Renal Pathophysiology: The Essentials Fifth edition Dr. Helmut G. Rennke MD, Dr. Bradley M. Denker MD PDF
Preview Renal Pathophysiology: The Essentials Fifth edition Dr. Helmut G. Rennke MD, Dr. Bradley M. Denker MD
Acquisitions Editor: Crystal Taylor Development Editors: Andrea Vosburgh and Robyn Alvarez Editorial Coordinator: Kerry McShane Production Project Manager: Kim Cox Manufacturing Coordinator: Margie Orzech Marketing Manager: Jason Oberacker Design Coordinator: Holly McLaughlin Prepress Vendor: Absolute Service, Inc. Fifth Edition Copyright © 2020 Wolters Kluwer Copyright © 2014, 2010 Lippincott Williams & Wilkins, a Wolters Kluwer business. Copyright © 2007, 1994 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, 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.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Names: Rennke, Helmut G., author. | Denker, Bradley M., author. Title: Renal pathophysiology : the essentials / Helmut G. Rennke, Bradley M. Denker. Description: Fifth edition. | Philadelphia : Wolters Kluwer, [2020] | Includes bibliographical references and index. Identifiers: LCCN 2018054070 | ISBN 9781975109592 (paperback) Subjects: | MESH: Kidney Diseases—physiopathology | Kidney—physiopathology Classification: LCC RC903.9 | NLM WJ 300 | DDC 616.6/107—dc23 LC record available at https://lccn.loc.gov/2018054070 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data, and other factors unique to the patient. The publisher does not provide medical advice or guidance, and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made, and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings, and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used, or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. shop.lww.com To our families, Stephanie and Christianne Mary, Brendan, Jennifer, and Mackenzie PREFACE In this fifth edition of Renal Pathophysiology: The Essentials, we have maintained the general principles that guided us in the design and approach of the last four editions of the book. Over these last years, we have received many comments and suggestions not only from our second-year medical students but also from house staff, nephrology fellows, and colleagues; we are most grateful for their feedback and encouraging words. As a consequence of these suggestions, we have further expanded the sections on molecular aspects of the mechanisms that result in kidney dysfunction and the morphologic expression of the major diseases that affect the kidney; the illustrations are in full color and inserted into the text. The list of suggested readings has been updated and summaries are included at the end of physiology chapters. We have also reviewed supplemental self-examination questions that permit application of key concepts to clinical cases and to develop more nuanced understanding. However, the core and the principal aim of this book remain unchanged: to provide the student with a solid understanding of the mechanisms that result in kidney dysfunction and disease and to serve as the basic reading material and text for a course in kidney pathophysiology. HGR AND BMD CONTENTS Preface 1 CHAPTER Review of Renal Physiology Introduction Relationship between Filtration and Excretion General Mechanism of Transtubular Sodium Reabsorption Tight Junctions and Membrane Polarity Segmental Sodium Reabsorption Proximal Tubule Loop of Henle Distal Tubule Calcium Transport Collecting Ducts Water Transport Countercurrent Mechanism Glomerular Filtration Rate Determinants of Glomerular Filtration Arteriolar Resistance and Glomerular Filtration Rate Clinical Estimation of Glomerular Filtration Rate Creatinine Clearance Plasma Creatinine Concentration and Glomerular Filtration Rate Blood Urea Nitrogen and Glomerular Filtration Rate 2 CHAPTER Regulation of Salt and Water Balance Introduction Physiologic Role of Osmotic Pressure Osmotic Pressure and Distribution of Body Water Relationship between Plasma Osmolality and Sodium Concentration Osmoregulation and Volume Regulation Hormonal Role in Water and Sodium Balance Osmoregulation Volume Regulation Antidiuretic Hormone, Thirst, and Maintenance of Water Balance Actions Vascular Resistance Renal Prostaglandins Control of Antidiuretic Hormone Secretion Osmoreceptors Thirst Volume Receptors Interactions of Osmotic and Volume Stimuli Hormonal Regulation of Sodium Excretion Definition of Effective Circulating Volume Renin–Angiotensin System Actions Aldosterone Actions Control of Aldosterone Secretion Maintenance of Sodium and Potassium Balance Atrial Natriuretic Peptide Actions Control of Atrial Natriuretic Peptide Secretion Physiologic Role of Atrial Natriuretic Peptide Other Atrial Natriuretic Peptide-like Hormones Pressure Natriuresis Steady State Role of Impaired Renal Excretion in Electrolyte Disorders Time Course of Diuretic Action 3 CHAPTER Disorders of Water Balance: Hyponatremia, Hypernatremia, and Polyuria Determinants of Plasma Sodium Concentration Clinical Importance of Osmoregulation Osmolytes and Cell Volume Regulation Implications for Symptoms and Treatment Hyponatremia Etiology Congestive Heart Failure Syndrome of Inappropriate Antidiuretic Hormone Reset Osmostat Diagnosis Plasma Osmolality Urine Osmolality Urine Sodium Concentration Basic Principles of Therapy Hypernatremia
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