s Nephrology and Acid-Base Disorders

321 Pages·2010·8.79 MB·English

HARRISON’S
Nephrology and
Acid-Base Disorders
Derived from Harrison’s Principles of Internal Medicine, 17th Edition
Editors
ANTHONY S. FAUCI, EUGENE BRAUNWALD,
MD MD
Chief,Laboratory of Immunoregulation; Distinguished Hersey Professor of Medicine,
Director,National Institute of Allergy and Infectious Diseases, Harvard Medical School;Chairman,TIMI Study Group,
National Institutes of Health,Bethesda Brigham and Women’s Hospital,Boston
DENNIS L. KASPER, MD STEPHEN L. HAUSER, MD
William Ellery Channing Professor of Medicine,Professor of Robert A.Fishman Distinguished
Microbiology and Molecular Genetics,Harvard Medical School; Professor and Chairman,
Director,Channing Laboratory,Department of Medicine, Department of Neurology,
Brigham and Women’s Hospital,Boston University of California,San Francisco
DAN L. LONGO, J. LARRY JAMESON,
MD MD,PhD
Scientific Director,National Institute on Aging, Professor of Medicine;
National Institutes of Health,Bethesda and Baltimore Vice President for Medical Affairs and Lewis
Landsberg Dean,
Northwestern University Feinberg School of
Medicine,Chicago
JOSEPH LOSCALZO,
MD,PhD
Hersey Professor of Theory and Practice of Medicine,
Harvard Medical School;Chairman,Department of Medicine;
Physician-in-Chief,Brigham and Women’s Hospital,Boston
HARRISON’S
Nephrology and
Acid-Base Disorders
Editors
J. Larry Jameson, MD, PhD
Professor of Medicine;
Vice President for Medical Affairs and Lewis Landsberg Dean,
Northwestern University Feinberg School of Medicine,Chicago
Joseph Loscalzo, MD, PhD
Hersey Professor of Theory and Practice of Medicine,
Harvard Medical School;Chairman,Department of Medicine;
Physician-in-Chief,Brigham and Women’s Hospital,Boston
New York Chicago San Francisco Lisbon London Madrid
Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto
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CONTENTS
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii 13 Transplantation in the Treatment
of Renal Failure . . . . . . . . . . . . . . . . . . . . . . . 137
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Charles B.Carpenter,Edgar L.Milford,
Mohamed H.Sayegh
SECTION I
INTRODUCTION TO THE RENAL SYSTEM 14 Infections in Transplant Recipients. . . . . . . . . . 147
Robert Finberg,Joyce Fingeroth
1 Basic Biology of the Kidney . . . . . . . . . . . . . . . . 2
Alfred L.George,Jr.,Eric G.Neilson
SECTION IV
2 Adaptation of the Kidney to Renal Injury . . . . . 14 GLOMERULAR AND TUBULAR DISORDERS
Raymond C.Harris,Jr.,Eric G.Neilson
15 Glomerular Diseases . . . . . . . . . . . . . . . . . . . . 156
Julia B.Lewis,Eric G.Neilson
SECTION II
ALTERATIONS OF RENAL FUNCTION AND 16 Polycystic Kidney Disease and Other
ELECTROLYTES Inherited Tubular Disorders . . . . . . . . . . . . . . . 180
David J.Salant,Parul S.Patel
3 Azotemia and Urinary Abnormalities. . . . . . . . . 22
Bradley M.Denker,Barry M.Brenner 17 Tubulointerstitial Diseases
of the Kidney . . . . . . . . . . . . . . . . . . . . . . . . . 196
4 Atlas of Urinary Sediments and Alan S.L.Yu,Barry M.Brenner
Renal Biopsies . . . . . . . . . . . . . . . . . . . . . . . . . 32
Agnes B.Fogo,Eric G.Neilson
SECTION V
RENAL VASCULAR DISEASE
5 Acidosis and Alkalosis . . . . . . . . . . . . . . . . . . . . 42
Thomas D.DuBose,Jr.
18 Vascular Injury to the Kidney. . . . . . . . . . . . . . 204
Kamal F.Badr,Barry M.Brenner
6 Fluid and Electrolyte Disturbances. . . . . . . . . . . 56
Gary G.Singer,Barry M.Brenner
19 Hypertensive Vascular Disease. . . . . . . . . . . . . . 212
Theodore A.Kotchen
7 Hypercalcemia and Hypocalcemia . . . . . . . . . . . 73
Sundeep Khosla
SECTION VI
8 Hyperuricemia and Gout . . . . . . . . . . . . . . . . . 78 URINARY TRACT INFECTIONS AND
Robert L.Wortmann,H.Ralph Schumacher,
OBSTRUCTION
Lan X.Chen
20 Urinary Tract Infections,Pyelonephritis,
9 Nephrolithiasis . . . . . . . . . . . . . . . . . . . . . . . . . 88
and Prostatitis . . . . . . . . . . . . . . . . . . . . . . . . . 236
John R.Asplin,Fredric L.Coe,Murray J.Favus
Walter E.Stamm
21 Urinary Tract Obstruction. . . . . . . . . . . . . . . . 248
SECTION III
Julian L.Seifter,Barry M.Brenner
ACUTE AND CHRONIC RENAL FAILURE
10 Acute Renal Failure . . . . . . . . . . . . . . . . . . . . . 98 SECTION VII
Kathleen D.Liu,Glenn M.Chertow CANCER OF THE KIDNEY AND
URINARY TRACT
11 Chronic Kidney Disease . . . . . . . . . . . . . . . . . 113
Joanne M.Bargman,Karl Skorecki
22 Bladder and Renal Cell
Carcinomas. . . . . . . . . . . . . . . . . . . . . . . . . . . 254
12 Dialysis in the Treatment of Renal Failure. . . . . 130
Howard I.Scher,Robert J.Motzer
Kathleen D.Liu,Glenn M.Chertow
v
vi Contents
Appendix
Laboratory Values of Clinical Importance . . . . . 261
Alexander Kratz,Michael A.Pesce,Daniel J.Fink
Review and Self-Assessment. . . . . . . . . . . . . . . 277
Charles Wiener,Gerald Bloomfield,Cynthia D.Brown,
Joshua Schiffer,Adam Spivak
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
CONTRIBUTORS
Numbers in brackets refer to the chapter(s) written or co-written by the contributor.
JOHN R.ASPLIN,MD ROBERT FINBERG,MD
Clinical Associate,Department of Medicine,University of Chicago; Professor and Chair,Department of Medicine,University of
Medical Director,Litholink Corporation,Chicago [9] Massachusetts Medical School,Worcester [14]
KAMAL F.BADR,MD JOYCE FINGEROTH,MD
Professor and Dean,School of Medicine,Lebanese American Associate Professor of Medicine,Harvard Medical School,
University,Byblos,Lebanon [18] Boston [14]
JOANNE M.BARGMAN,MD DANIEL J.FINK,MD,MPH†
Professor of Medicine,University of Toronto;Director,Peritoneal Associate Professor of Clinical Pathology,College of
Dialysis Program,and Co-Director,Combined Renal-Rheumatology Physicians and Surgeons,Columbia University,
Lupus Clinic,University Health Network,Toronto [11] New York [Appendix]
GERALD BLOOMFIELD,MD,MPH AGNES B.FOGO,MD
Department of Internal Medicine,The Johns Hopkins University Professor of Pathology,Medicine and Pediatrics;Director,
School of Medicine,Baltimore [Review and Self-Assessment] Renal/EM Division,Department of Pathology,Vanderbilt
University Medical Center,Nashville [4]
BARRY M.BRENNER,MD,AM,DSc(Hon),DMSc(Hon),
DIPL (Hon) ALFRED L.GEORGE,JR.,MD
Samuel A.Levine Professor of Medicine,Harvard Medical School; Grant W.Liddle Professor of Medicine and Pharmacology;
Director Emeritus,Renal Division,Brigham and Women’s Hospital, Chief,Division of Genetic Medicine,Department of Medicine,
Boston [3,6,17,18,21] Vanderbilt University,Nashville [1]
CYNTHIA D.BROWN,MD RAYMOND C.HARRIS,JR.,MD
Department of Internal Medicine,The Johns Hopkins University Ann and Roscoe R.Robinson Professor of Medicine;Chief,
School of Medicine,Baltimore [Review and Self-Assessment] Division of Nephrology and Hypertension,Department of
Medicine,Vanderbilt University,Nashville [2]
CHARLES B.CARPENTER,MD
Professor of Medicine,Harvard Medical School;Senior Physician, SUNDEEP KHOSLA,MD
Brigham and Women’s Hospital,Boston [13] Professor of Medicine and Physiology,Mayo Clinic College of
Medicine,Rochester [7]
LAN X.CHEN,MD
Clinical Assistant Professor of Medicine,University of Pennsylvania, THEODORE A.KOTCHEN,MD
Penn Presbyterian Medical Center and Philadelphia Veteran Affairs Associate Dean for Clinical Research;Director,General
Medical Center,Philadelphia [8] Clinical Research Center,Medical College of Wisconsin,
Wisconsin [19]
GLENN M.CHERTOW,MD
Professor of Medicine,Epidemiology and Biostatistics,University ALEXANDER KRATZ,MD,PhD,MPH
of California,San Francisco School of Medicine;Director,Clinical Assistant Professor of Clinical Pathology,Columbia University
Services,Division of Nephrology,University of California, College of Physicians and Surgeons;Associate Director,
San Francisco Medical Center,San Francisco [10,12] Core Laboratory,Columbia University Medical Center,
New York-Presbyterian Hospital;Director,Allen Pavilion
FREDRIC L.COE,MD Laboratory,New York [Appendix]
Professor of Medicine,University of Chicago,Chicago [9]
JULIA B.LEWIS,MD
BRADLEY M.DENKER,MD Professor of Medicine,Division of Nephrology and Hypertension,
Associate Professor of Medicine,Harvard Medical School;Physician, Department of Medicine,Vanderbilt University School of Medicine,
Brigham and Women’s Hospital;Chief of Nephrology,Harvard Nashville [15]
Vanguard Medical Associates,Boston [3]
KATHLEEN D.LIU,MD,PhD,MCR
THOMAS D.DUBOSE,JR.,MD Assistant Professor,Division of Nephrology,San Francisco [10,12]
Tinsley R.Harrison Professor and Chair of Internal Medicine;
Professor of Physiology and Pharmacology,Wake Forest University EDGAR L.MILFORD,MD
School of Medicine,Winston-Salem [5] Associate Professor of Medicine,Harvard Medical School;
Director,Tissue Typing Laboratory,Brigham and Women’s
MURRAY J.FAVUS,MD Hospital,Boston [13]
Professor of Medicine,Interim Head,Endocrine Section;Director,
Bone Section,University of Chicago Pritzker School of Medicine,
Chicago [9]
†Deceased.
vii
viii Contributors
ROBERT J.MOTZER,MD JULIAN L.SEIFTER,MD
Attending Physician,Department of Medicine,Memorial Physician,Brigham and Women’s Hospital;
Sloan-Kettering Cancer Center;Professor of Medicine,Weill Associate Professor of Medicine,Harvard Medical School,
Medical College of Cornell University,New York [22] Boston [21]
ERIC G.NEILSON,MD GARY G.SINGER,MD
Hugh J.Morgan Professor of Medicine and Cell Biology, Assistant Professor of Clinical Medicine,
Physician-in-Chief,Vanderbilt University Hospital;Chairman, Washington University School of Medicine,
Department of Medicine,Vanderbilt University School of St.Louis [6]
Medicine,Nashville [1,2,4,15]
KARL SKORECKI,MD
PARUL S.PATEL,MD Annie Chutick Professor in Medicine (Nephrology);
Transplant Neurologist,California Pacific Medical Center, Director,Rappaport Research Institute,
San Francisco [16] Director of Medical and Research Development,
Rambam Medical Health Care Campus,Haifa,
MICHAEL A.PESCE,PhD Israel [11]
Clinical Professor of Pathology,Columbia University
College of Physicians and Surgeons;Director of Specialty ADAM SPIVAK,MD
Laboratory,New York Presbyterian Hospital,Columbia Department of Internal Medicine,The Johns Hopkins University
University Medical Center,New York [Appendix] School of Medicine,Baltimore [Review and Self-Assessment]
DAVID J.SALANT,MD WALTER E.STAMM,MD
Professor of Medicine,Pathology,and Laboratory Medicine, Professor of Medicine;Head,Division of Allergy and Infectious
Boston University School of Medicine;Chief,Section of Diseases,University of Washington School of Medicine,
Nephrology,Boston Medical Center,Boston [16] Seattle [20]
MOHAMED H.SAYEGH,MD CHARLES WIENER,MD
Director,Warren E.Grupe and John P.Morill Chair in Professor of Medicine and Physiology;Vice Chair,Department of
Transplantation Medicine;Professor of Medicine and Medicine;Director,Osler Medical Training Program,The Johns
Pediatrics,Harvard Medical School,Boston [13] Hopkins University School of Medicine,Baltimore [Review and
Self-Assessment]
HOWARD I.SCHER,MD
Professor of Medicine,Weill Medical College of Cornell ROBERT L.WORTMANN,MD
University;D.Wayne Calloway Chair in Urologic Dartmouth-Hitchcock Medical Center,Lebanon [8]
Oncology;Chief,Genitourinary Oncology Service,
Memorial Sloan-Kettering Cancer Center,New York [22] ALAN S.L.YU,MB,BChir
Associate Professor of Medicine,Physiology and Biophysics,
JOSHUA SCHIFFER,MD University of Southern California Keck School of Medicine,
Department of Internal Medicine,The Johns Hopkins University Los Angeles [17]
School of Medicine,Baltimore [Review and Self-Assessment]
H.RALPH SCHUMACHER,MD
Professor of Medicine,University of Pennsylvania School of
Medicine,Philadelphia [8]
PREFACE
The Editors of Harrison’s Principles of Internal Medicine refer of medicine and represent a frequent source of renal
to it as the “Mother Book,” a description that confers consultation.
respect but also acknowledges its size and its ancestral sta- The first section of the book, “Introduction to the
tus among the growing list of Harrison’s products,which Renal System,” provides a systems overview, beginning
now include Harrison’s Manual of Medicine, Harrison’s with renal development,function,and physiology,as well
Online,and Harrison’s Practice,an online,highly structured as providing an overview of how the kidney responds to
reference for point-of-care use and continuing education. injury.The integration of pathophysiology with clinical
This book,Harrison’s Nephrology and Acid-Base Disorders,is management is a hallmark of Harrison’s,and can be found
a compilation of chapters related to kidney function. throughout each of the subsequent disease-oriented chap-
Our readers consistently note the sophistication of ters.The book is divided into seven main sections that
the material in the specialty sections of Harrison’s.Our reflect the scope of nephrology: (I) Introduction to the
goal was to bring this information to our audience in Renal System; (II) Alterations of Renal Function and
a more compact and usable form.Because the topic is Electrolytes; (III) Acute and Chronic Renal Failure;
more focused, it is possible to enhance the presenta- (IV) Glomerular and Tubular Disorders;(V) Renal Vascular
tion of the material by enlarging the text and the Disease; (VI) Urinary Tract Infections and Obstruction;
tables. We have also included a Review and Self- and (VII) Cancer of the Kidney and Urinary Tract.
Assessment section that includes questions and answers While Harrison’s Nephrology and Acid-Base Disorders is
to provoke reflection and to provide additional teach- classic in its organization,readers will sense the impact of
ing points. the scientific advances as they explore the individual
Renal dysfunction,electrolyte,and acid-base disorders chapters in each section.Genetics and molecular biology
are among the most common problems faced by the clin- are transforming the field of nephrology,whether illumi-
ician. Indeed, hyponatremia is consistently the most fre- nating the genetic basis of a tubular disorder or explaining
quently searched term for readers of Harrison’s Online. the regenerative capacity of the kidney. Recent clinical
Unlike some specialties, there is no specific renal exam. studies involving common diseases like chronic kidney
Instead,the specialty relies heavily on laboratory tests,uri- disease, hypertensive vascular disease, and urinary tract
nalyses, and characteristics of urinary sediments. Evalua- infections provide powerful evidence for medical decision
tion and management of renal disease also requires a making and treatment.These rapid changes in nephrology
broad knowledge of physiology and pathology since the are exciting for new students of medicine and underscore
kidney is involved in many systemic disorders.Thus,this the need for practicing physicians to continuously update
book considers a broad spectrum of topics including their knowledge base and clinical skills.
acid-base and electrolyte disorders,vascular injury to the Our access to information through web-based journals
kidney,as well as specific diseases of the kidney. and databases is remarkably efficient.While these sources
Kidney disorders,such as glomerulonephritis,can be a of information are invaluable,the daunting body of data
primary cause for clinical presentation.More commonly, creates an even greater need for synthesis and for high-
however,the kidney is affected secondary to other med- lighting important facts.Thus, the preparation of these
ical problems such as diabetes, shock, or complications chapters is a special craft that requires the ability to distill
from dye administration or medications. As such, renal core information from the ever-expanding knowledge
dysfunction may be manifest by azotemia,hypertension, base.The editors are therefore indebted to our authors,a
proteinuria,or an abnormal urinary sediment,and it may group of internationally recognized authorities who are
herald the presence of an underlying medical disorder. masters at providing a comprehensive overview while
Renal insufficiency may also appear late in the course of being able to distill a topic into a concise and interesting
chronic conditions such as diabetes,lupus,or scleroderma chapter.We are grateful to Emily Cowan for assisting with
and significantly alter a patient’s quality of life. Fortu- research and preparation of this book. Our colleagues at
nately,intervention can often reverse or delay renal insuf- McGraw-Hill continue to innovate in healthcare publish-
ficiency.And,when this is not possible,dialysis and renal ing.This new product was championed by Jim Shanahan
transplant provide life-saving therapies. and impeccably produced by Kim Davis.
Understanding normal and abnormal renal function We hope you find this book useful in your effort to
provides a strong foundation for diagnosis and clinical achieve continuous learning on behalf of your patients.
management.Therefore,topics such as acidosis and alka-
losis, fluid and electrolyte disorders, and hypercalcemia J.Larry Jameson,MD,PhD
are covered here.These basic topics are useful in all fields Joseph Loscalzo,MD,PhD
ix