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There are certain structural and functional changes that develop in the urinary tract during normal regnancy, which are significantly different than non-pregnant normal females. During pregnancy in women with underlying chronic kidney disease (CKD), the adaptation to these changes may not be optimal. Under these circumstances, the pregnancy outcome as well as maternal CKD may be affected. The issue focuses on the physiological changes in the kidney and assessment of proteinuria and GFR during pregnancy. The current update also details the cases of pregnancy in the setting of CKD describing the effect of CKD on pregnancy as well as effect of pregnancy on CKD. The chapter on pregnancy-induced hypertension―Pre-eclampsia focuses on the prevention and management of complications in the patient. The authors also give an insight into the pregnancy in cases after kidney transplantation.
The prevalence of Diabetes Mellitus is increasing rapidly all over the world and more so in the developing countries. The global burden of diabetes is expected to double between 2000 and 2030, with the greatest increases in prevalence occurring in the Middle East, sub-Saharan Africa and India. Moreover, the development of type 2 diabetes during the childbearing years is also likely to increase, primarily in the developing countries. It has already been established that Diabetes is the most common primary cause leading to end stage renal disease (ESRD) and Diabetic Nephropathy is the leading cause of chronic kidney disease (CKD) in India. The cornerstones of management of Diabetic Kidney Diseases include early diagnosis of diabetic nephropathy, prevention of its progression and treatment of the co-morbid conditions. Substantial under-diagnosis of both diabetes and chronic kidney disease leads to lost opportunities for prevention. An inadequate or inappropriate care of patients with diabetic kidney disease contributes to disease progression eventually up to a stage that requires renal replacement therapy, which is not a feasible option for many on a long-term basis, especially in a developing country like ours. This book covers various aspects of diabetic kidney disease in detail and attempts to familiarize the reader with the existing aspects of the conditions as well as touch upon the new advances in the field. The first chapter outlines the extent to which the condition affects the population globally as well as in our country. The second chapter explores the underlying mechanism by which the disease starts and progresses and the pathological markers of the same. The third chapter delineates the clinical and diagnostic markers of the condition. The fourth and fifth chapters speak of the non-diabetic glomerular and non-glomerular diseases in diabetics. The sixth chapter addresses the most important and desirable goal of preventing the progression and ideally the onset of the disease. The seventh chapter puts together the various treatment modalities available and the subsequent chapter explores the management options for cases requiring renal replacement. In addition to the emphasis to Indian literature at the end of each chapter, the ninth chapter is specially included to highlight the salient aspects of this condition from the Indian perspective. This book will be beneficial not only for the nephrologists, but also for the epidemiologists, medical students, diabetologists and every doctor who deals with diabetes mellitus.
Hypertension is fast becoming a pandemic of enormous proportions, and its sequelae of cardiovascular and cerebrovascular adverse events is making it a leading cause of morbidity and mortality worldwide. The interrelationship of hypertension and kidney changes though established for quite some time, the exact mechanisms and causality are still being discovered. The role of kidney as evidenced by subtle changes in the initiation of ‘primary hypertension’ is increasingly being scrutinized. The effects of established renal causes that induce hypertension such as renal artery stenosis are well established. Pediatric population is also no longer immune to this potentially debilitating condition. This book will help the readers to: Understand the intricacies of the genesis of hypertension and its effects on the kidney Explore the various established guidelines and newer promising aspects in diagnosis and management of hypertension and the kidney changes Know the newer emerging concepts in the treatment of hypertension in the pediatric population Enlighten them about the benefits of timely management of the condition to prevent its progression to end-stage kidney disease, which requires expensive and invasive interventions not suitable to majority of population in a developing country like ours. This book aims to guide the practitioner to diagnose and manage hypertension in the setting of suspected, diagnosed, or established kidney disease with special reference to practical experience in India.
Renal cystic diseases include a large number of sporadic and genetically determined congenital, developmental, or acquired conditions. A cyst is a cavity lined by epithelium and filled with fluid. Cysts derive primarily from tubules (from Bowman’s capsule to the collecting duct). Cystic kidneys of different etiologies may appear morphologically similar, whereas the same etiologic entity may cause a wide spectrum of renal abnormalities. Simple renal cysts are acquired and are not associated with any disease. In contrast, polycystic kidney diseases can be complicated by renal failure or tumor development. Autosomal dominant polycystic kidney disease (ADPKD) is the most common potentially lethal single-gene disorder. Its prevalence at birth is between 1:400 and 1:1,000. It may progress to end stage renal disease by age 60 with 4.4% of patients requiring renal replacement therapy (dialysis or transplant) have ADPKD. The book is a comprehensive guide to diagnosis and management of the condition with special reference and experience around the same in India. The authors have put together the most relevant facts about the disease for an easy comprehension and understanding of the same by practitioners and students across the specialty.
With the increase in lifestyle-related diseases like diabetes and hypertension the prevalence of Chronic Kidney Disease (CKD) is increasing exponentially and with it is increasing the burden of its ominous consequence, End Stage Renal Disease (ESRD). While ESRD is no longer a death sentence with the advent of efficient renal replacement therapies and the success of renal transplantation, factors such as high cost of these procedures, limited availability of donated kidneys and not enough number of centers equipped with these facilities puts the effective management of ESRD beyond the reach of an average person many-a-times. Additionally the presence of co-existing diseases that contribute to and sometimes complicate the renal impairment as well as delayed referral of the patients to nephrologists also makes matters worse. ESRD is not just a medical but also a social and economic condition that devastates the person and his/her entire family. Hence, early detection and effective prevention of progression of CKD in early stages to advanced CKD and ESRD is the call of the day. In fact, understanding the pathophysiology of the condition and adopting methods of primordial prevention in populations at risk may be desirable to ensure reduction in the incidence of CKD. In those with established CKD, a proactive approach to manage the disease manifestations and limit the ravages of other comorbidities is desirable. For those in advanced stages of CKD, the institution of an appropriate renal replacement therapy individually suited to the patient keeping in view the medical status, lifestyle requirements, economic viability and social acceptability should be advised. This book will help the reader understand the intricacies of the aspects mentioned above and guide the practitioner to diagnose and manage End Stage Renal Disease with special reference to practical experience of the same in India. The authors have put together the most relevant facts about the disease for an easy comprehension and understanding of the same by practitioners and students across the specialty.
The skeleton is a metabolically active organ that undergoes continuous remodeling throughout life. This remodeling is necessary both to maintain the structural integrity of the skeleton and to fulfill its metabolic functions as a storehouse of calcium and phosphorus. Skeletal remodeling can be triggered by changes in mechanical forces or microdamage and by hormonal response to changes in circulating calcium and phosphorus levels. The skeleton also serves as the second line of defense against acidosis, and it is able to liberate buffers in the form of inorganic phosphates. Disorders of Bone and Mineral Metabolism is a multi-authored clinical update that covers all major aspects of bone and its mineral disorders. The first chapter is divided into different sections describing various minerals of clinical importance followed by regulation of mineral metabolism by parathyroid hormone, and vitamin D. There is a very good balance of basic information to act as a primer for the reader and the supporting experimental evidence. The complicated and often difficult topics of mineralization of bone and its regulation and other aspects of mineral metabolism are presented in a particularly clear and interesting manner. A long and useful bibliography follows every chapter. This update contains thorough discussions of the pathophysiology, diagnostic techniques, and therapy of mineral diseases with a wealth of detail. The book is a very useful reference for those interested in bone and mineral physiology and disease, be it a general physician or a nephrologist.
This book discusses the epidemiology, recognition, screening, and management of the various common systemic diseases that commonly present with renal manifestations like diabetic nephropathy, lupus nephritis, hypertension and renal involvement, liver disease, and dysproteinemias. Diabetic nephropathy remains the leading cause of end-stage renal disease across the world. The outlook for patients who have lupus nephritis has improved in the last decade. Kidney disease is common in patients who have advanced liver disease, and creatinine-based methods do not provide an accurate estimation of renal function in this population. Dysproteinemias are associated with protean renal manifestations, and renal disease may be the presenting manifestation. The authors have given a very comprehensive view pertaining to each topic and have given an insight to their own clinical experiences along with the standard guidelines as followed.
Kidney transplantation is one of the breakthroughs in medical science. The most important consideration in the procedure is the natural tendency of the human immune system to reject any foreign tissue—be it a harmful bacteria or a life-saving kidney. After transplantation, the immune system of the patient will reject the kidney in no time. The answer to the solution has been the tremendous development in the identification and use of immunosuppressive medicines. But on the other hand, as we reduce the strength of immune system, the patients are highly prone to infections and it can cause life-threatening infections if left undiagnosed. So, the greatest job of the nephrologist is to balance the immune system to a level where the kidneys are not rejected and at the same time keep the immune system at a level where the infections are kept under control. This is akin to walking on a tight rope. The last few years witnessed significant improvisations in kidney transplantation—the introduction of newer immunosuppressive drugs to increase the success rates of transplantation; steps to increase the donor availability (by doing ABO incompatible transplantation and by performing transplants from non-heart beating donors); and lastly, kidney removal from the donor through laparoscopic donor nephrectomy. This book focuses on the various aspects of choosing the donor, to donor nephrectomy, the outpatient care of the donor and the recipient and also the legal and ethical issues related to the same.
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