Therapy of Renal Diseases and Related Disorders

986 Pages·1990·32.449 MB·English

by  Stephen Brennan, J. Carlos Ayus (auth.), Wadi N. Suki, Shaul G. Massry (eds.)

Therapy of Renal Diseases and Related Disorders, Second Edition
Therapy of Renal Diseases and
Related Disorders, Second Edition
Edited by
Wadi N. Suki
The Methodist Hospital
Baylor College of Medicine
Houston, Texas
and
Shaul G. Massry
Division of Nephrology
University of Southern
California
Los Angeles, California
.....
"
KLUWER ACADEMIC PUBLISHERS
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Library of Congress Cataloging-in-Publication Data
Therapy of renal diseases and related disorders/edited by Wadi N.
Suki and Shaul G. Massry.-2nd ed.
p. em.
Includes bibliographical references.
ISBN-13: 978-1-4612-8027-9 e-ISBN-13: 978-1-4613-0689-4
DOl: 10.1 007/978-1-4613-0689-4
1. Kidneys-Diseases-Treatment. 2. Urinary organs
Diseases-Treatment. I. Suki, Wadi N., 1934-
II. Massry, Shaul G.
[DNLM: 1. Kidney Diseases-therapy. WJ 300 T398j
RC902.T49 1990
616.6' 106-dc20
DNLMIDLC
for Library of Congress 90-4136
CIP
Copyright © 1991 by Kluwer Academic Publishers
Softcover reprint of the hardcover 2nd edition 1991
Third Printing 1993
Printed on acid-free paper.
All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system or transmitted in any
form or by any means, mechanical, photocopying, recording, or
otherwise, without the prior written permission of the publisher,
Kluwer Academic Publishers, 101 Philip Drive. Assinippi Park,
Norwell. Massachusetts 02061.
Contents
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Preface to the First Edition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Preface to the Second Edition ....................................................................... . xiii
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. xv
PART ONE: DISORDERS OF FLUID, ELECTROLYTE, AND ACID-BASE BALANCE
1. Treatment of hypoo smolar and hyperosmolar states STEPHEN BRENNAN AND J. CARLOS A YUS
2. Polyuric syndromes WILLIAM P. MULDOWNEY AND MICHAEL H. HUMPHREYS. . . . . . . . . . . . . . . .. 17
3. Edematous states ARTHUR GREENBERG AND JULES B. PUSCHETT . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 27
4. Disorders of potassium metabolism JACQUES J. BOURGOIGNIE, JAMES R. OSTER,
GUIDO O. PEREZ, AND DOLLIE F. GREEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 45
5. Disorders of calcium metabolism AARON HALABE AND ROGER A.L. SUTTON. . . . . . . . . . . . . . . . . . . .. 91
6. Disorders of magnesium metabolism THOMAS DYCKNER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 111
7. Disorders of phosphate metabolism MOSHE LEVI AND JAMES P. KNOCHEL. . . . . . . . . . . . . . . . 121
8. Nephrolithiasis and nephrocalcinosis JOAN H. PARKS AND FREDRIC L. COE. . . . . . . . . . . . . . . . 139
9. Metabolic alkalosis SANDRA SABATINI AND NEIL A. KURTZMAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 159
10. Metabolic acidosis ROBERT M.A. RICHARDSON AND MITCHELL L. HALPERIN. . . . . . . . . . . . . . . .. 177
11. Diabetic ketoacidosis HORACIO J. ADROGUE, JORGE BARRERO, AND GEORGE M. DOLSON... 193
12. Renal tubular acidosis FERNANDO SANTOS, GAD KAINER, AND JAMES C.M. CHAN ............ 207
13. Respiratory acid-base disturbances GREGORIO 1. CASAR AND R. KEITH WILSON. . . . . . . . . . . . 223
14. Mixed acid-base disorders JOHN T. HARRINGTON AND NICOLAOS E. MADIAS .................. 233
15. Fluid and electrolyte abnormalities in children ADRIAN SPITZER AND RICHARD NEIBERGER . . . . .. 245
16. Fluid and electrolyte disorders in the surgical patient HERVY H. HINER, JR. AND WADI N. SUKI . . . . .. 263
17. Fluid and electrolyte disorders in the thermally injured CHARLES BAXTER .......................... 277
18. Acute renal failure DAVID M. GILLUM, JOHN D. CONGER, AND ROBERT J. ANDERSON ........ 285
PART TWO: INTRINSIC PARENCHYMAL DISEASE
A. Glomerular
19. Acute glomerulonephritis and glomerulonephritis in bacterial endocarditis DAVID S. BALDWIN
AND JOEL NEUGARTEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
v
vi Contents
20. Nephrotic syndrome GERALD C. GROGGEL AND WAYNE A. BORDER. . . . . . . . . . . . . . . . . . . . . . . . .. 317
2l. Goodpasture's syndrome CURTIS B. WILSON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 333
22. Hematuria and IgA nephropathy JOn OHNO ..................................................... 343
B. Tubulointerstitial
23. Urinary tract infections MARVIN FORLAND. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 349
24. Vesicoureteral reflux and reflux nephropathy PRISCILLA KINCAID-SMITH . . . . . . . . . . . . . . . . . . . . . . . . .. 363
25. Genitourinary tuberculosis JAMES E. GOW ...................................................... 387
PART THREE: RENAL INVOLVEMENT IN SYSTEMIC DISEASE
26. Systemic lupus erythematosus SUSAN L. ANDREW AND DAVID P. HUSTON. . . . . . . . . . . . . . . . . . . . . .. 395
27. Vasculiticdiseases of the kidney JAMESE. BALOW AND HOWARD A. AUSTIN III ................. 413
28. Noninflammatory vascular diseases of the kidney GARABED EKNOYAN ............................ 425
29. Thrombotic microangiopathy ELLIN LIEBERMAN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 443
30. Renal involvement in dysproteinemias DOMINIQUE GANEVAL AND JEAN-PIERRE GRUNFELD ... 453
3l. Hyperuricemic nephropathy EDWARD R. AHRENS AND THOMAS H. STEELE . . . . . . . . . . . . . . . . . . .. 469
32. Renal disorders in liver disease MURRA Y EPSTEIN ............................................... 477
33. Renal complications of pregnancy JOHN M. DAVISON, ADRIAN I. KATZ, AND MARSHALL
D. LINDHEIMER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 495
34. Diabetic nephropathy ELI A. FRIEDMAN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 533
PART FOUR: HEREDITARY AND CONGENITAL DISEASES
35. Renal cystic disorders JARED J. GRANTHAM, JOANN B. RECKLING,
AND SHARON L. SLUSHER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 543
36. Renal disorders in sickle hemoglobinemia STEPHANIE LEAR AND ROBERT M. ROSA .............. 573
37. Inherited renal tubular disorders RUSSELL W. CHESNEY ......................................... . 581
PART FIVE: NEOPLASIA
38. Cancers of the kidney and urinary tract PETER T. SCARDINO AND MADELINE CANTINI ........... 593
PART SIX: CHEMICAL AND PHYSICAL INJURIES
39. Toxic nephropathies JOHN F. MAHER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 613
40. Acute drug intoxications JAMES F. WINCHESTER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 639
PART SEVEN: CHRONIC RENAL FAILURE
A. Medical therapy
41. Prevention of progression of renal insufficiency GIUSEPPE MASCHIO, LAMBERTO OLDRIZZI,
AND CARLO RUGIU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 649
42. Renal insufficiency EBERHARD F. RITZ ........................................................ 659
43. Anesthesia and surgery in the patient with renal failure DAVID R. BEVAN. . . . . . . . . . . . . . . . . . . . . . . . . . .. 669
44. Nutritional management of the uremic patient MARKUS TESCHNER AND AUGUST HEIDLAND . . . .. 675
45. Cardiovascular complications of uremia and dialysis J. CARLOS A YUS AND R.K. KROTHAP ALLI . . . .. 697
46. Renal osteodystrophy SHAUL G. MASSRY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 711
47. Neurologic and psychiatric disorders in renal failure SUHAIL AHMAD
AND CHRISTOPHER R. BLAGG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 719
48. Hematologic disorders in renal failure K.M. KOCH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 733
Contents VII
B. Peritoneal dialysis
49. Acute, intermittent, and cycled peritoneal dialysis JOSE A. DIAZ-BUXO .. . . . . . . . . . . . . . . . . . . . . . . . . . .. 739
50. Continuous ambulatory peritoneal dialysis ROBERT A. MACTIER AND KARL D. NOLPH . . . . . . . . . . .. 755
C. Hemodialysis
51. Dialysis access surgery GEORGE P. NOON AND H. DAVID SHORT ............................... 775
52. Dialyzers, dialysates, and water treatment N.K. MAN AND J.L. FUNCK-BRENTANO . . . . . . . . . . . . . . . .. 791
53. Membrane biocompatibility ALFRED K. CHEUNG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 813
54. Dialysis, ultrafiltration, and hemofiltration RAYMOND C. VANHOLDER, NICOLAS H. HOENICH,
AND SEVERIN M. RINGOIR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 841
55. Use of drugs in uremia and dialysis D. CRAIG BRATER ........................................... . 853
D. Transplantation
56. Donor and recipient selection STUART M. FLECHNER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 867
57. Immunosuppression and treatment of rejection YVES F. CH. VA NRENTERGHEM. . . . . . . . . . . . . . . 887
58. Tubular and metabolic dysfunction following kidney transplantation J. WINAVER, J. GREEN,
AND O. S. BEITER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 905
59. Renal transplantation in systemic inherited and metabolic disease ELEANOR D. LEDERER AND
WADIN.SUKT ............................................................................... 921
60. Complications of renal transplantation JOHN A. MURIE AND PETER J. MORRIS. . . . . . . . . . . . . . . . . . .. 943
PART EIGHT: MISCELLANEOUS
61. The catheter GRANNUM R. SANT AND EDWIN M. MEARES, JR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 955
62. Nonsurgical management of vesicourethral dysfunction J. KEITH LIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 969
Index............................................................................................. 975
Forewordl
"Where are all these kidney patients coming from? A few perfection the study of the urinary sediment, clinically
years ago we had never heard of kidney disease and now practical kidney function tests, and the natural history of a
you are speaking of patients in the hundreds of thousands number of kidney diseases including glomerulonephritis.
and indeed potentially millions." My reply, not meant to William Goldring, Herbert Chasis, Dana Atchley, and
be grim, was "From the cemetery, Sir." This is a summary others studied the effects of hypertension, endocarditis,
of some Congressional testimony lance gave on behalf of and circulatory diseases on the kidney and spawned suc
extending kidney disease under Medicare. Where indeed cessive generations of alert clinical investigators, who be
were all the patients with kidney disease in the United gan to chronicle the natural histories of a wide variety of
States before World War II? They were certainly not kidney diseases. Quantitative studies of renal function
under the care of nephrologists! Nephrology was not listed flourished under a school headed by Homer Smith, and
in the questionnaires for any state or the American Medi surprisingly precise techniques were developed for study
cal Association as a subspecialty or even as a special ing a whole range of explicit nephron functions. Imagine
interest. Indeed, even in the late 1960s, when I wrote the the joy with the advent of vascular catheterization to be
American Medical Association editor and asked why able to apply extraction ratios and the Fick principle in a
nephrology had not been included on a questionnaire to precise way to an organ such as the kidney by sampling
American physicians about their specialty interests, I re arterial blood, venous blood, and the output of the urine!
ceived a "tongue in check" answer, "What's nephrology?" One had a quantitative handle on the entire function of a
Indeed, for those of us who bridge back, it is often hard to vital organ - perhaps for the first time in biologic history.
realize the rapid evolution of our specialty. For uremia, One no longer looked only at the street side of the
we gave low-protein diets, adequate hydration, attention revolving door; one could find out, for example, that if
to fluid and electrolytes, comfort, and prayer. In my first ammonia did not go into the acid trap of the urine, it
two years at Georgetown, where every death in the hos indeed might go back into the circulation via the renal
pital was reviewed, my nephrology division made death vein.
conference all but a few weeks out of the first two years. The same story unfolded for a broad range of physio
In a 1961 book on uremia2 I wrote: logic substances. In the metabolic school of nephrology,
The reversibility of uremic coma has received some attention represented perhaps most brilliantly by Professor John
but could use more. In a further effort to discourage pessimism Peters at Yale, a host of pioneer investigators applied the
we have therefore placed a capital 'R' following each of the methods of quantitative clinical biochemistry to the ele
potentially reversible types of renal disease. It is our sincere ments of the blood whose homeostasis was so carefully
hope that the number of 'R's' will provide a pleasant surprise regulated by the kidney. His deep interest in endocrino
for the many physicians and medical students who want to
logy and metabolism pointed our way to appreciate the
think of the uremic syndrome as a terminal state during which
endocrine role of the kidney in making or releasing a whole
little treatment can be instituted except that designed for the
array of potent hormones affecting bodily function (e.g.,
comfort of the patient.
This is not to say that the science underlying nephrology erythropoietin, renin, aldosterone, etc.), and indeed the
was inactive, Quite to the contrary, many cases of fruitful very survival of the human organism. The role of the kidney
science relating to the kidney area not only existed but in controlling vitamin D metabolism, calcium absorption,
flourished and had a profound impact on many young parathyroid function, and the complex inter-relation
clinicians. Thomas Addis raised to a state of applied ships comprising calcium/phosphorous homeostasis, bone
growth, and bone repair were only mistily appreci
I Revised for the second edi tion. ated and became one of the great metabolic success stories
of postwar nephrology and metabolism. Postwar nephro
2 Schreiner GE Maher JF: Uremia, Chemistry and Pathogenesis logy rushed to the fore and supplied nephrologists with
& Treatment. Charles C. Thomas, Springfield, IL, p 24, 1961. such wonderful tools as the f1amephotometer, electro-
ix
x Foreword
phoresis, microchemistry, immunoassay, sonography, pediatrician, for it is the final common pathway of literally
renal biopsy, immunofluorescence, electron microscopy, hundreds of disease processes that lead to scarring and
and unclear magnetic resonance, and permitted a total destruction of nephrons.
integration of form, histologic structure, and function. We estimate that there are well in excess of 300,000
Clinical nephrology became indeed the real fusion of bio patients in the world living on the varied methodologies
chemistry, physiology, immunology, renal endocrinology, represented by the three basic forms of substituted kidney
and the focus of newer imaging techniques. function - hemodialysis, peritoneal dialysis, and renal
With this precision in diagnosis, one could realistically transplantation: over 100,000 persons in the United States
hope for rational therapy, and one could be optimistic that alone, well over 110,000 in the countries compromising
some day the correct therapy would be correctly applied the EDTA Registry, and over 100,000 in the Pacific Rim.
to the correct patient with the appropriately diagnosed If we add on South America, Africa, and the lesser de
disease. veloped nations, the total could well be over 400,000 by
With the evolution of such developments, an expert the time this book is printed. These 400,000 plus persons
observer could indeed realistically hope that out of the and their families, who have intimate, repetitive personal
myriad and mushrooming books of nephrology would experiences with uremia, serve as living withnesses of the
come one with a message of constructive hope, focusing on medical progress of nephrology in the past three decades.
the treatment of renal disease. Indeed, Dr. Suki and Dr. They are witnesses of the fact that many of today's kidney
Massry have fulfilled that hope with this book, which is patients have indeed, literally, "come from the cemetery."
appropriately entitled, The Therapy of Renal Disease and But it is not enough to consider only the techniques of
Related Disorders. They have systematically taken the substitution therapy. For with living patients come not
available scientific information and fused it into a practical only the facets of uremia that are not yet handled by
text of therapy for the patient. The first section, entitled therapy, such as cardiovascular complications, renal
"Disorders of Fluid, Electrolyte and Acid-Base Balance," osteodystrophy, anemia, disorders of immune surveil
covers some of the more challenging general conditions, lance, nutritional problems, etc., but there is also a neces
such as hyperosmolar and hypoosmolar states, polyuria, sity to know which particular patients fit which particular
edema, and acute renal failure. The book then proceeds therapy best, and to choose the optimum time for applying
systematically to disorders of the ions, potassium, calcium, one particular therapy to one particular patient. Indeed,
magnesium, phosphate, and the major quartet of acid the management of the uremic patients becomes essenti
base balance, embracing alkalosis and acidosis in its ally a life plan for that person, and the ills that kidney
clinically presentable forms. The book proceeds to the patients have live on with them, instead of going pre
intrinsic parenchymal diseases, covering the major areas maturely with them to the grave.
of glomerular and tubular interstitial disorders and what This is a book that is unique among many books avail
can be done about them. From there it launches into the able today. This is a book that presents material positively.
vast sea of relationships with systemic diseases such as This is a book that blends the analytical aspects of diagnosis
SLE, vasculitis, hyperuricemia, dysproteinemia, liver dis with the hard realities of scientific and appropriate ther
ease, pregnancy, and diabetes, among others. Adequate apy. This is a book that will be enjoyed by young nephro
attention is paid to genetic and congenital disorders, logists and by physicians with a wide diversity of interests.
including the genetic counseling of families beset by gene Most of all, it is a book that will be deeply appreciated by
tically determined disorders. Neoplasia, chemical and their patients.
physical injuries, and a number of other unusual events
are considered with practical insights. Then the book George E. Schreiner, M.D.
tackles the vast problem of uremia and the newer experi Distinguished Professor of Medicine
ence with diet, dialysis, and transplantation. Former Director, Division of Nephrology
Uremia is to the nephrologist what the baby is to the Georgetown University School of Medicine
Preface to the First Edition
In the last fifteen years, many books and monographs have The major strides forward in renal therapy shall be clear
been published which deal with different aspects of renal to the reader of this volume. Areas where advances or
structure and function, and the various renal diseases. The breakthroughs are still needed or where solid, objective
number of published works reflects the explosion of scien proof of efficacy is still lacking shall be equally clear. The
tific knowledge about the kidney and its diseases. Parallel rapid pace of new research on renal therapy continued
with this increased knowledge have come major advances during the period that this text was in preparation, and this
in the handling and management of patients suffering from rapid pace attests to the vitality of nephrology as a disci
disorders of the kidney. These advances, many of which pline. We look forward to the preparation of new editions
are life-saving, in large measure have been responsible for of this volume reflecting substantive advances which will
the emergence of nephrology as a full-fledged medical continue to be made.
specialty. It is fitting, in closing, to acknowledge the generosity of
In spite of the progress made in the therapy of renal each of the contributing authors who have given selflessly
diseases and related disorders, there has not been a text of their precious time to prepare their respective chapters,
devoted fully to this subject. The present text attempts to and the forbearance of our publisher, who has waited
bring together in one ready reference what is known about patiently as the process of assembling and editing this
renal therapeutics today thereby focusing attention on this volume proceeded.
vital aspect of nephrology and recording the present state
of-the-art. Wadi N. Suki
Shaul G. Massry
Preface to the Second Edition
It is said that a static science is a dead science, and to any above all for our patients, advances have been made and
observer of nephrology it is quite clear that there has been continue to be made as we write these words. We have
nothing static about this discipline. Even while the first invited many of the past authors to update their chapters,
edition was under preparation, newer treatments were while several new authors were invited to rewrite chapters
being developed, the efficacy of new treatments was being on topics previously covered or to write new chapters on
tested, and the results of such trials were being published. topics not previously covered. The task of writing a chap
It is impossible to capture in a book all the progress that ter is an onerous task and, having ourselves written many
is being made in a particular discipline that is changing chapters for many texts, we are keenly aware of the time
rapidly, for to do so would be akin to capturing motion in a and effort that goes into the preparation of a chapter. In
still picture. One can convey the impression of motion in a addition, it is all for very little reward, whether it is in
still picture, but it takes a video or a movie to capture terms of monetarv returns to the author or in terms of the
motion. And so it is in nephrology, a field in which it academic recognition that the author derives from writing
should be clear to anyone who takes more than a cursory a chapter, as compared with a scientific article in a peer
look that major developments and important advances are reviewed journal reporting original scientific research.
being made steadily. We were almost prophetic, there One can only conclude, therefore, that hundreds of au
fore, when we said in the preface to the first edition: thors undertake the task of writing a chapter propelled not
The rapid pace of new research on renal therapy continued by the motive of profit but by that of the noble commit
during the period that this text was in preparation, and this ment to convey to their fellow physicians the latest ad
rapid pace attests to the vitality of nephrology as a discipline. vances in their respective areas of expertise, with the aim
We look forward to the preparation of new editions of this
of bettering the health of their patients and of raising the
volume reflecting substantial advances which will continue to
be made. standards of the care they receive. It is fitting then to bear
in mind that a text such as this is a tribute to each of the
No sooner had the first edition come out in print than
authors who contributed to it, and all of us who shall
had a process of obsolescence already begun to set in as
consult this text, as we tackle the complexities of managing
the wheels of progress kept on turning - hopefully lead
our patients, are in their debt.
ing us all forward. We were almost prophetic in predicting
"the preparation of new editions." So now we come back
Wadi N. Suki
with a new edition to report on some of the advances that
Shaul G. Massry
were made since the first edition, and luckily for us all, and