Harrison's Nephrology and Acid-Base Disorders

337 Pages·9.89 MB·english

by  Jameson J.L

2nd Edition
’ TM
HARRISON S
Nephrology
aNd acid-Base
disorders
Derived from Harrison’s Principles of Internal Medicine, 18th Edition
Editors
Dan L. Longo, anthony s. Fauci,
md md
Professor of Medicine, Harvard Medical School; Chief, Laboratory of Immunoregulation;
Senior Physician, Brigham and Women’s Hospital; Director, National Institute of Allergy and Infectious Diseases,
Deputy Editor, New England Journal of Medicine, National Institutes of Health, Bethesda, Maryland
Boston, Massachusetts
DEnnis L. KaspEr, stEphEn L. hausEr,
md md
William Ellery Channing Professor of Medicine, Robert A. Fishman Distinguished Professor and Chairman,
Professor of Microbiology and Molecular Genetics, Department of Neurology, University of California, San Francisco,
Harvard Medical School; Director, Channing Laboratory, San Francisco, California
Department of Medicine, Brigham and Women’s Hospital,
Boston, Massachusetts
J. Larry JamEson, , JosEph LoscaLzo, ,
md phd md phd
Robert G. Dunlop Professor of Medicine; Hersey Professor of the Theory and Practice of Medicine,
Dean, University of Pennsylvania School of Medicine; Harvard Medical School; Chairman, Department of Medicine;
Executive Vice-President of the University of Pennsylvania for the Physician-in-Chief, Brigham and Women’s Hospital,
Health System, Philadelphia, Pennsylvania Boston, Massachusetts
2nd Edition
’
TM
HARRISON S
Nephrology
aNd acid-Base
disorders
EDitors
J. Larry Jameson, mD, phD
Robert G. Dunlop Professor of Medicine;
Dean, University of Pennsylvania School of Medicine;
Executive Vice-President of the University of Pennsylvania for the Health System
Philadelphia, Pennsylvania
Joseph Loscalzo, mD, phD
Hersey Professor of the Theory and Practice of Medicine,
Harvard Medical School; Chairman, Department of Medicine;
Physician-in-Chief, Brigham and Women’s Hospital
Boston, Massachusetts
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contentS
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii 11 Chronic Kidney Disease . . . . . . . . . . . . . . . . . .123
Joanne M. Bargman, Karl Skorecki
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
12 Dialysis in the Treatment of Renal Failure . . . .141
Kathleen D. Liu, Glenn M. Chertow
Section i
IntroductIon to 13 Transplantation in the Treatment
the renal SyStem of Renal Failure . . . . . . . . . . . . . . . . . . . . . . .148
Anil Chandraker, Edgar L. Milford,
1 Cellular and Molecular Biology of the Kidney . . . .2
Mohamed H. Sayegh
Alfred L. George, Jr., Eric G. Neilson
14 Infections in Kidney Transplant Recipients . . . .158
2 Adaption of the Kidney to Renal Injury . . . . . . .14
Robert Finberg, Joyce Fingeroth
Raymond C. Harris, Eric G. Neilson
Section iV
Section ii
Glomerular and
alteratIonS of renal functIon
tubular dISorderS
and electrolyteS
15 Glomerular Diseases . . . . . . . . . . . . . . . . . . . . .162
3 Azotemia and Urinary Abnormalities . . . . . . . . .22
Julia B. Lewis, Eric G. Neilson
Julie Lin, Bradley M. Denker
16 Polycystic Kidney Disease and Other
4 Atlas of Urinary Sediments and
Inherited Tubular Disorders . . . . . . . . . . . . . . .189
Renal Biopsies . . . . . . . . . . . . . . . . . . . . . . . . . .32
David J. Salant, Craig E. Gordon
Agnes B. Fogo, Eric G. Neilson
17 Tubulointerstitial Diseases of the Kidney . . . . . .205
5 Acidosis and Alkalosis . . . . . . . . . . . . . . . . . . . .43
Laurence H. Beck, David J. Salant
Thomas D. DuBose, Jr.
6 Fluid and Electrolyte Disturbances . . . . . . . . . . .56
Section V
David B. Mount
renal VaScular dISeaSe
7 Hypercalcemia and Hypocalcemia . . . . . . . . . . .81
18 Vascular Injury to the Kidney . . . . . . . . . . . . . .218
Sundeep Khosla
Stephen C. Textor, Nelson Leung
8 Hyperuricemia and Gout . . . . . . . . . . . . . . . . . .85
19 Hypertensive Vascular Disease . . . . . . . . . . . . .228
Christopher M. Burns, Robert L. Wortmann,
Theodore A. Kotchen
H. Ralph Schumacher, Lan X. Chen
9 Nephrolithiasis . . . . . . . . . . . . . . . . . . . . . . . . .95
Section Vi
John R. Asplin, Fredric L. Coe, Murray J. Favus
urInary tract InfectIonS
and obStructIon
Section iii
20 Urinary Tract Infections, Pyelonephritis,
acute KIdney Injury and
and Prostatitis . . . . . . . . . . . . . . . . . . . . . . . . .254
chronIc renal faIlure
Kalpana Gupta, Barbara W. Trautner
10 Acute Kidney Injury . . . . . . . . . . . . . . . . . . . .104
Sushrut S. Waikar, Joseph V. Bonventre
v
vi Contents
21 Urinary Tract Obstruction . . . . . . . . . . . . . . . .265 Appendix
Julian L. Seifter Laboratory Values of Clinical Importance . . . . .281
Alexander Kratz, Michael A. Pesce,
Robert C. Basner, Andrew J. Einstein
Section Vii
cancer of the KIdney Review and Self-Assessment . . . . . . . . . . . . . . .299
and urInary tract Charles Wiener, Cynthia D. Brown, Anna R. Hemnes
22 Bladder and Renal Cell Carcinomas . . . . . . . . .272
Howard I. Scher, Robert J. Motzer Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313
contrIbutorS
Numbers in brackets refer to the chapter(s) written or co-written by the contributor.
John R. Asplin, MD Andrew J. Einstein, MD, PhD
Medical Director, Litholink Corporation, Chicago, Illinois [9] Assistant Professor of Clinical Medicine,
Columbia University College of Physicians and Surgeons;
Joanne M. Bargman, MD, FRCPC
Department of Medicine, Division of Cardiology, Department of
Professor of Medicine, University of Toronto; Staff Nephrologist,
Radiology, Columbia University Medical Center and New York-
University Health Network; Director, Home Peritoneal Dialysis
Presbyterian Hospital, New York, New York [Appendix]
Unit, and Co-Director, Renal Rheumatology Lupus Clinic,
University Health Network, Toronto, Ontario, Canada [11] Murray J. Favus, MD
Professor, Department of Medicine, Section of Endocrinology,
Robert C. Basner, MD
Diabetes, and Metabolism; Director, Bone Program, University of
Professor of Clinical Medicine, Division of Pulmonary,
Chicago Pritzker School of Medicine, Chicago, Illinois [9]
Allergy, and Critical Care Medicine, Columbia University
College of Physicians and Surgeons, Robert Finberg, MD
New York, New York [Appendix] Chair, Department of Medicine, University of Massachusetts
Medical School, Worcester, Massachusetts [14]
Laurence H. Beck, Jr., MD, PhD
Assistant Professor of Medicine, Boston University Joyce Fingeroth, MD
School of Medicine, Boston, Massachusetts [17] Associate Professor of Medicine, Harvard Medical School,
Boston, Massachusetts [14]
Joseph V. Bonventre, MD, PhD
Samuel A. Levine Professor of Medicine, Harvard Medical School; Agnes B. Fogo, MD
Chief, Renal Division; Chief, BWH HST Division of Bioengineering, John L. Shapiro Professor of Pathology; Professor of Medicine
Brigham and Women’s Hospital, Boston, Massachusetts [10] and Pediatrics, Vanderbilt University Medical Center,
Nashville, Tennessee [4]
Cynthia D. Brown, MD
Assistant Professor of Medicine, Division of Pulmonary and Critical Alfred L. George, Jr., MD
Care Medicine, University of Virginia, Charlottesville, Virginia Professor of Medicine and Pharmacology;
[Review and Self-Assessment] Chief, Division of Genetic Medicine,
Vanderbilt University School of Medicine, Nashville, Tennessee [1]
Christopher M. Burns, MD
Assistant Professor, Department of Medicine, Craig E. Gordon, MD, MS
Section of Rheumatology, Dartmouth Medical School; Assistant Professor of Medicine, Boston University
Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire [8] School of Medicine; Attending, Section of Nephrology,
Boston Medical Center, Boston, Massachusetts [16]
Anil Chandraker, MD, FASN, FRCP
Associate Professor of Medicine, Harvard Medical School; Kalpana Gupta, MD, MPH
Medical Director of Kidney and Pancreas Transplantation; Associate Professor, Department of Medicine, Boston University
Assistant Director, Schuster Family Transplantation Research Center, School of Medicine; Chief, Section of Infectious Diseases,
Brigham and Women’s Hospital; Children’s Hospital, VA Boston Healthcare System, Boston, Massachusetts [20]
Boston, Massachusetts [13]
Raymond C. Harris, MD
Lan X. Chen, MD, PhD Ann and Roscoe R. Robinson Professor of Medicine;
Penn Presbyterian Medical Center, Philadelphia, Pennsylvania [8] Chief, Division of Nephrology, Vanderbilt University
School of Medicine, Nashville, Tennessee [2]
Glenn M. Chertow, MD, MPH
Norman S. Coplon/Satellite Healthcare Professor of Medicine; Anna R. Hemnes, MD
Chief, Division of Nephrology, Stanford University School of Assistant Professor, Division of Allergy, Pulmonary, and Critical
Medicine, Palo Alto, California [12] Care Medicine, Vanderbilt University Medical Center,
Nashville, Tennessee [Review and Self-Assessment]
Fredric L. Coe, MD
Professor of Medicine, University of Chicago, Chicago, Illinois [9] Sundeep Khosla, MD
Professor of Medicine and Physiology, College of Medicine,
Bradley M. Denker, MD
Mayo Clinic, Rochester, Minnesota [7]
Associate Professor, Harvard Medical School; Physician,
Department of Medicine, Brigham and Women’s Hospital; Theodore A. Kotchen, MD
Chief of Nephrology, Harvard Vanguard Medical Associates, Professor Emeritus, Department of Medicine;
Boston, Massachusetts [3] Associate Dean for Clinical Research,
Medical College of Wisconsin, Milwaukee, Wisconsin [19]
Thomas D. DuBose, Jr., MD, MACP
Tinsley R. Harrison Professor and Chair, Internal Medicine; Alexander Kratz, MD, PhD, MPH
Professor of Physiology and Pharmacology, Associate Professor of Pathology and Cell Biology,
Department of Internal Medicine, Wake Forest University Columbia University College of Physicians and Surgeons;
School of Medicine, Winston-Salem, Director, Core Laboratory, Columbia University Medical Center,
North Carolina [5] New York, New York [Appendix]
vii
viii Contributors
Nelson Leung, MD Howard I. Scher, MD
Associate Professor of Medicine, Professor of Medicine, Weill Cornell Medical College;
Department of Nephrology and Hypertension, D. Wayne Calloway Chair in Urologic Oncology;
Division of Hematology, Mayo Clinic, Rochester, Minnesota [18] Chief, Genitourinary Oncology Service, Department of Medicine,
Memorial Sloan-Kettering Cancer Center, New York, New York [22]
Julia B. Lewis, MD
Professor, Department of Medicine, Division of Nephrology, H. Ralph Schumacher, MD
Vanderbilt University Medical Center, Nashville, Tennessee [15] Professor of Medicine, Division of Rheumatology, University of
Pennsylvania, School of Medicine, Philadelphia, Pennsylvania [8]
Julie Lin, MD, MPH
Assistant Professor of Medicine, Julian L. Seifter, MD
Harvard Medical School, Boston, Massachusetts [3] Associate Professor of Medicine, Harvard Medical School; Brigham
and Women’s Hospital, Boston, Massachusetts [21]
Kathleen D. Liu, MD, PhD, MAS
Assistant Professor, Divisions of Nephrology and Critical Care Karl Skorecki, MD, FRCP(C), FASN
Medicine, Departments of Medicine and Anesthesia, Annie Chutick Professor in Medicine (Nephrology);
University of California–San Francisco, San Francisco, California [12] Director, Rappaport Research Institute,
Technion–Israel Institute of Technology;
Edgar L. Milford, MD Director, Medical and Research Development,
Associate Professor of Medicine, Harvard Medical School; Rambam Health Care Campus, Haifa, Israel [11]
Director, Tissue Typing Laboratory,
Brigham and Women’s Hospital, Boston, Massachusetts [13] Stephen C. Textor, MD
Professor of Medicine, Division of Nephrology and Hypertension,
Robert J. Motzer, MD Mayo Clinic, Rochester, Minnesota [18]
Professor of Medicine, Weill Cornell Medical College;
Attending Physician, Genitourinary Oncology Service, Barbara W. Trautner, MD, PhD
Memorial Sloan-Kettering Cancer Center, New York, New York [22] Assistant Professor, Section of Infectious Diseases,
Baylor College of Medicine; The Michael E. DeBakey
David B. Mount, MD, FRCPC Veterans Affairs Medical Center, Houston VA
Assistant Professor of Medicine, Harvard Medical School, Health Services Research and Development
Renal Division, VA Boston Healthcare System; Center of Excellence, Houston, Texas [20]
Brigham and Women’s Hospital, Boston, Massachusetts [6]
Sushrut S. Waikar, MD, MPH
Eric G. Neilson, MD Assistant Professor of Medicine, Harvard Medical School; Brigham
Thomas Fearn Frist Senior Professor of Medicine and Cell and and Women’s Hospital, Boston, Massachusetts [10]
Developmental Biology, Vanderbilt University School of Medicine,
Nashville, Tennessee [1, 2, 4, 15] Charles M. Wiener, MD
Dean/CEO Perdana University Graduate School of Medicine,
Michael A. Pesce, PhD Selangor, Malaysia; Professor of Medicine and Physiology,
Professor Emeritus of Pathology and Cell Biology, Columbia Uni- Johns Hopkins University School of Medicine,
versity College of Physicians and Surgeons; Columbia University Baltimore, Maryland [Review and Self-Assessment]
Medical Center, New York, New York [Appendix]
Robert L. Wortmann, MD, FACP, MACR
David J. Salant, MD Professor, Department of Medicine, Dartmouth Medical School and
Professor of Medicine, Boston University School of Medicine; Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire [8]
Chief, Section of Nephrology, Boston Medical Center, Boston,
Massachusetts [16, 17]
Mohamed H. Sayegh, MD
Raja N. Khuri Dean, Faculty of Medicine; Professor of Medicine
and Immunology; Vice President of Medical Affairs, American
University of Beirut, Beirut, Lebanon; Visiting Professor of Medicine
and Pediatrics, Harvard Medical School; Director, Schuster Family
Transplantation Research Center, Brigham and Women’s Hospital;
Children’s Hospital, Boston, Massachusetts [13]
Preface
Harrison’s Principles of Internal Medicine has been a respected The first section of the book, “Introduction to the
information source for more than 60 years. Over time, Renal System,” provides a systems overview, beginning
the traditional textbook has evolved to meet the needs of with renal development, function, and physiology, as
internists, family physicians, nurses, and other health care well as providing an overview of how the kidney re-
providers. The growing list of Harrison’s products now sponds to injury. The integration of pathophysiology
includes Harrison’s for the iPad, Harrison’s Manual of Medi- with clinical management is a hallmark of Harrison’s, and
cine, and Harrison’s Online. This book, Harrison’s Nephrol- can be found throughout each of the subsequent disease-
ogy and Acid-Base Disorders, now in its second edition, is a oriented chapters. The book is divided into seven main
compilation of chapters related to kidney function. sections that reflect the scope of nephrology: (I) Intro-
Our readers consistently note the sophistication of the duction to the Renal System; (II) Alterations of Renal
material in the specialty sections of Harrison’s. Our goal Function and Electrolytes; (III) Acute Kidney Injury
was to bring this information to our audience in a more and Chronic Renal Failure; (IV) Glomerular and Tubu-
compact and usable form. Because the topic is more fo- lar Disorders; (V) Renal Vascular Disease; (VI) Urinary
cused, it is possible to enhance the presentation of the Tract Infections and Obstruction; and (VII) Cancer of
material by enlarging the text and the tables. We have the Kidney and Urinary Tract.
also included a review and self-assessment section that While Harrison’s Nephrology and Acid-Base Disorders is
includes questions and answers to provoke reflection and classic in its organization, readers will sense the impact
to provide additional teaching points. of the scientific advances as they explore the individual
Renal dysfunction, electrolyte, and acid-base disorders chapters in each section. Genetics and molecular biol-
are among the most common problems faced by the cli- ogy are transforming the field of nephrology, whether
nician. The evaluation of renal function relies heavily on illuminating the genetic basis of a tubular disorder or ex-
laboratory tests, urinalyses, and characteristics of urinary plaining the regenerative capacity of the kidney. Recent
sediments. Evaluation and management of renal disease clinical studies involving common diseases like chronic
also requires a broad knowledge of physiology and pathol- kidney disease, hypertensive vascular disease, and urinary
ogy since the kidney is involved in many systemic disor- tract infections provide powerful evidence for medical
ders. Thus, this book considers a broad spectrum of topics decision making and treatment. These rapid changes in
including acid-base and electrolyte disorders, vascular in- nephrology are exciting for new students of medicine
jury to the kidney, as well as specific diseases of the kidney. and underscore the need for practicing physicians to con-
Kidney disorders, such as glomerulonephritis, can be a tinuously update their knowledge base and clinical skills.
primary basis for clinical presentation. More commonly, Our access to information through web-based jour-
however, the kidney is affected secondary to other medi- nals and databases is remarkably efficient. Although these
cal problems such as diabetes, shock, or complications sources of information are invaluable, the daunting body
from dye administration or medications. As such, renal of data creates an even greater need for synthesis by ex-
dysfunction may be manifest by azotemia, hypertension, perts in the field. Thus, the preparation of these chapters
proteinuria, or an abnormal urinary sediment, and it may is a special craft that requires the ability to distill core in-
herald the presence of an underlying medical disorder. formation from the ever-expanding knowledge base. The
Renal insufficiency may also appear late in the course editors are therefore indebted to our authors, a group of
of chronic conditions such as diabetes, lupus, or sclero- internationally recognized authorities who are masters at
derma and significantly alter a patient’s quality of life. providing a comprehensive overview while being able
Fortunately, intervention can often reverse or delay renal to distill a topic into a concise and interesting chapter.
insufficiency. And, when this is not possible, dialysis and We are indebted to our colleagues at McGraw-Hill. Jim
renal transplant provide lifesaving therapies. Shanahan is a champion for Harrison’s and these books
Understanding normal and abnormal renal function pro- were impeccably produced by Kim Davis.
vides a strong foundation for diagnosis and clinical manage- We hope you find this book useful in your effort to
ment. Therefore, topics such as acidosis and alkalosis, fluid achieve continuous learning on behalf of your patients.
and electrolyte disorders, and hypercalcemia are covered
here. These basic topics are useful in all fields of medicine J. Larry Jameson, MD, PhD
and represent a frequent source of renal consultation. Joseph Loscalzo, MD, PhD
ix