Management of Kidney Diseases

Description

This book provides an evidence based guide to the management of common kidney conditions. Concise and highly structured chapters outline a diagnosis and treatment framework for kidney diseases encountered within daily practice. Particular attention is given to the management of chronic kidney disease, genetic kidney diseases, cardiovascular complications, haemodialysis, kidney cancer, peritoneal dialysis, and kidney transplantation. Management of Kidney Disease aims to improve outcomes for patients with kidney diseases and is relevant to trainee and practising nephrologists, as well as healthcare professional treating kidney diseases. Additional questions and answers via app: Download the Springer Nature Flashcards app free of charge and use exclusive additional material to test your knowledge. Foreword Preface Contents 1: The Approach to the Patient with Kidney Disease Introduction Common Kidney Patient Presentations Common Kidney Syndromes and Definitions Anatomical Localisation of Kidney Diseases Aetiology of Kidney Syndromes Approach to a Patient with Kidney Disease Radiological Abnormalities Haematuria Presentation of Kidney Failure Patients on Kidney Replacement Therapy Conclusions Questions References 2: Investigating Kidney Disease Introduction Blood Tests Serum Biochemistry Urea and Electrolytes Urea and Creatinine The Glomerular Filtration Rate (GFR) Urine Tests Appearance Radiological Imaging Plain Radiography Chest X-Ray Abdominal X-Ray Intravascular Contrast Studies Ultrasound Renal Doppler Ultrasound Scans What Is the Resistive Index (RI)? Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Nephrogenic Systemic Fibrosis Nuclear Medicine Imaging: Renal Scintigraphy Histopathology Kidney Biopsy Indications Light and Electron Microscopy Light Microscopy (LM) Immunohistochemistry Electron Microscopy Tissue Examination and Interpretation of the Histopathological Report Conclusions Questions References 3: Proteinuria and Haematuria Proteinuria Introduction Pathophysiology Glomerular Barrier Tubular Reabsorption and Secretion Definitions Measurement of Protein Excretion Urine Dipstick Test Timed Urine Collections Spot Urine Measurements (Albumin or Total Protein to Creatinine Ratio) Clinical Associations Microalbuminuria Isolated, Asymptomatic Proteinuria Glomerular Proteinuria Tubular Proteinuria Overflow Proteinuria Management Prognosis Haematuria Introduction History Investigation of Haematuria Dipstick Testing of Urine [5] Microscopic Examination of the Urinary Sediment Imaging Investigations Cystoscopy Microscopic Haematuria Macroscopic Haematuria Causes of Haematuria Glomerular Disease Cancer Schistosoma Haematobium Infection (Bilharzia): [18, 19] Sickle Cell Disease and Trait Conclusions Questions References 4: Acute Kidney Injury Introduction AKI, AKD, CKD and NKD Epidemiology, Aetiology, and Risk Assessment Clinical Presentation Investigations Differential Diagnosis Management General Management Principles Sepsis Hypovolaemia Toxins Obstruction Parenchymal Managing AKI Complications Hyperkalaemia Acidosis Hypervolaemia Symptomatic Uraemia Kidney Replacement Therapy (KRT) in AKI Indications Modalities Discontinuation of KRT Palliative Care AKI and KRT Worldwide Outcomes and Follow-up for AKI Patients Conclusions Questions References 5: Chronic Kidney Disease (CKD): Evaluation of the Cause and Prevention of Progression Introduction The Epidemiology of Chronic Kidney Disease Pathophysiology of Chronic Kidney Disease The Classification of Chronic Kidney Disease Progression and Complications of Chronic Kidney Disease Prevention of CKD Conclusions Questions References 6: CKD: Management and Prognosis Introduction Epidemiology and Causes Investigations Management Treatment of Reversible Causes of Kidney Failure Slowing the Progression of Kidney Disease Other Treatments Treatment of CKD Complications Drug Dosing and Adjustments in CKD Identification and Adequate Preparation of the Patient in Whom Kidney Replacement Therapy Will Be Required Conclusions Questions References 7: Management of Anaemia in Chronic Kidney Disease Introduction Definition of Anaemia in CKD Prevalence The Patient in the Clinical Scenario Has Diabetes, and Is Therefore more Likely to Have Anaemia What Factors Might Contribute to Anaemia Why Treat this Patient’s Anaemia of CKD? Investigations for Iron Deficiency in CKD in our Patient Prescribing Intravenous (IV) Iron Potential Adverse Effects of Iron Other Potential Risks of IV Iron Infection Risk Oxidative Stress The Patient’s Symptoms Improved with IV Iron, But His Haemoglobin Remains Low; Should He Start an ESA? Practical Administration of ESA Despite Our Patient’s History, He Is on the Transplant List: Why Should One Aim to Avoid Transfusions? Future Therapies Conclusions Questions References 8: Blood Pressure in CKD Introduction Clinic Blood Pressure and the ‘White-Coat’ Effect Treating to a Target Blood Pressure Slowing the Progression of CKD Effect on Cardiovascular and All-Cause Mortality Potential Exceptions to a Lower Target Management of Hypertension Lifestyle and Blood Pressure Dietary Salt Restriction Barriers to a Healthy Diet Exercise Pharmacological Treatment of Hypertension in CKD Non-Diabetics Diabetics Monitoring a Patient on an ACEi or ARB Other Agents Mineralocorticoid Receptor Antagonist Calcium Channel Blockers, Beta-Blockers, Alpha Blockers and Diuretics Blood Pressure Treatment in Dialysis Patients Blood Pressure Management in Peritoneal Dialysis (PD) Patients Blood Pressure Management in Transplant Patients Conclusions Questions References 9: Mineral and Bone Disorder in CKD Introduction Epidemiology Pathogenesis Pathogenesis of Mineral Metabolism Abnormalities and Bone Diseases (Fig. 9.2) Pathogenesis of Vascular Calcification (Fig. 9.4) Clinical Presentation Investigations Management Overview Phosphate Restriction Phosphate Binders Native Vitamin D Active Vitamin D Calcimimetics Parathyroidectomy Magnesium Calcium Future Perspectives Conclusions Questions References 10: Diabetes and CKD Introduction Epidemiology and Causes Clinical Presentation Investigations Differential Diagnosis Diabetes Management Glycaemic Control Antihyperglycaemic Therapy Lifestyle Changes First-Line Therapy Augmenting Therapy GLP-1 Receptor Antagonists DPP-4 Inhibitors Sulfonylureas Thiazolidinediones Meglitinides Post-transplant Diabetes Mellitus Management of Hypertension in DKD [for details see Chap. 8] Type 1 Diabetes Antihypertensive Medication in T1DM Type 2 Diabetes Mellitus Conclusions Questions References 11: Cardiovascular Complications of CKD Introduction Coronary Artery Disease Clinical Presentation Investigations Management Lipid Modification Revascularisation Acute Coronary Syndromes Clinical Presentation Investigation and Diagnosis Revascularisation in Acute Coronary Syndromes ST Elevation Myocardial Infarction (STEMI) Non-ST Elevation Myocardial Infarction (NSTEMI) Contrast Induced AKI (CI-AKI) Heart Failure Arrythmias Atrial Fibrillation Anticoagulation/Avoid stroke Better Symptom Control Cardiovascular Risk Factors and Concomitant Diseases Ventricular Arrhythmias Prevention of Death from Ventricular Arrhythmias Valvular Heart Disease Assessing VHD in CKD Patients Prevention of VHD Aortic Stenosis Management of Severe Aortic Stenosis Follow Up Post Valve Replacement (Transcatheter and Surgical) Mitral Regurgitation Investigation Management of Severe Mitral Regurgitation Choice of Prosthesis Investigating the Pre-transplant Patient Conclusions Questions References Further Reading 12: Primary Glomerular Disease Introduction Minimal Change Disease Introduction Epidemiology and Aetiopathogenesis Clinical Presentation and Laboratory Findings Pathology Treatment Focal Segmental Glomerulosclerosis Introduction Epidemiology and Aetiopathogenesis Clinical Presentation and Laboratory Findings Pathology Treatment Membranous Nephropathy Introduction Epidemiology and Aetiopathogenesis Clinical Presentation and Laboratory Findings Pathology Treatment IgA Nephropathy Introduction Epidemiology and Aetiopathogenesis Clinical Presentation and Laboratory Findings Pathology Treatment Membranoproliferative Glomerulonephritis Introduction Epidemiology and Aetiopathogenesis Clinical Presentation and Laboratory Findings Pathology Treatment Post Streptococcal Glomerulonephritis Introduction Epidemiology and Aetiopathogenesis Clinical Presentation and Laboratory Findings Pathology Treatment Anti-glomerular Basement Membrane (GBM) Antibody Glomerulonephritis Management of Anti-glomerular Basement Membrane (GBM) Antibody Glomerulonephritis Conclusions Questions References 13: Secondary Glomerular Disease and Renal Vasculitis Introduction Anti-Neutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis Introduction Epidemiology and Causes Clinical Presentation Investigations Differential Diagnosis Management Other Forms of Vasculitis and the Kidney Lupus Nephritis Introduction Epidemiology and Causes Clinical Presentation Investigations Differential Diagnosis Management Antiphospholipid Syndrome Cryoglobulinaemia Introduction Epidemiology and Causes Clinical Presentation Investigations Differential Diagnosis Management Protein Deposition Diseases Introduction Epidemiology and Causes Clinical Presentation Investigations Differential Diagnosis Management Other Forms of Protein Deposition Disease Thrombotic Microangiopathies (TMAs) Introduction Epidemiology and Causes Clinical Presentation Differential Diagnosis Investigation and Management Conclusions Questions References 14: Infections and the Kidney Introduction Bacterial Infections and Kidney Disease Mechanisms of Bacterial Infection-Related Kidney Diseases Direct Injury to the Kidney Urinary Tract Infections (UTIs) Reflux Nephropathy Aetiology Background Clinical Management Investigations Clinical Features in Adults Mycobacterial Infections Tuberculosis Classical Uro-Genital Tuberculosis (UGTB) Clinical Features Investigations Treatment Tuberculous Interstitial Nephritis End-Stage Kidney Disease Leprosy Clinical Features Treatment Leptospirosis Indirect or Immune-Mediated Damage to the Kidney Bacterial Infection-Related Glomerulonephritis (B-IRGN) Post-streptococcal GN (PSGN) Kidney Injury as Part of Ongoing Sepsis Nephrotoxic Damage from Medications, Used in Patients with Infection Viral Infections and the Kidney Dengue Virus Hantavirus Ebola Virus Parvovirus Polyoma Virus Cytomegalovirus Varicella Infections Hepatitis E Virus Hepatitis A Hepatitis B Virus Hepatitis C Virus HIV Severe Acute Respiratory Syndrome Coronavirus-2 [SARS-CoV-2] Protozoal and Parasitic Infections and the Kidney Malaria Kidney Disease with Malaria Diagnosis Treatment Schistosomiasis Clinical Features Kidney Disease Diagnosis Treatment Prevention and Control Fungal Infections and Kidney Disease Conclusions Questions References 15: Genetic Kidney Diseases Introduction Monogenic and Polygenic Kidney Disease Genetic Testing An Approach to Genetic Testing Classification of Genetic Kidney Diseases Monogenic Kidney Diseases Cystic Kidney Disease Interstitial Kidney Diseases Tumourous Kidney Diseases Glomerular Diseases Kidney Tubular and Metabolic Diseases Nephrolithiasis Congenital Abnormalities of Kidney and Urinary Tract (CAKUT) Hereditary Systemic Amyloidosis Conclusions Questions References 16: Kidney Cancer Introduction Epidemiology and Causes Genetic Basis of Kidney Cancer Clinical Presentation Investigations Renal Tumour Biopsy Diagnosis and Classification Management Surgery Adrenalectomy Lymph Node Dissection (LND) Alternatives to Surgery Watchful Waiting & Active Surveillance Cryoablation Radiofrequency Ablation (RFA) Systemic Therapy Prognosis Follow up Conclusions Appendix 1 Questions References 17: Hemodialysis in Clinical Practice Introduction Basic Principles of Dialysis Diffusion Ultrafiltration Convection Clearance Components of the Haemodialysis Machine and Extracorporeal Blood Circuit Extracorporeal Blood Circuit (ECC) Dialysate Preparation & Monitoring Ultrafiltration Control Systems Water Treatment Systems Dialyser Membranes and its Performance Hemodialysis Techniques Prescribing Hemodialysis Standard Prescription Anticoagulation in Haemodialysis Acute Heparin Free/Minimal Anticoagulant Dialysis Ultrafiltration (UF) and Residual Renal Function (RRF) Connecting and Commencing Treatment Optimizing Dialysis Prescription Other HD Techniques Isolated Ultrafiltration (Iso UF) Machine in Bypass and Recirculation Mode Single Needle Hemodialysis (SNHD) Dialyser Reuse Home Hemodialysis Buttonhole Cannulation Haemodialysis Governance and Quality Assurance Personalized Dialysis: Future and Emerging Opportunities Conclusions Questions References 18: Complications of Haemodialysis Introduction Cardiovascular Complications of Haemodialysis Intradialytic Hypotension Intradialytic Hypertension Cardiac Arrhythmias, Sudden Cardiac Arrest, and Sudden Cardiac Death Dialysis Pericarditis Dialysis Access Ischemia Steal Syndrome Neurological Complications of Haemodialysis Seizures Headache Dialysis Dementia Dialysis-Related Muscle Cramps Haematologic Complications of Haemodialysis Intra-Dialytic Haemolysis Haemorrhage Thrombocytopaenia and Other Platelet Function Abnormalities Other Complications of Haemodialysis Dialysis-Associated Pruritus Post-Dialysis Fatigue Infections in Hemodialysis Patients Priapism Hearing Loss Conclusions Questions References 19: Peritoneal Dialysis Introduction Assessing and Preparing Kidney Failure Patients for PD Choice in PD Modality PD Catheter Placement Urgent Start PD Initiation of PD Therapy for End-Stage Kidney Disease PD Modalities PD Solutions Constituents of PD Solutions Types of PD Solutions Glucose-Based Solutions Adverse Effects of Glucose-Based PD Solution Glucose Polymer Solution or Icodextrin Neutral pH Low-GDP Solutions Amino Acid Solutions PD Prescription in Terms of Choice of PD Modality, PD Solutions and Doses Key Principles in PD Care Delivery Residual Kidney Function Preserving Residual Kidney Function in PD Patients Assessment of RKF Assessment of Indices of Dialysis Adequacy Estimation of Normalized Protein Nitrogen Appearance (nPNA) Peritoneal Equilibration Test (PET) Is There a Target for Small Solute Clearance? Evaluation of Patients with Low Delivered Urea/Creatinine Clearance Values General Principles in Adjusting PD Prescription Ultrafiltration and Volume Control as a Treatment Target High Transporters Low Transporters Acute Peritoneal Membrane Dysfunction Ultrafiltration Failure (UFF) Conclusions Questions Further Reading 20: Complications of Peritoneal Dialysis: Prevention and Management Introduction Infective Complications Prevention of Infection Diagnosis of Infection Catheter-Related Infections Peritonitis Treatment of Infections Catheter-Related Infection Peritonitis Initial Management of Suspected Peritonitis Specific Organisms and Their Treatment Prognosis Non-Infective Complications PD Catheter Obstruction Prevention of PD Catheter Obstruction Management of PD Catheter Obstruction Hernia and Leak Hernias Hernia Prevention and Management Leaks Hydrothorax Management of Hydrothorax Encapsulating Peritoneal Sclerosis (EPS) Conclusions Questions References 21: Kidney Transplantation: The Pre-Transplantation Recipient & Donor Work-Up Introduction Recipient Evaluation Referral for Kidney Transplantation Recipient Evaluation Team Transplant Recipient Testing Comorbid Conditions in Renal Transplant Recipient Cardiovascular Disease Cerebrovascular Disease Peripheral Vascular Disease Malignancy Obesity Age Infections—HIV, Hepatitis B, Hepatitis C, Tuberculosis HIV Hepatitis B Hepatitis C Tuberculosis Pulmonary Disorder Hematologic Disorders Living Donor Evaluation Kidney Donation Evaluation Donor History Risk of Donation Surgical Risk Medical Risk Pre-Eclampsia Special Considerations in Kidney Donors Glomerular Filtration Rate Albuminuria Hematuria Prediabetes BMI >35 Hypertension Gout Older Donors APOL1 Genetic Testing Family History of Polycystic Kidney Disease Conclusions Questions References 22: Management of the Patient After Kidney Transplantation Introduction Pre Transplant Evaluation and Factors that Influence Post-Transplant Care Aetiology of Kidney Disease Co-Morbidities that Affect Post-Transplant Care Assessment of the Immunological Risk of Transplantation Donor Factors that May Influence Post-Transplant Management Donor Related Factors that Can Influence Post-Transplant Management Include Peri-Operative Events Which Affect Post-Operative Care Surgical Complications that May Affect Post-Transplant Management Discharge and Education Post-Discharge Care Care Plan at a Post-Transplant Clinic Visit Obtaining Standardized Clinical and Laboratory Data at Each Encounter Post Clinic Visit Lab Review and Follow-Up Common Clinical and Laboratory Abnormalities and Triage Clinical Complete Blood Count Blood Chemistry Microbiology Imaging Abnormalities Ultrasound with Doppler Pharmacology of Transplant care: Immunosuppression Post-Transplant Infections Urinary Tract Infections Pneumonia Fungal Viral BK Virus Cytomegalovirus Systemic Infections Localized Infections Evaluation of Fever in Transplant Recipient Thrombotic Microangiopathy Rapid Recurrence or Occurrence of Major Allograft Pathology Special Considerations in Post Transplant follow Up Recipients of High-Risk Donor Organs Recipients of HCV Positive Donor Organs Recipients with Known Major Psychiatric Illnesses Recipients with Known History of Neoplasia Preventive Measures Cardiovascular Risk Reduction Dermatology Surveillance Ophthalmology Follow Up Cancer Screening Vascular Access in a Successful Transplant Recipient Vaccination Travelers Failing Kidney Allograft and Kidney Replacement Therapy The ‘Difficult-to-care-for’ Kidney Transplant Patient Long Term Continuum of Care of Kidney Disease Patients Conclusions Questions References 23: Complications of Kidney Transplantation Introduction Outcomes: Patient and Graft survival Surgical Complications of Kidney Transplantation Urological Complications High drain output post kidney transplant surgery Hydronephrosis of the Transplant Kidney Vascular Complications Oliguria post kidney transplant Medical Complications of Kidney Transplantation Infections Cytomegalovirus (CMV) Epstein–Barr Virus (EBV) and Post-Transplant Lymphoproliferative Disorders (PTLD) BK Virus (BKV) Pneumocystis Jiroveccii (Carinii) Mycobacterium Tuberculosis (MTB) Pre-transplant Screening for Latent Mycobacterium Tuberculosis (LMTB) Treatment of latent and active Mycobacterium Tuberculosis (MTB) Fungal Infections in Kidney Transplant Recipients Diagnosis and Management of Fungal Infections COVID-19 Infection and Kidney Transplant Recipients Other Common Infections and Vaccinations Post-Transplant Post-Transplant Diabetes Acute and Chronic Rejection Calcineurin Inhibitor Nephrotoxicity Delayed Graft Function (DGF) Chronic Allograft Failure Cancer Questions References 24: An Approach to Obstetric Nephrology Introduction Chronic Kidney Disease Preparation for Pregnancy Antenatal Care Management of Hypertension in the Preconception, Antenatal and Postnatal Period Diagnosing Pre-Eclampsia in the Context of Pre-Existing Kidney Disease Dialysis and Pregnancy Kidney Transplantation and Pregnancy Contraception in Women with CKD Acute Kidney Injury (AKI) in Pregnancy Specific Conditions and Their Management Pre-eclampsia HELLP Syndrome Thrombotic Microangiopathies (TMAs) Thrombotic Thrombocytopaenic Purpura (TTP) Atypical Haemolytic Uraemic Syndrome (aHUS) Postpartum Haemorrhage (PPH) Conclusions Questions References 25: Transitional Care of Adolescents and Young Adult Patients with Kidney Disease Introduction Transitional Care What Makes Healthcare for the Young Adult Population Different? What Makes Adolescents and Young Adults on the Kidney Unit Different? How Can We Improve Outcomes for Young People in the Kidney Unit? Impact of Young Adult Care and Transition on Caregivers Global Perspectives of Young Adult Care and Transition Conclusions Appendix 1: The Transitional Care Referral Form Questions References 26: Conservative Care for Patients with Chronic Kidney Disease Introduction What is Conservative Care? Why do we Require a Conservative Care Pathway? Variations in Conservative Care Provision What Are the Key Elements of the Conservative Care Pathway? Training and Empowering the Clinical Team Assessment, Education, Choice and Shared Decision Making Measures to Prevent Progression of CKD Excellent Symptom Control Drug Chart Review Wider Needs Assessments Creating a Network of Care Palliative Care Teams Primary Care/General Practitioners/Family Medicine Social Work District Nursing/Community Nursing Teams Social Care/Home Health Aides Advance Care Planning Family Support After Bereavement Conclusions Questions References 27: Electrolytes & Acid Base Disorders Introduction Hyponatremia Treatment of hyponatraemia Hypernatremia Etiology Diagnosis Treatment of Hypernatraemia Hypokalemia Treatment of Hypokalaemia Hyperkalemia Metabolic Alkalosis Metabolic Acidosis Conclusions Questions References 28: The Role of Renal Registries Introduction Renal Registries Around the World Which Questions Can Be Answered by Renal Registries? Establishing Renal Registries Identifying Stakeholders and Building the Registry Team Clarifying the Purpose, Scope and Minimum Outputs Defining and Finding Cases A Minimum Dataset and the Data Dictionary Collecting Data and Ensuring Data Quality Data Ownership and Access, and Dissemination of Findings Ethical Considerations Impact of Registries Improving Access to Care Embedding Interventional Studies in Renal Registries Conclusions Questions References Index