid Excretion Extracellular pH Effective Circulating Volume Depletion Plasma Potassium Concentration Metabolic Alkalosis Pathogenesis Generation of Metabolic Alkalosis Maintenance of Metabolic Alkalosis Urine Chloride Concentration in Diagnosis of Metabolic Alkalosis Relationship between Urinary Bicarbonate Sodium, Potassium, and Chloride Urinary Electrolytes in Metabolic Alkalosis Treatment Edematous States CHAPTER 6 Metabolic Acidosis Introduction Decreased Acid Excretion Renal Failure Treatment Type 1 Renal Tubular Acidosis Type 2 Renal Tubular Acidosis Increased Acid Generation Anion Gap in Diagnosis of Metabolic Acidosis Lactic Acidosis Arterial versus Mixed Venous pH The Role of Bicarbonate in the Treatment of Lactic Acidosis Diabetic Ketoacidosis Ingestions Salicylate Intoxication Other Intoxications Anion Gap in Renal Failure Bicarbonate Loss Treatment Urine Anion Gap CHAPTER 7 Disorders of Potassium Balance Physiologic Effects of Potassium Regulation of Potassium Balance Potassium Uptake by Cells Urinary Potassium Excretion Hyperkalemia Etiology Metabolic Acidosis Insulin Deficiency and Hyperglycemia Exercise Renal Failure Hypoaldosteronism Symptoms Treatment Hypokalemia Etiology Urinary Potassium Wasting Hypokalemia and Metabolic Alkalosis with and without Hypertension Symptoms Diagnosis Treatment SUGGESTED READINGS CHAPTER 8 Urinalysis and Approach to the Patient with Renal Disease Introduction Urinalysis Proteinuria Limitations of the Dipstick Normal Values and Quantitation Specific Gravity and Osmolality Examination of Urine Sediment Casts Red Cells White Cells Epithelial Cells and Lipiduria Crystals Normal Urine Sediment Acute versus Chronic Renal Disease Correlation of Urinalysis with Differential Diagnosis Urine Sodium Excretion Urine Sodium Concentration Fractional Excretion of Sodium Urine Volume CHAPTER 9 Pathogenesis of Major Glomerular and Vascular Diseases Introduction Nephrotic versus Nephritic Syndromes Nephritic Syndrome Structure and Function of the Glomerular Microcirculation Glomerulus as a Size-Selective and Charge-Selective Barrier Mechanisms of Glomerular Proteinuria Mechanisms of Glomerular Disease Visceral Epithelial Cell Injury Secondary Focal and Segmental Glomerulosclerosis Immune Complex Formation Immune Complex Formation in the Lamina Rara Externa (or Subepithelial Space) Immune Complex Formation in the Lamina Rara Interna (or Subendothelial Space) and the Mesangium Antibodies Directed against Glomerular Basement Membrane Antigens Crescent Formation and Cell-Mediated Immunity Basement Membrane Abnormalities Mechanisms of Vascular Injury Systemic Vasculitis and Antineutrophil Cytoplasmic Antibodies Thrombotic Angiopathies Direct Injury to the Endothelium Direct Activation of Platelets Antibody-Mediated Endothelial Injury CHAPTER 10 Tubulointerstitial Diseases Anatomic Relationships Clinical Manifestations Mechanisms of Tubulointerstitial Injury Bacterial Infection Pathogenesis Symptoms Pathology Reflux Nephropathy Acute Drug-Induced Interstitial Nephritis Pathogenesis Pathology Clinical Course Drug-Induced Tubular Injury Analgesic Abuse Nephropathy Pathology Pathogenesis Course Urinary Tract and Intratubular Obstruction Intratubular Obstruction and Myeloma Kidney Obstruction in the Collecting Systems Prognosis Cyst Formation Pathogenesis Acquired Cystic Kidney Disease CHAPTER 11 Acute Kidney Injury Definition of Renal Injury Early Renal Disease Acute Kidney Injury Diagnostic Approach Time of Onset Exclusion of Urinary Tract Obstruction Urinalysis Distinction between Prerenal Disease and Acute Tubular Necrosis Blood Urea Nitrogen to Plasma Creatinine Ratio Urine Sodium Concentration and Fractional Excretion of Sodium Urine Osmolality Prerenal Disease Hepatorenal Syndrome Renal Artery Stenosis and Angiotensin-Converting Enzyme Inhibitors Nonsteroidal Anti-inflammatory Drugs Acute Tubular Necrosis Pathogenesis Treatment and Prevention Aminoglycoside-Induced Acute Tubular Necrosis Pathogenesis Prevention Contrast Nephropathy Pathogenesis Prevention Clinical Course CHAPTER 12 Signs and Symptoms of Chronic Renal Failure Pathogenesis of Uremia Diminished Excretion of Electrolytes and Water Steady State in Chronic Renal Failure Intact Nephron Hypothesis Reduced Excretion of Organic Solutes Decreased Renal Production of Hormones Trade-off Hypothesis Renal Osteodystrophy Hormonal Regulation of Calcium and Phosphate Homeostasis Parathyroid Hormone Fibroblast Growth Factor 23 Vitamin D Phosphate and Calcium Metabolism in Renal Failure Renal Bone Disease and Treatment of Hyperphosphatemia Treatment of Hyperphosphatemia Hypertension Potential Role of Pressure Natriuresis Anemia of Chronic Renal Failure Pathogenesis Treatment What Treatment Options Are Available When Kidneys Fail? Solute Diffusion Efficacy of Dialysis Fluid Removal Solute Removal CHAPTER 13 Progression of Chronic Kidney Disease Introduction Remnant Kidney Model of Focal Glomerulosclerosis Functional Adaptations Structural Adaptations Pathogenesis of Proteinuria and Glomerulosclerosis Epithelial Cell Injury Hyaline Accumulation and Mesangial Expansion Microaneurysm Formation Endothelial Cell Dysfunction Vascular and Tubulointerstitial Damage Prevention of Secondary Glomerular Injury Dietary Protein Restriction Antihypertensive Therapy Lipid-Lowering Therapy Experimental Diabetic Nephropathy Human Studies Kidney Response to Nephron Loss Effect on Evaluation of Patients with Chronic Kidney Disease Diabetic Nephropathy Type 2 Diabetes Mellitus Effect of Strict Glycemic Control Kidney Function at Onset of Overt Disease Efficacy of Dietary Protein Restriction Response in Diabetic Nephropathy Efficacy of Antihypertensive Therapy Reduction in Protein Excretion Index Copyright Title Page Dedication Contents Chapter 1: ‘I’m thinking’ – Oh, but are you? Chapter 2: Renegade perception Chapter 3: The Pushbacker sting Chapter 4: ‘Covid’: The calculated catastrophe Chapter 5: There is no ‘virus’ Chapter 6: Sequence of deceit Chapter 7: War on your mind Chapter 8: ‘Reframing’ insanity Chapter 9: We must have it? So what is it? Chapter 10: Human 2.0 Chapter 11: Who controls the Cult? Chapter 12: Escaping Wetiko Postscript Appendix: Cowan-Kaufman-Morell Statement on Virus Isolation Bibliography Index "Renal pathophysiology can be a difficult subject even for the most advanced medical students. This Fifth Edition of Renal Pathophysiology: The Essentials provides an easy-to-read, case-based approach to learning the mechanisms of renal disease. Each chapter focuses on a mechanism of kidney disease and includes an opening case, learning objectives, integrated open-ended questions, and chapter-ending summaries. Updated with the latest clinical advances and research, this edition also features full-color illustrations and photomicrographs, suggested readings, and online and in-book Q & As"--Provided by publisher "Renal pathophysiology can be a difficult subject even for the most advanced medical students. This Fifth Edition of Renal Pathophysiology: The Essentials provides an easy-to-read, case-based approach to learning the mechanisms of renal disease. Each chapter focuses on a mechanism of kidney disease and includes an opening case, learning objectives, integrated open-ended questions, and chapter-ending summaries. Updated with the latest clinical advances and research, this edition also features full-color illustrations and photomicrographs, suggested readings, and online and in-book Q&As"--Résumé de l'éditeur