All Rights Reserved. MANUAL OF nephrology Eighth Edition (c) 2015 Wolters Kluwer. All Rights Reserved. MANUAL OF nephrology Eighth Edition Edited by Robert W.
Schrier, MD Professor Emeritus Division of Renal Disease and Hypertension University of Colorado Health Sciences Center Aurora, Colorado (c) 2015 Wolters Kluwer. All Rights Reserved. Acquisitions Editor: Julie Goolsby Product Development Editor: Leanne Vandetty Production Project Manager: Alicia Jackson Senior Manufacturing Coordinator: Beth Welsh Strategic Marketing Manager: Stephanie Manzo Design Coordinator: Teresa Mallon Production Service: Integra Software Services Pvt. © 2015 by Wolters Kluwer Health Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com Seventh edition, © 2009 by LIPPINCOTT WILLIAMS & WILKINS, a Wolters Kluwer business Sixth edition, © 2005 Lippincott Williams & Wilkins Fifth edition, © 1999 Lippincott Williams & Wilkins Fourth edition, © 1995 Little, Brown & Co.
All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.
government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Manual of nephrology / edited by Robert W. Includes bibliographical references and index. Kidney Diseases—diagnosis—Handbooks.
Kidney Diseases—therapy— Handbooks. Metabolic Diseases—diagnosis—Handbooks. Metabolic Diseases—therapy— Handbooks.6'1—dc23 2014008807 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication.
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Visit Lippincott Williams & Wilkins on the Internet: at LWW. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. All Rights Reserved. Contributors Phyllis August, MD Laurence Chan, MD Professor of Medicine and Obstetrics and Professor Gynecology Department of Medicine Weill Medical College of Cornell University Division of Renal Diseases and Hypertension New York, New York University of Colorado Health Sciences Center William M.
Bennett, MD University of Colorado Hospital Professor of Medicine (Retired) Aurora, Colorado Department of Medicine Oregon Health and Science University Michel Chonchol, MD Medical Director Professor Transplant Services Department of Medicine Legacy Good Samaritan Medical Center Division of Renal Diseases and Hypertension Portland, Oregon University of Colorado Health Sciences Center Tomas Berl, MD University of Colorado Hospital Professor Aurora, Colorado Department of Medicine Division of Renal Diseases and James E. Cooper, MD Hypertension Assistant Professor University of Colorado Health Sciences Department of Medicine Center Division of Renal Diseases and Hypertension University of Colorado Hospital University of Colorado Health Sciences Aurora, Colorado Center University of Colorado Hospital Judy Blaine, MD Aurora, Colorado Assistant Professor Department of Medicine Charles L. Edelstein, MD, PhD Division of Renal Diseases and Hypertension Professor University of Colorado Health Sciences Department of Medicine Center Division of Renal Diseases and Hypertension University of Colorado Hospital University of Colorado Health Sciences Aurora, Colorado Center University of Colorado Hospital Godela M. Brosnahan, MD Aurora, Colorado Associate Professor Department of Medicine David H.
Ellison, MD Division of Renal Diseases and Hypertension Professor of Medicine University of Colorado Health Sciences Head, Division of Nephrology and Center Hypertension University of Colorado Hospital Oregon Health and Science University Aurora, Colorado Portland, Oregon v (c) 2015 Wolters Kluwer. All Rights Reserved. vi CONTRIBUTORS Sarah Faubel, MD Marilyn E. Levi, MD Associate Professor Associate Professor Department of Medicine Department of Medicine Division of Renal Diseases and Hypertension Division of Infectious Diseases University of Colorado Health Sciences University of Colorado Health Sciences Center Center University of Colorado Hospital University of Colorado Hospital Aurora, Colorado Aurora, Colorado Seth Furgeson, MD Stuart L.
Linas, MD Assistant Professor Professor Department of Medicine Department of Medicine Division of Renal Diseases and Hypertension Division of Renal Diseases and University of Colorado Health Sciences Center Hypertension University of Colorado Hospital University of Colorado Health Sciences Aurora, Colorado Center University of Colorado Hospital Diana I. Jalal, MD Aurora, Colorado Associate Professor Department of Medicine Charles R. Nolan, MD Division of Renal Diseases and Hypertension Professor of Medicine University of Colorado Health Sciences University of Texas Health Sciences Center Center at San Antonio University of Colorado Hospital San Antonio, Texas Aurora, Colorado Ali Olyaei, PharmD William D. Kaehny, MD Professor Professor School of Medicine Department of Medicine Division of Nephrology and Division of Renal Diseases and Hypertension Hypertension University of Colorado Health Sciences Oregon Health and Science University Center Portland, Oregon University of Colorado Hospital College of Pharmacy Aurora, Colorado Department of Pharmacy Practice Oregon State University Jessica B.
Kendrick Corvallis, Oregon Assistant Professor Department of Medicine Sarah E. Panzer, MD Division of Renal Diseases and Hypertension Assistant Professor University of Colorado Health Sciences Department of Medicine Center Division of Nephrology University of Colorado Hospital University of Wisconsin Madison Aurora, Colorado Madison, WI (c) 2015 Wolters Kluwer. All Rights Reserved. CONTRIBUTORS vii Jeffrey G.
Penfield, MD Jie Tang, MD, MSc, MPH Associate Professor Assistant Professor Department of Medicine Department of Medicine Division of Nephrology Division of Renal Diseases and Hypertension University of Texas Southwestern Medical University of Colorado Health Sciences Center Center University of Colorado Hospital VA North Texas Health Care System Aurora, Colorado Dallas, Texas Isaac Teitelbaum Robert F. Reilly, MD Professor Professor Department of Medicine Department of Medicine Division of Renal Diseases and Hypertension Division of Nephrology University of Colorado Health Sciences University of Texas Southwestern Medical Center Center University of Colorado Hospital VA North Texas Health Care System Aurora, Colorado Dallas, Texas Joshua M. Barth Reller, MD Associate Professor Professor of Medicine and Pathology Department of Medicine Department of Medicine and Pathology Division of Renal Diseases and Hypertension Duke University Medical Center University of Colorado Health Sciences Durham, North Carolina Center University of Colorado Hospital Robert W. Schrier, MD Aurora, Colorado Professor Emeritus Department of Medicine Alexander Wiseman, MD Division of Renal Diseases and Professor Hypertension Department of Medicine University of Colorado Health Sciences Division of Renal Diseases and Hypertension Center University of Colorado Health Sciences Center University of Colorado Hospital University of Colorado Hospital Aurora, Colorado Aurora, Colorado (c) 2015 Wolters Kluwer.
All Rights Reserved. Preface The eighth edition of the Manual of Nephrology continues to focus on the practical clini- cal aspects of the diagnosis and management of patients with electrolyte and acid–base disorders, urinary tract infections, kidney stones, glomerulonephritis and vasculitis, acute or chronic renal failure, hypertension, hypertension and renal disease in pregnancy, and drug dosing with renal impairment. Because of the growing number of patients with end- stage renal disease (ESRD), there are separate chapters on treatment by chronic renal replacement therapy with dialysis and kidney transplantation. The Manual of Nephrology should continue to be of excellent clinical value for those caregivers encountering patients with the above disorders.
This would include house officers, medical students, primary care physicians, nephrology fellows, nurse practitioners, and busy subspecialists outside of nephrology. I am very appreciative of the outstanding contributions by the authors who have made every effort to update each chapter with recent advances in the diagnosis and manage- ment of the spectrum of hypertensive and kidney disorders. There are new lead authors on eight chapters who are outstanding clinician-educators. The Manual of Nephrology is dedicated to Professor Hugh de Wardener who just died at age 97.
He made enormous contributions to the fields of hypertension and nephrology as a clinician, scientist, and educator for over 60 years. Schrier, MD viii (c) 2015 Wolters Kluwer. All Rights Reserved. Contents Contributors v Preface viii 1 The Edematous Patient: Cardiac Failure, Cirrhosis, and Nephrotic Syndrome 01 Robert W.
Schrier and David H. Ellison 2 The Patient with Hyponatremia or Hypernatremia 28 Robert W. Schrier and Tomas Berl 3 The Patient with Hypokalemia or Hyperkalemia 48 Jie Tang and Stuart L. Linas 4 The Patient with an Acid–Base Disorder 62 William D.
Kaehny 5 The Patient with Disorders of Serum Calcium and Phosphorus 79 Jeffrey G. Penfield and Robert F. Reilly 6 The Patient with Kidney Stones 106 Robert F. Reilly 7 The Patient with Urinary Tract Infection 125 Jessica B.
Barth Reller, and Marilyn E. Levi 8 The Patient with Hematuria, Proteinuria, or Both, and Abnormal Findings on Urinary Microscopy 158 Godela M. Brosnahan 9 The Patient with Glomerular Disease or Vasculitis 180 Sarah E. Panzer and Joshua M.
Thurman 10 The Patient with Acute Kidney Injury 201 Sarah Faubel and Charles L. Edelstein 11 The Patient with Chronic Kidney Disease 241 Michel Chonchol and Jessica B. Kendrick 12 The Patient Receiving Chronic Renal Replacement with Dialysis 253 Seth Furgeson and Isaac Teitelbaum ix (c) 2015 Wolters Kluwer. All Rights Reserved.
x CONTENTS 13 The Patient with a Kidney Transplant 263 James E. Cooper, Laurence Chan, and Alexander Wiseman 14 The Patient with Kidney Disease and Hypertension in Pregnancy 286 Phyllis August, Diana I. Jalal, and Judy Blaine 15 The Patient with Hypertension 318 Seth Furgeson, Charles R. Nolan, and Robert W.
Schrier 16 Practical Guidelines for Drug Dosing in Patients with Impaired Kidney Function 351 Ali Olyaei and William M. Bennett Index 409 (c) 2015 Wolters Kluwer. All Rights Reserved. 1 The Edematous Patient: Cardiac Failure, Cirrhosis, and Nephrotic Syndrome Robert W.
Schrier and David H. BODY FLUID DISTRIBUTION. Of the total fluids in the human body, two- thirds reside inside the cell (i., intracellular fluid) and one-third resides outside the cells [i. The patient with generalized edema has an excess of ECF.
The ECF resides in two locations: in the vascular com- partment (plasma fluid) and between the cells of the body, but outside of the vascular compartment (interstitial fluid). In the vascular compartment, approx- imately 85% of the fluid resides on the venous side of the circulation and 15% on the arterial side (Table 1-1). An excess of interstitial fluid constitutes edema. On applying digital pressure, the interstitial fluid can generally be moved from the area of pressure, leaving an indentation; this is described as pitting edema.
This demonstrates that the excess interstitial fluid can move freely within its space between the body’s cells. If digital pressure does not cause pitting in the edematous patient, then interstitial fluid cannot move freely. Such nonpitting edema can occur with lymphatic obstruction (i., lymphedema) or regional fibrosis of subcutaneous tissue, which may occur with chronic venous stasis. Although generalized edema always signifies an excess of ECF, specifically in the interstitial compartment, the intravascular volume may be decreased, normal, or increased.
For example, because two-thirds of ECF resides in the interstitial space and only one-third in the intravascular compartment, a rise in total ECF volume may occur as a consequence of excess interstitial fluid (i.