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 BOSTON I DORDRECHT I LONDON

Distributors for North America: Kluwer Academic Publishers 101 Philip Drive Assinippi Park Norwell, Massachusetts 02061 USA

Distributors for all other countries: Kluwer Academic Publishers Group Distribution Centre Post Office Box 322 3300 AH Dordrecht, THE NETHERLANDS

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

DOl: 10.1 007/978-1-4613-0689-4

e-ISBN-13: 978-1-4613-0689-4

1. Kidneys-Diseases-Treatment. 2. Urinary organs­Diseases-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

Copyright © 1991 by Kluwer Academic Publishers

Softcover reprint of the hardcover 2nd edition 1991

Third Printing 1993 Printed on acid-free paper.

90-4136 CIP

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 hypo osmolar 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. V ANRENTERGHEM. . . . . . . . . . . . . . . 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

Foreword l

"Where are all these kidney patients coming from? A few years ago we had never heard of kidney disease and now you are speaking of patients in the hundreds of thousands and indeed potentially millions." My reply, not meant to be grim, was "From the cemetery , Sir." This is a summary of some Congressional testimony lance gave on behalf of extending kidney disease under Medicare. Where indeed were all the patients with kidney disease in the United States before World War II? They were certainly not under the care of nephrologists! Nephrology was not listed in the questionnaires for any state or the American Medi­cal Association as a subspecialty or even as a special interest. Indeed, even in the late 1960s, when I wrote the American Medical Association editor and asked why nephrology had not been included on a questionnaire to American physicians about their specialty interests, I re­ceived a "tongue in check" answer, "What's nephrology?" Indeed, for those of us who bridge back , it is often hard to realize the rapid evolution of our specialty. For uremia , we gave low-protein diets, adequate hydration, attention to fluid and electrolytes, comfort, and prayer. In my first two years at Georgetown, where every death in the hos­pital was reviewed , my nephrology division made death conference all but a few weeks out of the first two years. In a 1961 book on uremia2 I wrote :

The reversibility of uremic coma has received some attention but could use more. In a further effort to discourage pessimism we have therefore placed a capital ' R' following each of the potentially reversible types of renal disease. It is our sincere hope that the number of 'R's' will provide a pleasant surprise for the many physicians and medical students who want to think of the uremic syndrome as a terminal state during which little treatment can be instituted except that designed for the comfort of the patient. This is not to say that the science underlying nephrology

was inactive , Quite to the contrary, many cases of fruitful science relating to the kidney area not only existed but flourished and had a profound impact on many young clinicians. Thomas Addis raised to a state of applied

I Revised for the second edi tion.

2 Schreiner GE Maher JF: Uremia , Chemistry and Pathogenesis & Treatment. Charles C. Thomas, Springfield, IL, p 24 , 1961.

perfection the study of the urinary sediment, clinically practical kidney function tests, and the natural history of a number of kidney diseases including glomerulonephritis. William Goldring, Herbert Chasis, Dana Atchley, and others studied the effects of hypertension, endocarditis, and circulatory diseases on the kidney and spawned suc­cessive generations of alert clinical investigators, who be­gan to chronicle the natural histories of a wide variety of kidney diseases. Quantitative studies of renal function flourished under a school headed by Homer Smith, and surprisingly precise techniques were developed for study­ing a whole range of explicit nephron functions . Imagine the joy with the advent of vascular catheterization to be able to apply extraction ratios and the Fick principle in a precise way to an organ such as the kidney by sampling arterial blood , venous blood, and the output of the urine! One had a quantitative handle on the entire function of a vital organ - perhaps for the first time in biologic history . One no longer looked only at the street side of the revolving door; one could find out, for example, that if ammonia did not go into the acid trap of the urine, it indeed might go back into the circulation via the renal vein.

The same story unfolded for a broad range of physio­logic substances. In the metabolic school of nephrology, represented perhaps most brilliantly by Professor John Peters at Yale, a host of pioneer investigators applied the methods of quantitative clinical biochemistry to the ele­ments of the blood whose homeostasis was so carefully regulated by the kidney. His deep interest in endocrino­logy and metabolism pointed our way to appreciate the endocrine role of the kidney in making or releasing a whole array of potent hormones affecting bodily function (e.g., erythropoietin, renin, aldosterone, etc.) , and indeed the very survival of the human organism. The role of the kidney in controlling vitamin D metabolism, calcium absorption, parathyroid function, and the complex inter-relation­ships comprising calcium/phosphorous homeostasis, bone growth, and bone repair were only mistily appreci­ated and became one of the great metabolic success stories of postwar nephrology and metabolism . Postwar nephro­logy rushed to the fore and supplied nephrologists with such wonderful tools as the f1amephotometer , electro-

ix

x Foreword

phoresis, microchemistry, immunoassay, sonography, renal biopsy, immunofluorescence, electron microscopy , and unclear magnetic resonance, and permitted a total integration of form, histologic structure, and function . Clinical nephrology became indeed the real fusion of bio­chemistry, physiology, immunology, renal endocrinology, and the focus of newer imaging techniques .

With this precision in diagnosis , one could realistically hope for rational therapy, and one could be optimistic that some day the correct therapy would be correctly applied to the correct patient with the appropriately diagnosed disease.

With the evolution of such developments , an expert observer could indeed realistically hope that out of the myriad and mushrooming books of nephrology would come one with a message of constructive hope, focusing on the treatment of renal disease. Indeed, Dr. Suki and Dr. Massry have fulfilled that hope with this book, which is appropriately entitled, The Therapy of Renal Disease and Related Disorders. They have systematically taken the available scientific information and fused it into a practical text of therapy for the patient. The first section , entitled "Disorders of Fluid, Electrolyte and Acid-Base Balance," covers some of the more challenging general conditions, such as hyperosmolar and hypoosmolar states, polyuria, edema, and acute renal failure. The book then proceeds systematically to disorders of the ions, potassium, calcium, magnesium, phosphate, and the major quartet of acid­base balance , embracing alkalosis and acidosis in its clinically presentable forms . The book proceeds to the intrinsic parenchymal diseases, covering the major areas of glomerular and tubular interstitial disorders and what can be done about them. From there it launches into the vast sea of relationships with systemic diseases such as SLE, vasculitis, hyperuricemia , dysproteinemia, liver dis­ease, pregnancy, and diabetes, among others . Adequate attention is paid to genetic and congenital disorders, including the genetic counseling of families beset by gene­tically determined disorders. Neoplasia, chemical and physical injuries, and a number of other unusual events are considered with practical insights. Then the book tackles the vast problem of uremia and the newer experi­ence with diet, dialysis, and transplantation.

Uremia is to the nephrologist what the baby is to the

pediatrician, for it is the final common pathway of literally hundreds of disease processes that lead to scarring and destruction of nephrons .

We estimate that there are well in excess of 300,000 patients in the world living on the varied methodologies represented by the three basic forms of substituted kidney function - hemodialysis , peritoneal dialysis, and renal transplantation: over 100,000 persons in the United States alone, well over 110,000 in the countries compromising the EDTA Registry, and over 100,000 in the Pacific Rim. If we add on South America, Africa, and the lesser de­veloped nations, the total could well be over 400 ,000 by the time this book is printed. These 400,000 plus persons and their families, who have intimate, repetitive personal experiences with uremia, serve as living withnesses of the medical progress of nephrology in the past three decades. They are witnesses of the fact that many of today's kidney patients have indeed , literally, "come from the cemetery."

But it is not enough to consider only the techniques of substitution therapy. For with living patients come not only the facets of uremia that are not yet handled by therapy , such as cardiovascular complications, renal osteodystrophy, anemia , disorders of immune surveil­lance , nutritional problems, etc., but there is also a neces­sity to know which particular patients fit which particular therapy best, and to choose the optimum time for applying one particular therapy to one particular patient. Indeed, the management of the uremic patients becomes essenti­ally a life plan for that person , and the ills that kidney patients have live on with them , instead of going pre­maturely with them to the grave.

This is a book that is unique among many books avail­able today. This is a book that presents material positively. This is a book that blends the analytical aspects of diagnosis with the hard realities of scientific and appropriate ther­apy. This is a book that will be enjoyed by young nephro­logists and by physicians with a wide diversity of interests. Most of all, it is a book that will be deeply appreciated by their patients.

George E . Schreiner, M.D. Distinguished Professor of Medicine Former Director, Division of Nephrology Georgetown University School of Medicine

x Foreword

phoresis, microchemistry, immunoassay, sonography, renal biopsy, immunofluorescence, electron microscopy , and unclear magnetic resonance, and permitted a total integration of form, histologic structure, and function . Clinical nephrology became indeed the real fusion of bio­chemistry, physiology, immunology, renal endocrinology, and the focus of newer imaging techniques .

With this precision in diagnosis , one could realistically hope for rational therapy, and one could be optimistic that some day the correct therapy would be correctly applied to the correct patient with the appropriately diagnosed disease.

With the evolution of such developments , an expert observer could indeed realistically hope that out of the myriad and mushrooming books of nephrology would come one with a message of constructive hope, focusing on the treatment of renal disease. Indeed, Dr. Suki and Dr. Massry have fulfilled that hope with this book, which is appropriately entitled, The Therapy of Renal Disease and Related Disorders. They have systematically taken the available scientific information and fused it into a practical text of therapy for the patient. The first section , entitled "Disorders of Fluid, Electrolyte and Acid-Base Balance," covers some of the more challenging general conditions, such as hyperosmolar and hypoosmolar states, polyuria, edema, and acute renal failure. The book then proceeds systematically to disorders of the ions, potassium, calcium, magnesium, phosphate, and the major quartet of acid­base balance , embracing alkalosis and acidosis in its clinically presentable forms . The book proceeds to the intrinsic parenchymal diseases, covering the major areas of glomerular and tubular interstitial disorders and what can be done about them. From there it launches into the vast sea of relationships with systemic diseases such as SLE, vasculitis, hyperuricemia , dysproteinemia, liver dis­ease, pregnancy, and diabetes, among others . Adequate attention is paid to genetic and congenital disorders, including the genetic counseling of families beset by gene­tically determined disorders. Neoplasia, chemical and physical injuries, and a number of other unusual events are considered with practical insights. Then the book tackles the vast problem of uremia and the newer experi­ence with diet, dialysis, and transplantation.

Uremia is to the nephrologist what the baby is to the

pediatrician, for it is the final common pathway of literally hundreds of disease processes that lead to scarring and destruction of nephrons .

We estimate that there are well in excess of 300,000 patients in the world living on the varied methodologies represented by the three basic forms of substituted kidney function - hemodialysis , peritoneal dialysis, and renal transplantation: over 100,000 persons in the United States alone, well over 110,000 in the countries compromising the EDTA Registry, and over 100,000 in the Pacific Rim. If we add on South America, Africa, and the lesser de­veloped nations, the total could well be over 400 ,000 by the time this book is printed. These 400,000 plus persons and their families, who have intimate, repetitive personal experiences with uremia, serve as living withnesses of the medical progress of nephrology in the past three decades. They are witnesses of the fact that many of today's kidney patients have indeed , literally, "come from the cemetery."

But it is not enough to consider only the techniques of substitution therapy. For with living patients come not only the facets of uremia that are not yet handled by therapy , such as cardiovascular complications, renal osteodystrophy, anemia , disorders of immune surveil­lance , nutritional problems, etc., but there is also a neces­sity to know which particular patients fit which particular therapy best, and to choose the optimum time for applying one particular therapy to one particular patient. Indeed, the management of the uremic patients becomes essenti­ally a life plan for that person , and the ills that kidney patients have live on with them , instead of going pre­maturely with them to the grave.

This is a book that is unique among many books avail­able today. This is a book that presents material positively. This is a book that blends the analytical aspects of diagnosis with the hard realities of scientific and appropriate ther­apy. This is a book that will be enjoyed by young nephro­logists and by physicians with a wide diversity of interests. Most of all, it is a book that will be deeply appreciated by their patients.

George E . Schreiner, M.D. Distinguished Professor of Medicine Former Director, Division of Nephrology Georgetown University School of Medicine

Preface to the First Edition

In the last fifteen years, many books and monographs have been published which deal with different aspects of renal structure and function, and the various renal diseases. The number of published works reflects the explosion of scien­tific knowledge about the kidney and its diseases. Parallel with this increased knowledge have come major advances in the handling and management of patients suffering from disorders of the kidney. These advances, many of which are life-saving, in large measure have been responsible for the emergence of nephrology as a full-fledged medical specialty.

In spite of the progress made in the therapy of renal diseases and related disorders, there has not been a text devoted fully to this subject. The present text attempts to bring together in one ready reference what is known about renal therapeutics today thereby focusing attention on this vital aspect of nephrology and recording the present state­of-the-art.

The major strides forward in renal therapy shall be clear to the reader of this volume. Areas where advances or breakthroughs are still needed or where solid , objective proof of efficacy is still lacking shall be equally clear. The rapid pace of new research on renal therapy continued during the period that this text was in preparation, and this rapid pace attests to the vitality of nephrology as a disci­pline . We look forward to the preparation of new editions of this volume reflecting substantive advances which will continue to be made.

It is fitting, in closing, to acknowledge the generosity of each of the contributing authors who have given selflessly of their precious time to prepare their respective chapters, and the forbearance of our publisher, who has waited patiently as the process of assembling and editing this volume proceeded.

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 observer of nephrology it is quite clear that there has been nothing static about this discipline. Even while the first edition was under preparation , newer treatments were being developed, the efficacy of new treatments was being tested, and the results of such trials were being published. It is impossible to capture in a book all the progress that is being made in a particular discipline that is changing rapidly, for to do so would be akin to capturing motion in a still picture. One can convey the impression of motion in a still picture , but it takes a video or a movie to capture motion. And so it is in nephrology, a field in which it should be clear to anyone who takes more than a cursory look that major developments and important advances are being made steadily. We were almost prophetic, there­fore, when we said in the preface to the first edition:

The rapid pace of new research on renal therapy continued during the period that this text was in preparation, and this rapid pace attests to the vitality of nephrology as a discipline . We look forward to the preparation of new editions of this volume reflecting substantial advances which will continue to be made. No sooner had the first edition come out in print than

had a process of obsolescence already begun to set in as the wheels of progress kept on turning - hopefully lead­ing us all forward. We were almost prophetic in predicting "the preparation of new editions." So now we come back with a new edition to report on some of the advances that were made since the first edition , and luckily for us all, and

above all for our patients, advances have been made and continue to be made as we write these words. We have invited many of the past authors to update their chapters, while several new authors were invited to rewrite chapters on topics previously covered or to write new chapters on topics not previously covered. The task of writing a chap­ter is an onerous task and, having ourselves written many chapters for many texts, we are keenly aware of the time and effort that goes into the preparation of a chapter. In addition, it is all for very little reward, whether it is in terms of monetarv returns to the author or in terms of the academic recognition that the author derives from writing a chapter, as compared with a scientific article in a peer­reviewed journal reporting original scientific research. One can only conclude, therefore , that hundreds of au­thors undertake the task of writing a chapter propelled not by the motive of profit but by that of the noble commit­ment to convey to their fellow physicians the latest ad­vances in their respective areas of expertise, with the aim of bettering the health of their patients and of raising the 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 authors who contributed to it, and all of us who shall consult this text , as we tackle the complexities of managing our patients, are in their debt.

Wadi N. Suki Shaul G. Massry

CHAPTER 1

Stephen Brennan, M.D. Assistant Professor of Medicine Department of Medicine Baylor College of Medicine Houston , Texas 77030

J. Carlos Ayus, M.D. Professor of Medicine Department of Medicine Baylor College of Medicine Houston , Texas 77030

CHAPTER 2

William P. Muldowney, M.D. Fellow in Nephrology San Francisco General Hospital San Francisco, California 94110

Michael H. Humphreys, M.D. Chief, Division of Nephrology San Francisco General Hospital Associate Professor of Medicine University of California San Francisco, California 94110

CHAPTER 3

Arthur Greenberg, M.D. Associate Professor of Medicine Renal-Electrolyte Division University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania 15261

Jules B. Puschett, M.D. Professor and Chairman Department of Medicine Tulane University School of Medicine 1430 Tulane Avenue New Orleans, Louisiana 70112-2699

Contributors

CHAPTER 4

Jacques J. Bourgoignie, M.D. Professor of Medicine Chief, Division of Nephrology University of Miami/Jackson Memorial Medical Center VA Medical Center Miami, Florida 33101

James R. Oster, M.D. Professor of Medicine University of Miami VA Medical Center Miami, Florida 33101

Guido O. Perez, M.D. Professor of Medicine University of Miami VA Medical Center Miami, Florida 33101

Dollie F. Green , M.D. Assistant Professor of Clinical Medicine University of Miami School of Medicine Miami, Florida 33101

CHAPTER 5

Aaron Halabe , M.D. Visiting Scientist Department of Medicine Vancouver General Hospital University of British Columbia Vancouver, B.C., Canada V5Z 1M9

Roger A.L. Sutton, M.D. Vancouver General Hospital Laurel Pavillion-3 910 West 10th Avenue Vancouver, B.C. , Canada , V5Z IM9

xvi Contributors

CHAPTER 6

Thomas Dyckner Associate Professor of Medicine Department of Internal Medicine Nacka Sjukhus Nacka, Sweden

CHAPTER 7

Moshe Levi, M.D. Assistant Professor of Medicine University of Texas Southwestern Medical Center and Chief, Home Dialysis VA Medical Center Dallas , Texas 75216

James P. Knochel , M.D . Professor of Medicine University of Texas Southwestern Medical Center and V A Medical Center Dallas , Texas 75235-9030

CHAPTER 8

Joan H. Parks, ' M.B.A. Nephrology Section Box 28 University of Chicago 5841 South Maryland Avenue Chicago, IL 60637

Fredric L. Coe, M.D. Professor of Medicine Department of Medicine Michael Reese Hospital University of Chicago Chicago, Illinois 60616

CHAPTER 9

Sandra Sabatini , Ph.D., M.D. Professor of Medicine Department of Internal Medicine and Physiology Texas Tech University Health Sciences Center Lubbock, Texas 79430

Neil A. Kurtzman , M.D. Professor of Medicine Chairman, Department of Medicine Texas Tech University Health Sciences Center Lubbock, Texas 79430

CHAPTER 10

Robert M.A. Richardson, M.D. University of Toronto Division of Nephrology Toronto General Hospital and St. Michael's Hospital Toronto, Ontario , Canada M5B 1A6

Mitchell L. Halperin, M.D. Professor of Medicine University of Toronto Toronto General Hospital and St. Michael's Hospital Toronto, Ontario, Canada M5B 1A6

CHAPTER 11

Horacio J. Adrogue , M.D. Associate Professor of Medicine Department of Medicine Baylor College of Medicine Houston, Texas 77030

Jorge Barrero, M.D. Fellow in Nephrology Department of Medicine Baylor College of Medicine Houston , Texas 77030

George M. Dolson, M.D. Assistant Professor of Medicine VA Medical Center Houston , Texas 77030

CHAPTER 12

Fernando Santos , M.D. Professor of Pediatrics University of Oviedo Ministerio de Sanidad y Consumo Instituto Nacional de la Salud Hospital "NTRA. STA. de Covadonga" Oviedo, Asturia Spain

Gad Kainer, M.B., B.S .. F.R.A.C.P. Visiting Scholar, Department of Pediatrics Virginia Commonwealth University's Medical College of Virginia Richmond, Virginia 23298

James C.M. Chan , M.D. Professor and Vice Chairman Department of Pediatrics Chairman, Division of Nephrology Children's Medical Center Department of Pediatrics Virginia Commonwealth University's Medical College of Virginia Richmond , Virginia 23298

CHAPTER 13

Gregorio I. Casar, M.D. Instructor in Medicine Pulmonary Section Baylor College of Medicine Houston, Texas 77030

R. Keith Wilson, M.D. Associate Professor Department of Medicine Director of Respiratory Care Services Baylor College of Medicine and The Methodist Hospital Houston, Texas 77030

CHAPTER 14

John T. Harrington , M.D. Professor of Medicine Tufts University School of Medicine and Chief of Medicine Newton-Wellesley Hospital Newton, Massachusetts

Nicolaos E. Madias, M.D. Professor of Medicine Tufts University School of Medicine and Chief, Division of Nephrology New England Medical Center Hospitals Boston, Massachusetts 02111

CHAPTER 15

Adrian Spitzer, M.D. Professor of Pediatrics Director, Division of Nephrology Albert Einstein College of Medicine Bronx, New York 10461

Richard Neiberger, M.D., Ph.D. Assistant Professor Department of Pediatrics Albert Einstein College of Medicine Bronx, New York 10461

CHAPTER 16

Hervy H. Hiner, Jf. M.D . Assistant Professor of Medicine Department of Medicine Baylor College of Medicine Houston, Texas 77030

Wadi N. Suki, M.D. Professor of Medicine Chief, Renal Section Baylor College of Medicine Houston, Texas 77030

CHAPTER 17

Charles Baxter , M.D. Professor of Surgery Department of Surgery University of Texas Health Sciences Center Dallas, Texas 75235

CHAPTER 18

David M. Gillum, M.D . Assistant Professor of Medicine Department of Medicine Baylor College of Medicine Houston, Texas 77030

John D. Conger , M.D. Associate Professor of Medicine Division of Renal Diseases V A Medical Center Denver, Colorado 80220

Robert J. Anderson, M.D. Professor of Medicine Chief, Medical Service University of Colorado Health Sciences Center Denver, Colorado 80220

CHAPTER 19

David S. Baldwin, M.D.

Contributors XVII

New York University Medical Center Renal Section New York, N.Y. 10016

Joel Neugarten, M.D . Montefiore Hospital 111 East 210th Street Bronx, New York 10467

CHAPTER 20

Gerald C. Groggel , M.D. Assistant Professor of Medicine University of Vermont 0305 Given Building Burlington, Vermont 05405

Wayne A. Border, M.D. Professor of Medicine Chief, Division of Nephrology & Hypertension University of Utah Health Science Center Salt Lake City , Utah 84132

xviii Contributors

CHAPTER 21

Curtis B. Wilson, M.D. Professor of Medicine Department of Immunology Research Institute of Scripps Clinic La Jolla, California 92037

CHAPTER 22

Joji Ohno, M.D . Professor Emeritus Department of Internal Medicine Juntendo University School of Medicine Tokyo, Japan

CHAPTER 23

Marvin Forland, M.D. Associate Dean for Clinical Affairs Professor of Medicine University of Texas Health Science Center San Antonio, Texas 78284-7790

CHAPTER 24

Priscilla Kincaid-Smith , M.D. Professor of Medicine Department of Medicine University of Melbourne Director of Nephrology The Royal Melbourne Hospital Parkville, Victoria 3052 Australia

CHAPTER 25

James E. Gow, M.D Ingerthorpe Liverpool L23 6 UL England

CHAPTER 26

Susan L. Andrew Clinical Immunology Senior Fellow Department of Medicine Baylor College of Medicine Houston, Texas 77030

David P. Huston, M.D. Associate Professor Department of Medicine and Microbiology and Immunology Baylor College of Medicine Director, Immunology Service and Immunotherapy Unit The Methodist Hospital Houston, Texas 77030

CHAPTER 27

James E. Balow, M.D. Clinical Director, NIDDK Chief, Kidney Disease Section National Institutes of Health Bethesda, Maryland 20892

Howard A. Austin III , M.D. Chief, Nephrology Service, NIDDK National Institutes of Health Bethesda, Maryland 20892

CHAPTER 28

Garabed Eknoyan , M.D. Professor of Medicine Department of Medicine Baylor College of Medicine Houston , Texas 77030

CHAPTER 29

Ellin Lieberman, M.D. Children's Hospital of Los Angeles P.O. Box 54700 Los Angeles, California 90054-0700

CHAPTER 30

Dominique Ganeval, M.D. Department de Nephrologie Hopital NECKER Paris, France

Jean-Pierre Griinfeld , M.D. Professeur of Medicine Department de Nephrologie Hopital NECKER Paris, France

CHAPTER 31

Edward R. Ahrens, M.D. Fellow in Nephrology Department of Medicine University of Wisconsin Madison , Wisonsin 53706

Thomas H. Steele, M.D. Professor of Medicine Department of Medicine University of Wisconsin Madison, Wisconsin 53706

CHAPTER 32

Murray Epstein, M.D. Professor of Medicine University of Miami Chief, Renal Section V A Medical Center Miami, Florida 33125

CHAPTER 33

John M. Davison, M.D. Professor of Medicine and Obstetrics & Gynecology University of Chicago Chicago, Illinois 60637

Adrian I. Katz, M.D. Dept. of Medicine University of Chicago 5841 S. Maryland Chicago, Illinois 60637

Marshall D. Lindheimer, M.D. Dept. of Medicine University of Chicago 5841 S. Maryland Chicago, Illinois 60637

CHAPTER 34

Eli A. Friedman, M.D . Professor of Medicine Department of Medicine State University of New York Health Science Center Brooklyn, New York

CHAPTER 35

Jared J. Grantham, M.D. Professor of Medicine Director, Division of Nephrology University of Kansas Medical Center Kansas City, Kansas 66103

Joann B. Reckling, R.N ., M.N. Research Assistant Division of Nephrology University of Kansas Medical Center Kansas City, Kansas 66103

Sharon L. Slusher, R.N . Nurse Coordinator University of Kansas Medical Center Kansas City, Kansas 66103

CHAPTER 36

Stephanie Lear, M.D. Department of Medicine Beth Israel Hospital and Harvard Medical School Boston, Massachusetts 02215

Robert M. Rosa, M.D. Assistant Professor of Medicine Harvard Medical School Associate Director Clinical Research Center Beth Israel Hospital Boston, Massachusetts 02215

CHAPTER 37

Russell W. Chesney, M.D. Le Bonheur Professor and Chair Department of Pediatrics

Contributors XIX

The University of Tennessee, Memphis 848 Adams, Room 306 Memphis, Tennessee 38104

CHAPTER 38

Peter T. Scardino, M.D. Professor of Urology Department of Urology Baylor College of Medicine Houston , Texas 77030

Madeline Cantini , R.N. Department of Urology Baylor College of Medicine Houston, Texas 77030

CHAPTER 39

John F. Maher , M.D. Professor of Medicine Director, Nephrology Division F. Edward Hebert School of Medicine Bethesda, Maryland 20814-4799

CHAPTER 40

James F. Winchester, M.D. Professor of Medicine Department of Medicine Division of Nephrology Georgetown University Medical Center Washington, D.C. 20007

CHAPTER 41

Giuseppe Maschio, M.D. Division of Nephrology Instituti Ospitalieri Verona, Italy

Lamberto Oldrizzi , M.D. Assistant Professor of Nephrology Division of Nephrology University of Verona Verona, Italy

Carlo Rugiu, M.D . Assistant Professor of Nephrology Division of Nephrology University of Verona Verona, Italy

xx Contributors

CHAPTER 42

Eberhard F. Ritz, M.D. Professor of Medicine Sektion Nephrologie Klinikum der Universitat Heidelberg Heidelberg , Germany

CHAPTER 43

David R. Bevan, M.D . Professor and Chairman Department of Anesthesia McGill University Montreal, Quebec, Canada

CHAPTER 44

Markus Teschner, M.D. Nephrologische Abteilung Medizinische Universitatsklinik Wurzburg, Germany

August Heidland, M.D. Professor of Medicine Chief, Nephrologische Abteilung Medizinische Universitatsklinik Wurzburg, Germany

CHAPTER 45

J. Carlos Ayus, M.D. Professor of Medicine Department of Medicine Baylor College of Medicine Houston, Texas 77030

R.K. Krothapalli, M.D. Clinical Assistant Professor of Medicine Department of Medicine University of Alabama Birmingham, Alabama

CHAPTER 46

Shaul G. Massry, M.D. Professor of Medicine Chief, Division of Nephrology University of Southern California Los Angeles, California 90033

CHAPTER 47

Suhail Ahmad, M.D. Associate Professor of Medicine University of Washington Medical Director Scribner Kidney Center Seattle, Washington 98915

Christopher R. Blagg, M.D. F.R.C.P. Executive Director Northwest Kidney Center Seattle, Washington 98122

CHAPTER 48

K.M. Koch, M.D. Department of Nephrology Center of Internal Medicine Hannover Medical School Federal Republic of Germany

CHAPTER 49

Jose A. Diaz-Buxo, M.D. Director, Home Dialysis Metrolina Kidney Center Associate Clinical Professor of Medicine University of North Carolina Charlotte , North Carolina 28204

CHAPTER 50

Robert A. Mactier, M.D. Renal Fellow Division of Nephrology Department of Medicine University of Missouri Columbia, Missouri 65212

Karl D. Nolph , M.D. Director, Division of Nephrology Professor of Medicine Department of Medicine University of Missouri VA Hospital and Dalton Research Center Columbia, Missouri 65212

CHAPTER 51

George P. Noon , M.D. Professor of Surgery Department of Surgery Baylor College of Medicine Houston, Texas 77030

H . David Short, M.D. Assistant Professor of Surgery Department of Surgery Baylor College of Medicine Houston, Texas 77030

CHAPTER 52

N.K. Man, M.D. Department of Nephrologie Hopital NECKER Paris , France

J.L. Funck-Brentano, M.D. Professeur of Medicine Department of Nephrologie Hopital NECKER Paris, France

CHAPTER 53

Alfred K. Cheung, M.D. Assistant Professor of Medicine University of Utah School of Medicine V A Medical Center Salt Lake City, Utah 84148

CHAPTER 54

Raymond C. Vanholder, M.D. Nephrology Department University Hospital Universitair Ziekenhuis Ghent, Belgium

Nicolas H. Hoenich, M.D. Department of Medicine University of Newcastle-upon-Tyne Newcastle-upon-Tyne, United Kingdom

Severin M. Ringoir, M.D. Director, Nephrology Division Nephrology Department Universitair Ziekenhuis Ghent, Belgium

CHAPTER 55

D. Craig Brater, M.D. Director of Clinical Phamacology Professor of Medicine Indiana University School of Medicine Indianapolis, Indiana 46202

CHAPTER 56

Stuart M. Flechner, M.D. Associate Professor of Surgery (Urology) Director, Division of Transplantation Department of Surgery Stanford University School of Medicine Stanford, California 94305

CHAPTER 57

Yves F. Ch. Vanrenterghem, M.D. Universitaire Ziekenhuizen Leuven Department of Nephrology Leuven, Germany

CHAPTER 58

J. Winaver, M.D. Department of Nephrology Rambam Medical Center and Department of Physiology Faculty of Medicine Technion, Haifa, Israel

J . Green, M.D. Department of Nephrology Rambam Medical Center and Department of Physiology Faculty of Medicine Technion, Haifa, Israel

O.S. Better, M.D. Department of Nephrology Rambam Medical Center and Department of Physiology Faculty of Medicine Technion, Haifa, Israel

CHAPTER 59 Eleanor D. Lederer, M.D. Assistant Professor of Medicine Department of Medicine Baylor College of Medicine Houston, Texas 77030

Wadi N. Suki, M.D . Professor of Medicine Chief, Renal Section Baylor College of Medicine Houston, Texas 77030

CHAPTER 60

Contributors XXI

John A. Murie, M.A., M.D., F.R.C.S. Consultant Surgeon The Royal Infirmary Edinburgh, U.K.

Peter J. Morris, M.D. Nuffield Department of Surgery University of Oxford John Radcliffe Hospital Oxford, England

CHAPTER 61 Grannum R. Sant , M.D. Associate Professor of Urology Department of Urology Tufts University School of Medicine and New England Medical Center Hospitals Boston, Massachusetts 02111

Edwin M. Meares, Jr. , M.D. Charles M. Whitney Professor and Chairman Department of Urology Tufts University School of Medicine and New England Medical Center Hospitals Boston, Massachusetts 02111

CHAPTER 62

J. Keith Light, M.D. Associate Professor of Urology Scott Department of Urology Baylor College of Medicine Houston, Texas 77030