Textbook of Nephrology
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This third edition has been fully revised to bring clinicians fully up to date with the most recent advances in the field of nephrology. Divided into eight sections, the book covers diagnosis and management of different kidney-related problems, including fluid, electrolyte and acid-base disorders, renal failure, hypertension, glomerular disease and stone disease. New to this edition, are several chapters dedicated to diabetes, a key element in nephrology. The final sections discuss dialysis and transplantation, and paediatric nephrology. Written by recognised expert, Anil K Mandal, from University of Florida in Gainesville, this comprehensive new edition includes nearly 270 full colour images, diagrams and tables. Key points * Fully revised, new edition bringing clinicians fully up to date with latest developments in nephrology * Includes new chapters on diabetes and nephrology * Written by recognised expert from University of Florida * Previous edition published in 2004
suffers from multiple medical problems caused by diabetic microvascular and macrovascular complications. These are summarized in Table 5. It is obvious that complications of diabetes are much more common in patients with diabetes when they have DN. Thus, in addition to specific measures directed at managing kidney failure, intensive effort must be directed at identification and management of these Table 3. Lab parameters of case 1 during follow-up period Parameters Oct. 2004 Jan. 2005 Mar.
of potassium overload. In this context, it is worth emphasizing that use of beta-blockers that blunt epinephrine effect is not safe in hypertensive patients with renal failure. After consideration of the factors that control external and internal potassium homeostasis, the causes of hypokalemia can be appropriately defined. It is important to reiterate that among all these factors, high renal excretion of potassium determines most cases of hypokalemia. CAUSES OF HYPOKALEMIA Normal serum
the deficiency state can be classified as partial diabetes insipidus. Partial diabetes insipidus may remain stable or may progress, with no AVP release in response to hypertonic dehydration. This state of complete unresponsiveness to release of AVP is called complete diabetes insipidus. Patients with neurohypophyseal diabetes insipidus continue to exhibit usual diurnal variation in urine output. Thus, the rate of urine flow at night is approximately half that during the day, although both
loss accompanied by hypernatremia suggests severe polyuria, which is most consistent with complete central diabetes insipidus. Evaluating Water Deprivation Test Results In normal individuals, water deprivation increases urine osmolality to 800 to 900 Osm/kg. In patients with primary polydipsia (compulsive water drinkers), urine osmolality also increases substantially but may not reach the levels seen in controls. Urine osmolality may increase slightly or not at all from the baseline in patients
rickets. It is possible that PHEX might be responsible for the catabolism on a nonPTH circulating factor that regulates proximal tubule phosphate transport and vitamin D metabolism. When diagnosing disorders in phosphate metabolism, it is important to note that serum phosphate concentration varies with age, time of day, and fasting state. Serum phosphate concentration is higher in children than adults; the reference range is 4 to 7 mg/dL in children compared with 3 to 4.5 mg/dL in adults. A