THE WASHINGTON MANUAL™ Nephrology Subspecialty Consult Third Edition Editors Steven Cheng, MD Assistant Professor of Medicine Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Anitha Vijayan, MD Associate Professor of Medicine Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Series Editors Katherine E Henderson, MD Assistant Professor of Clinical Medicine Department of Medicine Division of Medical Education Washington University School of Medicine Barnes-Jewish Hospital St Louis, Missouri Thomas M De Fer, MD Associate Professor of Internal Medicine Washington University School of Medicine St Louis, Missouri Acquisitions Editor: Sonya Seigafuse Product Manager: Kerry Barrett Vendor Manager: Bridgett Dougherty Marketing Manager: Kimberly Schonberger Manufacturing Manager: Ben Rivera Design Coordinator: Stephen Druding Editorial Coordinator: Katie Sharp Production Service: 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Nephrology subspecialty consult IV Series: Washington manual subspecialty consult series [DNLM: Kidney Diseases—diagnosis—Handbooks Kidney Diseases —therapy—Handbooks Nephrology—methods—Handbooks WJ 39] 616.691—dc23 2011050022 The Washington Manual™ is an intent-to-use mark belonging to Washington University in St Louis to which international legal protection applies The mark is used in this publication by LWW under license from Washington University Care has been taken to rm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of the information in a particular situation remains the professional responsibility of the practitioner The authors, 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fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to pm, EST 10 6 Contributing Authors Raghavender Boothpur, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Lyndsey Bowman, PharmD Clinical Pharmacist Abdominal Organ Transplant Barnes-Jewish Hospital St Louis, Missouri Ying Chen, MD Instructor Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Steven Cheng, MD Assistant Professor of Medicine Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Sindhu Garg, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Yekaterina Gincherman, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Seth Goldberg, MD Assistant Professor of Medicine Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Ethan Hoerschgen, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Jennifer Iuppa, PharmD Clinical Pharmacist Lung Transplant Barnes-Jewish Hospital St Louis, Missouri Judy L Jang, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Peter J Juran, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Syed A Khalid, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Christina L Klein, MD Assistant Professor of Medicine Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Tingting Li, MD Assistant Professor of Medicine Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Biju Marath, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Imran A Memon, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Georges Saab, MD Assistant Professor of Medicine Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Sadashiv Santosh, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Andrew Siedlecki, MD Instructor Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Nicholas Taraska, MD Clinical Fellow 10 nonrenal tissues pain as contraindications for indications for acute renal failure as hematuria as nephrotic syndrome as proteinuria as renal allograft dysfunction as postbiopsy care in procedure evaluations for anesthesia in informed consent in needle insertion patient positioning in with pregnancy preprocedures in sterile technique ultrasound Renal colic 709 imaging modalities for CT in ultrasound in treatment of Renal cortical necrosis Renal cysts See Cysts, renal Renal failure, acute See also Acute kidney injury anion gap acidosis and from diabetic nephropathy hyponatremia and in pregnancy causes of Renal osteodystrophy acidosis in secondary hyperparathyroidism and vitamin deficiency in Renal replacement therapies See also Continuous renal replacement therapy; Hemodialysis for CKD CRRT anticoagulation in 710 complications from drug dosing in fluids in nomenclature of principles of regimen for dosing of IHD indications for modalities of comparisons among nomenclature for PD SLED Renal transplants for CKD complications from endocrine hematologic hypertension 711 infections malignancy metabolic viral pathogens patient care after pregnancy after Renal tubular acidosis (RTA) characteristics of types of Renin Renin-angiotensin-aldosterone system (RAAS) in CKD and Renovascular hypertension (RVHTN) characteristics of hypertension and imaging studies for CT in MRA in renal angiography in ultrasound 712 pathophysiology of symptoms of testing for diagnostic functional treatment forf intervention indications in PTRA in stent placement in Respiratory acidosis acute chronic Respiratory alkalosis acute chronic Rhabdomyolysis ATN and hypocalcemia from pathogenesis of symptoms of 713 RPGN See Rapidly progressive glomerulonephritis RTA See Renal tubular acidosis RVTHN See Renovascular hypertension Scleroderma renal crisis Screening for acquired renal cysts for ADPKD for diabetic nephropathy for hematuria for posttransplant patient care Septic shock SGF See Slow graft function Sickle cell disease SLE See Systemic lupus erythematosis SLED See Sustained low-efficiency dialysis Sodium bicarbonate Staging, of CKD Starvation ketoacidosis Statins Surgery, conventional, for RAS 714 Sustained low-efficiency dialysis (SLED) Syndromes See Milk-Alkali syndrome; Nephrotic syndrome Systemic lupus erythematosis (SLE) biopsies for classification of incidence rates for during pregnancy diagnosis of treatment for renal pathology for treatment for Tacrolimus Thiazide agents hypokalemia as for nephrolithiasis Thrombotic-thrombocytopenic purpura (TTP) syndrome TTP-HUS and definition of etiology of pathogenesis of 715 in pregnancy renal pathology of treatment for Thyrotoxicosis TIPS See Transjugular intrahepatic portosystemic shunt Tissue proteinuria TLS See Tumor lysis syndrome Tobramycin Transjugular intrahepatic portosystemic shunt (TIPS) Transplants See Renal transplants Triple phosphate crystals TTP syndrome See Thromboticthrombocytopenic purpura syndrome Tuberous sclerosis diagnostic criteria for treatment of Tubular proteinuria Tumoral calcinosis Tumor lysis syndrome (TLS) management of pathophysiology of 716 risk factors for Tumors, as hypercalcemia cause Tyrosine crystals Ultrasound for ADPKD for AKI for ethylene glycol intoxication for glomerular diseases for hematuria for RAS for renal colic for renal cysts for RVTHN Urea BUN and Ureterorenoscopy Urinalysis See also Urine dipsticks for AKI albumin in chemical properties in 717 definition of for glomerular diseases for hyperkalemia through microscopic exam of casts of cells of crystals of organisms physical properties in specimen collection for procedures for Urinary tract infections (UTIs) from MSK Urine See also Casts; Hematuria; Proteinuria casts in chemical properties in glucose presence hemoglobin presence ketones leukocyte esterase 718 nitrites pH protein presence crystals in acyclovir ammonium biurate bilirubin calcium cholesterol cystine drug-associated leucine sulfonamide triple phosphate tyrosine uric acid dipstick testing epithelial cells in MDRD study and microscopic analysis of 719 organisms in bacteria fungal parasites osmolality for increased low physical properties of clarity color odor specific gravity RBCs in WBCs in Urine dipsticks detection scale for for hematuria positive/negative tests with UTIs See Urinary tract infections Vancomycin 720 Vitamin D, phosphorus regulation by Vitamins hypercalcemia and hypocalcemia and hypophosphatemia and renal osteodystrophy and, from deficiency of Voiding cystourethrography Von Hippel–Lindau (VHL) syndrome Water balance disorders See also Hypernatremia; Hyponatremia ADH and hypernatremia causes of definition of etiology of evaluation of pathogenesis for symptoms of treatment for hyponatremia acute 721 acute renal failure and causes of chronic cirrhosis and classification of complications of congestive heart failure and definition of evaluation of nephrotic syndrome and risk factors for SIADH and treatment for Waxy casts WBCs See White blood cells Wegener’s granulomatosis (WG) epidemiology of renal pathology of symptoms of treatment for 722 WG See Wegener’s granulomatosis White blood cells (WBCs), in urinalysis White cell casts X-linked hypophosphatemic (XLH) rickets 723 [...]... Professor Interim Chairman of Medicine Co-Director of the Infectious Disease Division 12 Washington University School of Medicine 13 Preface T he rst and second editions of The Washington Manual Nephrology Subspecialty Consult achieved the goal of the “subspecialty” series because they were well written, well organized, and served as an e cient bedside resource for residents and students The hope of. .. produce another outstanding edition of this manual I would also like to thank Dr Melvin Blanchard, Chief of the Division of Medical Education in the Department of Medicine at Washington University School of Medicine, for his advice and guidance I believe this Subspecialty Manual will meet its desired goal of providing practical knowledge that can be directly applied at the bedside and in outpatient settings...Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Ahsan Usman, MD Clinical Fellow Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Anitha Vijayan, MD Associate Professor of Medicine Department of Internal Medicine Renal Division Washington University School of Medicine St Louis,... pleasure to present the new edition of The Washington Manual Subspecialty Consult Series: Nephrology Subspecialty Consult This pocketsize book continues to be a primary reference for medical students, interns, residents, and other practitioners who need ready access to practical clinical information to diagnose and treat patients with a wide variety of disorders Medical knowledge continues to increase... at Washington University School of Medicine and Barnes-Jewish Hospital Their commitment to patient care and education is unsurpassed, and their e orts and skill in compiling this manual are evident in the quality of the nal product In particular, I would like to acknowledge our editors, Drs Steven Cheng and Anitha Vijayan, and the series editors, Drs Katherine Henderson and Tom De Fer, who have worked... Glassock RJ, eds Textbook of Nephrology 4th ed Philadelphia, PA: Lippincott Williams and Wilkins; 2001:1765–1783 4 Rose BD, ed Clinical assessment of renal function In: Pathophysiology of Renal Disease 2nd ed New York, NY: McGraw-Hill; 1987:1–40 5 Misdraji J, Nguyen PL Urinalysis When—and when not—to order Postgrad Med 1996;100:173 6 Van Nostrand JD, Junkins AD, Bartholdi RK Poor predictive ability of urinalysis... confused with cellular casts, but polarized light demonstrates the characteristic Maltese cross appearance They are associated with nephrotic syndrome, mercury poisoning, and ethylene glycol poisoning Red cell casts: They are identified by their orange–red color on bright-field microscopy and well-defined cellular elements They are best seen in fresh urine At times, they may appear fractured Red cell... stages of progressive decline (Table 2-1) The classification into CKD stage can be misleading A GFR of 30 mL/min/1.73 m2 has half of the renal function as a GFR of 60 mL/min/1.73 m2, even though they are both classified as stage III CKD A GFR of 29 mL/min/1.73 m2 has virtually the same renal function as a GFR of 30 mL/min/1.73 m2, even though one is classified as stage IV and the other is classified as... lighter and concentrated urine attains a darker yellow to amber shade 21 Red urine may be noted with hematuria Positive dipstick test result for blood without evidence of red blood cells (RBCs) on microscopy is a clue to the presence of free hemoglobin or myoglobin in the urine, suggestive of conditions such as sickle-cell anemia, ABO incompatible blood transfusion, or rhabdomyolysis Red urine can also... and smooth borders Dysmorphic RBCs are associated with glomerular disease and are best seen on phase-contrast microscopy Swollen (ghost) cells or shrunken (crenated) cells are normal RBCs 26 that have been altered by osmolality of the urine Crenated cells (5 μm in diameter) have spiked borders and can be mistaken for small, granulated cells Ghost cells often require phase-contrast microscopy for viewing ...THE WASHINGTON MANUAL Nephrology Subspecialty Consult Third Edition Editors Steven Cheng, MD Assistant Professor of Medicine Department of Internal Medicine Renal Division Washington. .. Missouri Series Editors Katherine E Henderson, MD Assistant Professor of Clinical Medicine Department of Medicine Division of Medical Education Washington University School of Medicine Barnes-Jewish... Professor of Medicine Department of Internal Medicine Renal Division Washington University School of Medicine St Louis, Missouri Tingting Li, MD Assistant Professor of Medicine Department of