James M Gloor Vicente E Torres

Reflux nephropathy, or renal parenchymal scarring associated with vesicoureteral reflux (VUR), is an important cause of renal failure. Some studies have shown that in up to 10 of adults and 30 of children requiring renal replacement therapy for end-stage renal disease, reflux nephropathy is the cause of the renal failure. Reflux nephropathy is thought to result from the combination of VUR of infected urine into the kidney by way of an incompetent ureterovesical junction valve mechanism and...

Jnc Vi Classification Of Hypertension

Category* Systolic (mm Hg) Diastolic (mm Hg) High normal 130-139 or 85-89 Hypertension' Stage 1 140 159 or 90 99 Stage 2 160 179 or 100 109 Stage *Not taking anithypertensive drugs and not acutely ill. When systolic and diastolic blood pressures fall into different categories, the higher category should be selected to classify the individual's blood pressure status. For example, 160 92 mm Hg should be classified as stage 2 hypertension, and 174 120 mm Hg should be classified as stage 3...

Prophylaxis And Treatment Of Acute Uric Acid Nephropathy And Acute Tumor Lysis Syndrome

Patients presenting (before chemotherapy) with evidence of large, rapidly proliferating tumor burden and hyperuricemia 1. Correct initial electrolyte and fluid imbalance, and azotemia, if possible dialysis as indicated for established renal failure or unresponsive electrolyte or metabolic abnormalities 2. Maintain adequate hydration and urine output (> 3 L d). May require 4 to 5 L 24 h of intravenous hypotonic saline or bicarbonate diuretics as indicated 3. Give Allopurinol* (300 mg m2) at...

Herpes Simplex Virus

Linear esophageal ulcers caused by herpes simplex virus (HSV) and Candida. Infection with HSV-1 and -2 leads to stomatitis and esophagitis post-transplantation without acyclovir prophylaxis. Additionally, paronychia, corneal ulcers, encephalitis, genital lesions, disseminated involvement of the gastrointestinal tract, pancreas, and liver, and interstitial nephritis has been seen. HSV-6 causes exanthem subitum in children, mononucleosis, and hepatitis. There has been some evidence that...

Figure 721

The severity of vesicoureteral reflux (VUR) as graded in 1981 by the International Reflux Study Committee. When children have pyelonephritis, the possibility of VUR should always be considered. Childhood vesicoureteral reflux is five times more common in girls than in boys. It has a genetic background several cases occasionally occur in the same family. Unless detected and corrected early, especially the most severe forms of this class and when urine is infected (one episode of pyelonephritis...

Tinea Versicolor

Tinea versicolor (pityriasis versicolor) is a chronic superficial fungal disease caused by Malassezia furfur, a yeast normally found on the skin. It is in yeast form in the unaffected skin areas and in the mycelial phase on affected skin. The disease usually is located on the upper trunk, neck, or upper arms. Symptoms may include scaling, erythema, and pruritis. It may appear as slightly scaly brown macules or whitish macules. Treatment options include oral or topical terbinafine (1 cream or...

Renovascular Hypertension and Ischemic Nephropathy

The major issues in approaching patients with renal artery stenosis relate to the role of renal artery stenosis in the management of hypertension, ie, renovascular hypertension, and to the potential for vascular compromise of renal function, ie, ischemic nephropathy. Ever since the original Goldblatt experiment in 1934, wherein experimental hypertension was produced by renal artery clamping, countless investigators and clinicians have been intrigued by the relationship between renal artery...

Jeremy B Levy

Many patients receiving renal allografts become identified simply as recipients of kidney transplantation. All subsequent events involving changes in renal function are attributed to the process and natural history of transplantation itself acute and chronic rejection, immunosuppressive drug nephrotoxicity, graft vasculature thrombosis or stenosis, ischemia, infection, and lymphoproliferative disorders. However, it is important to remember the nature of the underlying disease that caused the...

Info

Goligorsky M, Iijima K, Krivenko Y, et al. Role of mesangial cells in macula densa-to-afferent arteriole information transfer. Clin Exp Pharm Physiol 1997, 24 527-531. Osswald H, Hermes H, Nabakowski G Role of adenosine in signal transmission of TGF. KidneyInt 1982, 22(Suppl. 12) S136-S142. Miller W, Thomas R, Berne R, Rubio R Adenosine production in the ischemic kidney. Circ Res 1978, 43(3) 390-397. Kon V, et al. Glomerular actions of endothelin in vivo. J Clin Invest 1989, 83 1762-1767....

Selected Bibliography

Neilson EG Symposium on the cell biology of tubulointerstitium. Kidney Int 1991, 39 369-556. Strutz F, Mueller GA Symposium on Renal Fibrosis prevention and progression. Kidney Int 1996, 49(suppl 54) 1-90. Chronic Tubulointerstitial Nephritis Eknoyan G, McDonald MA, Appel D, Truong LD Chronic tubulointerstitial nephritis correlation between structural and functional findings. Kidney Int 1990, 38 736-743. Jones CL, Eddy AA Tubulointerstitial nephritis. Ped Nephrol 1992, 6 572-586. Nath KA...

Sivasankaran Ambalavanan Gary Rabetoy Alfred K Cheung

Hemodialysis remains the major modality of renal replacement therapy in the United States. Since the 1970s the drive for shorter dialysis time with high urea clearance rates has led to the development of high-efficiency hemodialysis. In the 1990s, certain biocompatible features and the desire to remove amyloidogenic microglobulin has led to the popularity of high-flux dialysis. During the 1990s, the use of high-efficiency and high-flux membranes has steadily increased and use of conventional...

Figure 930

Autosomal-dominant polycystic kidney disease (ADPKD) renal replacement therapy. Transplantation nowadays is considered in any ADPKD patient with a life expectancy of more than 5 years and with no contraindications to surgery or immunosuppression. Pretransplant workup should include abdominal CT, echocardiogra-phy, myocardial stress scintigraphy, and, if needed (see Figure 9-26), screening for intracranial aneurysm. Pretransplant nephrectomy is advised for patients with a history of renal cyst...

Figure 820

Role of diuretics in the treatment of malignant hypertension. Traditionally, it had been taught that patients with malignant hypertension require potent parenteral diuretics in conjunction with potent vasodilator therapy during the initial phase of management of malignant hypertension. However, evidence now exists to suggest that parenteral diuretic therapy during the acute management phase actually may be deleterious. In experimental animals, spontaneous natriuresis appears to be the...

Causes Of Parenchymatous Acute Renal Failure

Acute tubular necrosis Hemodynamic cardiovascular surgery,* sepsis,* prerenal causes* Toxic antimicrobials,* iodide contrast agents,* anesthesics, immunosuppressive or antineoplastic agents,* Chinese herbs, Opiaceous, Extasis, mercurials, organic solvents, venoms, heavy metals, mannitol, radiation Intratubular deposits acute uric acid nephropathy, myeloma, severe hypercalcemia, primary oxalosis, sulfadiazine, fluoride anesthesics Organic pigments (endogenous nephrotoxins) Myoglobin...

Management Of Diabetic Ketoacidosis And Nonketotic Hyperglycemia

Give initial IV bolus of 0.2 U kg actual body weight. 2. Add 100 U of regular insulin to 1 L of normal saline (0.1 U mL), and follow with continuous IV drip of 0.1 U kg actual body weight per h until correction of ketosis. 3. Give double rate of infusion if the blood glucose level does not decrease in a 2-h interval (expected decrease is 40-80 mg dL h or 10 of the initial value.) 4. Give SQ dose (10-30 U) of regular insulin when ketosis is corrected and the blood glucose level decreases to 300...

Rashad S Barsoum Magdi R Francis Visith Sitprija

Tropical nephrology is no longer a regional issue. With the enormous expansion of travel and immigration, the world has become a global village. Today, a health problem in a particular region has worldwide repercussions. Typical examples are the acquisition of malaria in European airports, renal disease associated with herbal medications, and increasing encounters of parasitic infections in immunocompromised persons 1-3 . Lessons learned from the study of tropical diseases have considerably...

Potential Causes Of Apoptosis In Acute Renal Failure

Potential causes of apoptosis in acute renal failure (ARF). The same cytotoxic stimuli that induce necrosis cause apoptosis. The mechanism of cell death induced by a specific injury depends in large part on the severity of the injury. Because most cells require constant external signals, called survival signals, to remain viable, the loss of these survival signals can trigger apoptosis. In ARF, a deficiency of growth factors and loss of cell-substrate adhesion are potential causes of apoptosis....

L Gabriel Navar L Lee Hamm

Despite extensive animal and clinical experimentation, the mechanisms responsible for the normal regulation of arterial pressure and development of essential or primary hypertension remain unclear. One basic concept was championed by Guyton and other authors 1-4 the long-term regulation of arterial pressure is intimately linked to the ability of the kidneys to excrete sufficient sodium chloride to maintain normal sodium balance, extracellular fluid volume, and blood volume at normotensive...

References

Kaplan NM Clinical Hypertension, edn 6. Baltimore Williams & Wilkins 1994 50. 2. Kawasaki T, Delea CS, Bartter FC, Smith H The effect of high-sodium and low-sodium intakes on blood pressure and other related variables in human subjects with idiopathic hypertension. Am J Med 1978, 64 193-198. 3. Guyton AC, Coleman TG, Yang DB, et al. Salt balance and long-term blood pressure control. Annu Rev Med 1980, 31 15-27. 4. Julius S, Krause L, Schork NJ Hyperkinetic borderline hypertension in...

Figure Itit

Nephritis caused by systemic lupus erythematosus SLE rarely recurs in transplantations. SLE accounts for approximately 1 of all patients receiving allografts, and less than 1 of these will develop recurrent renal disease. Time to recurrence has been reported as 1.5 to 9 years after transplantation 24,25 . Cyclosporine therapy does not prevent recurrence. It is reasonable to ensure that serologic test results for SLE are minimally abnormal before transplantation and certainly that patients have...

Lance D Dworkin Douglas G Shemin

Hypertension is a cause and consequence of chronic renal disease. Data from the United States Renal Data System USRDS identifies systemic hypertension as the second most common cause of end-stage renal disease, with diabetes mellitus being the first. Renal failure in patients with hypertension has many causes, including functional impairment secondary to vascular disease and hypertensive nephrosclerosis. Even in those in whom hypertension is not the primary process damaging the kidney,...

Stephen C Textor

Hypertension and parenchymal disease of the kidney are closely interrelated. Most primary renal diseases eventually disturb sodium and volume control sufficiently to produce clinical hypertension. Both on theoretical and practical grounds, many authors argue that any sustained elevation of blood pressure depends ultimately on disturbed renal sodium excretion, ie, altered pressure natriuresis. Hence, some investigators argue that a clinical state of hypertension represents de facto evidence of...

Figure 1125

A, The probability of end-stage renal disease in patients with proliferative lupus nephritis treated with different drug regimens. This update of the prospective trial by the National Institutes of Health NIH on the treatment of these patients clearly demonstrates that prednisone monotherapy, in a significantly greater proportion of patients, leads to the development of end-stage renal disease compared with patients on regimens containing cytotoxic drugs. The results between azathio-prine and...

Steven B Miller Babu J Padanilam

The kidney possesses a remarkable capacity for restoring its structure and functional ability following an ischemic or toxic insult. It is unique as a solid organ in its ability to suffer an injury of such magnitude that the organ can fail for weeks and yet recover full function. Studying the natural regenerative process after an acute renal insult has provided new insights into the pathogenesis of acute renal failure ARF and possible new therapies. These therapies may limit the extent of...

Figure 1215

Urinalysis in acute renal failure ARF . A normal urinalysis suggests a prerenal or postrenal form of ARF however, many patients with ARF of postrenal causes have some cellular elements on urinalysis. Relatively uncommon causes of ARF that usually present with oligoanuria and a normal urinalysis are mannitol toxicity and large doses of dextran infusion. In these disorders, a hyperoncotic state occurs in which glomerular capillary oncotic pressure, combined with the intratubular hydrostatic...

Causes Of Aseptic Leukocyturia

Self-medication before urine culture Sample contamination by cleansing solution Vaginal discharge Urinary stone Urinary tract tumor Chronic interstitial nephritis especially due to analgesics Fastidious microorganisms requiring special culture medium Ureaplasma urealyticum, Chlamydia, Candida Leukocyturia. A significant number of leukocytes more than 10,000 per milliliter is also required for the diagnosis of urinary tract infection, as it indicates urothelial inflammation. Abundant...

Biff F Palmer

Hemodialysis is a life-sustaining procedure for the treatment of patients with end-stage renal disease. In acute renal failure the procedure provides for rapid correction of fluid and electrolyte abnormalities that pose an immediate threat to the patient's well-being. In chronic renal failure, hemodialysis results in a dramatic reversal of uremic symptoms and helps improve the patient's functional status and increase patient survival. To achieve these goals the dialysis prescription must ensure...

Figure

Thick Ascending Limb Loop Henle

Urea plays an important role in the generation of medullary interstitial hypertonicity. A recycling mechanism operates to minimize urea loss. The urea that is reabsorbed into the inner medullary stripe from the terminal inner medullary collecting duct step 3 in Fig. 1-4 is carried out of this region by the ascending vasa recta, which deposits urea into the adjacent descending thin limbs of a short loop of Henle, thus recycling the urea to the inner medullary...