Table Of Content

Abe the Ata Glance sevies ‘he series contain adixiltion of wiser al eing pulluzeberby exes wih he lp af ste ed deco: feviewer. Thereview are camod cut af to difleweat stapes. t> lip ide the uuboes te hatcan he tat and what needs beterexphnation The focus hai egined by stmlents io tren, bt cesail bak ound onmaom in ineloded eo fetes undastading rae han ie lesen, This bosk spat of he betel Ata Lance seis, hich hoe becotne famous foe astve ayo omc ee tea von dings, Se welcome Fedak 0 please ‘ere ous Sth yee cormenls, Gu adarers is Medial auomal Depaviment lackwell Science Ld. Omes Mess, Osun! OX20EL, UEC Akeavely, you cancmailis 3 srs co, The Kidney at a Glanee C.A. O’;CALLAGHAN BA, BM BCh.MA.MRCP(UK3, DPR MRC Cini Sen Inatrtoaf Molecule Mie ‘Nuffield Departnencof Mesiene Universi of Oxtna Joka Raves Pra Oxford OK B.M. BRENNER AS, MID.DM (Hoa), DSc (on) RCP Samuel A LetinePinfastr ef MesBcing Lsvard Medical Scheol and Dinecior Emeritus Renal Digna Uigbam &€ Wornen’'s Hespital Soon MA ity b asl ‘abn Betts oe piniecincier otra: decpaetn emer ‘care Ray Fe I) HRY Sioa Das alan "ney acne. Uap RM. Rw [PNERCT Race areca lg Phe tigion naan Ho) Contents Prefae 9 Arcoicnon sae how to ve this book 7 Abbrevitens Ghexury 9 ‘Namenchtze 44 fatecton “The kidanysrvcurat overview “The kay funcional overview 14 Development ofthe renal ystem. 16 ‘Gini fearres kines dene 18 “The kde atoratiey negations ed opine inaging 20 iigcaal ions 4 Rensleodinm harling 22 1 Renalporasiue bling 24 5 Raalacid-base ander concep: 25 9 Renatacid-hgse Paling 28 1 Cals halo angio Matai HL The edney ad water handling 32 12 Bytheopuntn and semi ena Unease 34 1 Monalvancuar ology 36 14 Drug and engamcwttccul Laing by tee leney 38, 15) Renalparnasnlogp.dnretis 4 Disngvotrgeatrnabate uneon 1 Hereditary aleorders of aula anspor 42 17 Regulation afhody sodium and ods water 44 1 isons osedian and water rietabolioy 6 19. Fyponstemia and Wernatienia && 20, The edna sarin and water tention 50 21 Regulation of potest etaboliza S? 2 Hypohaends tnd hyperkalemia St 38 ‘Rogultin of aialeations end dsordesof fphesphate and magnesium 56 1 tlyporueensa wal hypercalcemia 58 co ” 0 Asi hase regplaionandvegpansenunasta-pase tstuamces 6 Clinical Usorders ut eil-base metabaign and melatelicacloas 62 Metabo alkaloss respira} aidan nd espratoryalkalass 64 Renal cabal acide 66 Ronsl wsesse mocesses (Glomersiegeng:an aversion 6 Glomeraepatrclogierand thei soda Useaser 70 sSpeciteaeases atectng ee omer T2 Proce andthe nepioticsyndrome 76 ‘iyperenson:eaunecandclinialevahution 7E ‘iyperernion: rep! eaions and terapy 50 Diabetes alta andthe Kidney €2 etal sasubardiszose 8 Telpeyic kidney disease 26, Acute rena isle: pathophysiology #8 ‘Acute cena suena peste 90 ‘Sioa onal flute and tema boc dca 92 “Chuo onal fhe. sisal complications end che management 94 “Treamentof rena. alae with days 8 Pesitoneal diajssand continuous emofilsation 9S Renal trangplaneacion 190 Urinary tae-afection 102 Reval tastes 4 Resa trasteancer 10 kal ates Chinkcl cate Le ealtasesiaeat 68 lnicl cates andenplanatioue 110 Inder 313 Preface “The lac few ears have s2en hage advances wm our Under: standing of how the kidnsy meek aad how borne: ‘af onal func czn affect the whals body. These devel ‘opments have often reulied ftom the application of lecular biogs hich has led the cloning of the major teangpert molecu, chanacls and rospents i the ‘Kidney and from arcfelpiolgicstudes ofthe fetion ofthese molecule in hetth and diese, These aanoes in basi sctonae hare ransoraed the “ld iat Ia Ja higbiy rational and understandable at all teh molecular studies of the traparer proteins 10 clinics Sule of pues. As an example although drogs auch as lbgp uiutics ve been presrited for many yous, ve ‘now koow the rease eangportcr nolzculea which they tobibt and we can sow teach, study and wndcrsand {er actions on patient a corpltey rational manner. Unfortunately much o: tis new information barremained in specail joorets in a piecemeal fasion that makes t ica for stents or pisemos (9 aoees oF put ito ote ‘Ourintenton to tring this science in aclear manner to ailwto need lo uncertand a, We believe that all medical ‘tulealy doctors an ater hele-cee providers nocd ¢9 Uunderstsod the kidney wtuchistheste fection aso en} cornmorly previhed drugs and plas a key rele m eke albeptosslogy of sv many common disorders including ‘congestive hear face and bypereasion, We Rave weit this took to deus all ke new infomation together and {negra wh the Iradisonal concept 0 enal func and diese We hope Il this new cpproach. which ite yas all We Televi disuplines, eiduding molealar 6 Preface >iclopy. physiology und sini medicine wi boofusctnall crhove work inelves the stone of the Bidaey We belive fat (hi applies (oa feats of medicine and all py ‘vs We ato bope ha ths buok wl prowede he atorma- "aon nicestiry for thers, such a6 nurses, oF conical Seis oral liane bemselce with be panto: hesujert which hey need to kno ‘We bive parivulniy emphasized an unending 0 ‘he normal mechonisos and the pathopbyeiclogy af the ‘etal spots ANugh ew degen testmens may Be fetcloped they musta an he sare gst adie me discases sa a ksowledge of basic otal Tuncton atl path Dhysalogy wil stand the 1eadee in gos eM for many eats to ce Tisisanessing ell and toot ition we fave setup acompaning website which wil puvidea range ff supplementary afovnetia, ietiing Updates a new detelopments ine Feld The website ake cual sell tusssstent terial and keypeint sumaris2¢ wall at suggestions for further reading and feedhack, a please riiethe site at win degrades ‘We ate very gest tall ac Black Science fo teit ‘ohusarm and suppare without rham, his work Soul] no have een posable Tat ve would ike a thal Er lice fore supgot and all thace who have Kindly on seated on the manuscript. specially Dr CG. Wins Dr JD. Fits and Dr RIM, Hilton. Tirade has heer fstrcmely bef? and any deficiencies eat remain are ‘mtrlycurova, his O*Callaghar Barry M. Brenner Introduction and how to use this book ‘This bouk prides # compeanentive cous In the mer sepecis of renal mt ary stem sisnce and aeste, ‘itch iv sitable for sunents of neaaane ana exer sek co2es Inne, hp rat cls ook wl 2 yatusble Ieiringin revison inttorthose In morcadvanced ala {op and wit peeve & nan eferonee book fr mare eX Daten cicans In pares, the meorpertion oft ‘ety test molecular ional physiology maxes this book ‘eal for thote fie wit tsaulcnal Tonal sence to piste taniselves wen mi new etormatlon, ‘Aegh mos. dnaanet are nee renal paylans, the keanay & wlved le many cenaons. Almst al doctors vesowne tinge a acton tne kidnsy.such a iuedeaon 8 Fagot as, and ae Invlved In aeesing and adjusting false etecwotyte Dalane. Hor the Foason, we beline that aclearundersanding tena science resent ioca ‘whe cre fo panne and we hope tha this beok provides Ge asl fer such an undersandiag. Ar well ws deine specie ena diseases, dhere is fl oveenge of te mj uid andelectolytediatrbances. ‘We bave placed strong emphoss om he undertancing ‘ofthe mechs of dieare Deca, nll drgrur eve isc mvesizations, the mechanisrs of w dsetse wil be the some throughout a clinician's euseer A gout ers stuodng of reoal aod Wectroyte Tonoralites wi st 3 fessional fxn, ‘Renal scence sas undergune dramatic tarsfureations over sect years expec with Ge clumiog uf the ajo ransponers and ion channels, (as uke tbe whole fabjen much easier to enderstaad, We oo Koco te precie molecu mechanisms of wliogof muanberol key age auch as urcerae sr Woe other nei wi tow osahe 0 give cle eaplantin of ei prec {etone inary that v8 not peony psi. We oe (eae tenders ad patients will benest fot an increased ulettondiagof this subject "The subject chapters are grouped inte tar sestcns md ech chapter deaks wih a etre topic The fi ection foie ngencrlindaciny nd toca beskgsuind {othe renal and orimary systems the acend setion dala irik ase renal clones he th ello dele ith st tobe regulation snd clinica dowraare of uid and aloe robe Raton, the fourth secten deals with specie ition fectingthe Kim, nn the mun praca ‘ons of renal ican, ane with promis tothe arin alter sent and uranic senlreplaceoit tap Ingencral each chapter irslCsubicinl, bal ez ese ‘eleenar may be tpl So for easopl, aay be wot loresew Ihe chapcrs fee Ihe eoohdsucied on ea sodiun and water handling when studying the chapter in ‘the thindsoction oa diorders of body sodiwa and ster ‘mcuabolzn, ‘Thoindiidual chapters srearrangedsothat he esentat tarsi] fe encopslned ia te pices, nd ingen it ‘nc be necessary cry omemoric eer mo. in the pictces The test provides sm esplataion uf the iioor co accompary the piclaret We belie als iy {ving arational explanation cf hesubjec ste, ibd Teoatytoundermnd the material znd watorqurniy fy oe the pluses as quick corso als Generali soe ix not understoed proper itis vey full e Meas he fexcebould help lara by providing race! eaptace tion ofl thi presen Some errs in hell ut ‘eidtheir oun anodic to Ihe plore tig revising, Several Copies ve ven cde ft tnmpetene an Jor mere avant veer sel ms Ue aig ll netic, perc i nephecoy 0 Use gf. Daniably high newbs iv tir exaatons A geod example mend Wesel ua i Diagrams “The digriney of m wovenet all hae Wo the same ‘toe Hach eed eft ade Uso ag nd, vee, (OF Me a ete tu ann an the it side of he ie Se terete, of Ue ol fs te vena ners fi Deas em tr the Heead, In addon, wineporte tiulecley wre Geno dar ice fey mate ative Uranspoct ore Hy cles they went ner a for ton ctavweds ne slaw at aig Hine (oe Crgter2 Website “ie five established x cumparsin wits Loe thie book (goweleaneioeneenin) and we cneourage weaderd 10 apo fin encen esouee It wll provide Uplate ay trojan developments nthe Held and hat rage Of ‘Sccsrocat soto for ouch chapter, a3 ll a detailed (eaebiog saawera slong soe abe in the chapters sitio, thro fuer cephvaion of a uumber of ore ‘pies topes ox baskareued information or thes ho sreimirestla wolassbgaesionsfo-forthor roadie ond ‘links woes eppeopiiets, Fo pid earing, 0 have lea provided koypoinc temmaris fr cach hope, Weare ‘pasteally Koen to gst feedback fromisaders om tis book adon our teite and you sn sun aay feodbock oc {sion co ths euthorsehrough the fedback tk on The ‘cba 1 cet by omal ce foudbactBleamnoctorcan Iunoducton aadhow tuse sis book 7 Abbreviations ace anglornsinconventng ewyee ‘ACEI ngoorensin-converag emzee hbkor aE anion exchanger GEM an ginnerularbasomenamvemivarc ant body ANA ntimucteat antibody ANCA ant-ncwtophiteroplasmic amiboay ‘ANP. [a ptriurecepepuce ASOT/ASLO enetarepralyan 8 ne ate sdeooubetptosphate Be Bente Touesproccin BUN beat urea nope a 3 component of he wterative comate- tment ease e 3 oumpucenl ofthe eonmon complement cava. lowered by bath casi and aker- tntve complement seven cer Creative protein a compute emaaphy MSA dimemaptosuciak ooié—use for end. uclde suds of ena union DNA dyublesirandeIDNA, DIBA ebylentraminepente-aceti scid— 4 Abreviations ed Loc raion does of sea perteion liylenediumineetrsatcti aud ensue sedmeattien cite ‘tration Pacion ovumescae dpa lumerar basemen! membcane ‘Bomeruar Gheatien rate Juataghamerilarappacatus Imeteapconstytariyine ng vesomanes Inegng seaurnyarogen {NAH J orehanger nsec anl- anata dps eaninchipparae eget Ingato the Aycrogsa co Xe alec constant for an std-base courle renal anor tenasie renal load fom ena plasma tow enovatcoar hypotension Glossary Jere wong rapt anes ringer he en otaTr Alserene der eouced bythe eesti proline soinunreaborpinn othe coleting dete antlers zoe {ADM or waterete). 4 plgpentie iced byt ostrir nacy dcns7e swab eniathe ander dice nape Tame runt ane. pip Prgrammed on det ‘tl atu pepe (ANE! A peptide oats by cave ‘ese dmesporn Antibody ight hn proce dby el pe echeluniwbicharepenal ial un vod 209 ‘Sreein'cypin ‘Uwe bular eptetal corgonsat of oe ‘omer wich ontoys te gleiacs copra to fbem sats thauds space to tie hobinate pce ahs none othe wna pens The maj else spt ico ranor cages and ena apis pose into the mice an ‘anne ubpdans. Aa cays catungmercaon tcaton ee Cea gece ofl 1 pote Tiedt tleasn vlan fos let rnc se eg in he alee yah Che vey ade armen aug es poten connec ta, Congeeat a toes of ots tasere dy foci ona Tuaoo wiih Eromot ties iuhanubton and deacon, 3 ise compoucat afte alemetvesomplomenccoszate Ci Coons ef he coaion enfin xsi, vere hy bth stnse end alercatie complemen strain ‘cone Ie ce teal ise cntnemgne omer amdranson eponpolendasaletoes Groner ot wclple oe fn he ae ‘desene ene ie. enreme eee camage mate (Grane metalic prict Wf cetne mead lee ‘alec the kine. (thine Stole oles rat cin alee eho nd ‘age cea deae A lo feel tea svers at He "hunt tested iho end epicenter ‘ecg. A potein raced nthe ine whch perl ‘edo cel rmtinn Fundosopy. Locking al 26 ematia Rndn the arine. Frank hems ame ble ‘pdr recare. The psa eons ma equal (whys pene Aeteetial et eal el tat apport the babs of heey Dlaremo pai te wero lurrinen Casasve tm, me wacey, he eae as Iasi Asano’ holy Mel bt aioe eatated noe spesmetle, A procs that occurs without consing a chonae i ellie rset renbeonpie of sti rm he tte aan tae soa bings ater nh ha here ever changin oxalate ate ‘eteglonsrlr pps GA, Tecarbinton ofthe use ell ot he anal des, pair afferent ero el s Joapof Hens aad eer. tL a, Medi Tore the mine Lies yr he mine [Metil The inner ite cowtting the renal arimid oan rhe ony af Kem the mele nd pie eo Mec ah Rea at he omer ha sap the ‘Shmerar cpitny wal und oy hive mre strate Mesmopvi duct The dats fornshe sister actin men Mesmephne Tressconé etl ey Merlin A mal prin nthe ining apa ich “Myotis Msgr nui. DNephisyndtme Ace pomenseoephns Wik lnpertcsieo DNepwaclsneis Te Ns aponidoe fc io We 1a) epee Th aise nl comstngut be lms DNegot nrae, Proteinase cae 9 ti sega, ony sat an Gros 9 toga Te phy cl eet. ‘may houston of sla gew sigh Svar ‘Omens The tiovemet oa thuoigh et prea oer ioe fom aon oom ceo street comet ‘ns onofbigtoreosteng (gh enssunan), ptatkan Las evened roe Pty aise Doe in wlich ling dtd 0d Eich ‘anomie lth ea pupls basen PAR, peamninchingo x cletmy cpeeyslenel By sing ps broua e idbe bi an be wed ty eatnate eas oo§ dom rruesonsph dc The daca ome th al epee Parprtl. A prtsn cat i pesot et bigh ooactzatons aud “ea on annoy peed 3 Feel apa, Panera Mmume A prin cnc 3y De peed and eat on the Widnes to promote phoebe sereton ‘Stour sesbomptin, adi F endacon an [ Pasi tne. Aspe proven Hat Ace et wie Pedpespsin. A neaivelycharaed gece hat coves di Tore ithe pmera sp ary enh cat 9 Feral omer aweeat mene Peds Thai aul epithe ea ic rm poet hi itunes the Eometarenlee yale ses rie lems apapeia Exes water take ‘Pomin pelt, euron ozo in th pone whoa there Teepe coctomo mdeedonmelliy 10 Gtowsay reps Th le tl ney hich x70 futon atl ha. The mada asset of he ney coating Ae race tes terns ard veinand a rer’ pete el pei The pe eso ni the ice eedng fia the val plc tap. Teen th es ert fmtion ‘mateo umpetensa etal Anelate ed eae reunion [Bhabienyatin, Mince damage or desrution cusig the ‘Sapp The igri metwegn zen padgoter ‘tt ar of he glee Hig ater “Lan thet pun A pci weve by bale cape ‘iy eB ea nD tbe oopat Heme Help feta wgemercietrolencn ata eles ‘enol glen svat ot temas baer gpd ‘Lies i lt pia cebu dod eae ‘et a ese yh td, “aes Cnsiag cae seen nthe wae ‘asa rota, Paice descnng nd cs al casei ‘reel rom th comer ot dla Nk ao come ‘wth ho nop of Hee ‘aoe Aerie Proce cating Wel ination ad ‘oarage sic Neavog ote blog oeerrtsi ‘Synen brad hamone merablid Inne Homey 0 *e