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Overview of Nephrology 

Overview of Nephrology
Chapter:
Overview of Nephrology
Author(s):

Matthew McGuire

, and Subramaniam Pennathur

DOI:
10.1093/med/9780190862800.003.0036
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date: 18 September 2020

  1. A. Introduction

    1. a. The role of human kidneys is to maintain homeostasis of electrolytes, minerals, pH, volume, blood pressure, metabolism of nutrients, waste products/toxins, and erythropoiesis.

    2. b. Complex regulatory mechanisms maintain this homeostasis. Alterations in these mechanisms are the basis for nearly all renal diseases.

    3. c. While nephrology topics are often considered confusing, a rational stepwise approach can help provide insight into what is occurring in the individual patient using the following constructs:

      1. i. Understand normal renal physiology.

      2. ii. Identify perturbations of normal homeostasis (e.g., hyperkalemia).

      3. iii. Recognize the physiologic mechanism that has been disrupted to cause homeostatic perturbation (e.g., decreased renal potassium excretion due to mineralocorticoid deficiency).

      4. iv. Associate known disease processes with the disrupted physiology (e.g., primary adrenal failure or angiotensin inhibitor use).

  2. B. Renal Syndromes. The renal syndromes are discussed in more detail in Chapters 3740. Table 36.1 provides an overview.

    1. a. Many syndromes exist in nephrology, each with a set of causative diseases. Specific diseases are often capable of causing more than one syndrome.

      Hot Key

      In medicine, a “syndrome” refers to a set of clinical manifestations occurring together.

      Table 36.1 Overview of Renal Syndromes

      Syndrome

      Key to Diagnosis

      Examples of Causes

      Acute kidney injury

      Classify the cause as prerenal, postrenal, or intrarenal

      Dehydration, shock, toxins, interstitial nephritis, obstruction due to enlarged prostate, RPGN, HUS/TTP

      Nephrotic syndrome

      Classify the cause as renal or systemic

      Primary renal diseases (e.g., membranous, focal segmental glomerulosclerosis, minimal change disease); systemic diseases (e.g., diabetes, amyloid, SLE)

      Nephritic syndrome

      Classify the cause as pauciimmune (ANCA) or immune complex deposition-related disease

      Granulomatosis with polyangiitis, Goodpasture’s, afterpost streptococcal, infective endocarditis, SLE, MPGN, and IgA disease

      Renal tubular acidosis

      Classify the acidosis as type 1, 2, or 4

      Amyloid, multiple myeloma, drugs (e.g., amphotericin), diabetes, Addison’s disease

      ANCA = antineutrophil cytoplasmic antibody; GBM = glomerular basement membrane; HUS/TTP = hemolytic uremic syndrome/thrombotic thrombocytopenic purpura; IgA = immunoglobulin A; MPGN = membranoproliferative glomerulonephritis; RPGN = rapidly progressive glomerulonephritis; SLE = systemic lupus erythematosus.

    2. b. Knowing the clinical manifestations and laboratory data for renal syndromes can help identify diseases. The differential diagnoses for most of the renal syndromes are easy to remember; match the diagnosis with the patient’s complaints and data, and you’ll be off to a great start!

Suggested Further Readings

Rosner MH, Perazella MA. Acute kidney injury in patients with cancer. N Engl J Med 2017;377:500–1.Find this resource:

Vassalotti JA, Centor R, Turner BJ, Greer RC, Choi M, Sequist TD. Practical approach to detection and management of chronic kidney disease for the primary care clinician. Am J Med 2016;129:153–62.e7.Find this resource: