Suki and Massry's THERAPY OF RENAL DISEASES AND RELATED DISORDERS, THIRD EDITION

Suki and Massry's THERAPY OF RENAL DISEASES AND RELATED DISORDERS,

THIRD EDITION

edited by

Wadi N. Suki, M.D.

Shaul G. Massry, M.D.

SPRINGER SCIENCE+BUSINESS MEDIA, LLC

Library of Congress Cataloging-in-Publication Data

Suki and Massry's therapy of renal diseases and related disorders.-3rd ed. p. cm.

Rev. ed. of: Therapy of renal diseases and related disorders. 2nd ed. c1991. Includes bibliographical references and index. ISBN 978-1-4757-6634-9 ISBN 978-1-4757-6632-5 (eBook) DOI 10.1007/978-1-4757-6632-5

1. Kidneys-Diseases-Treatment. 2. Urinary organs-Diseases-Treatment. 1. Suki, Wadi N., 1934- . II. Massry, Shaul G. [DNLM: 1. Kidney Diseases-therapy. WJ 300 S9475 1997]

RC902. T49 1997 616.6'106--dc21 DNLM/DLC for Library of Congress 96-49630

Copyright© 1997 by Springer Science+Business Media New York Originally published by Kluwer Academic Publishers in 1997 Softcover reprint of the hardcover 3rd edition 1997

CIP

Ali rights reserved. N o part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, mechanical, photo-copying, recording, or otherwise, without the prior written permission of the publisher, Springer Science+Business Media, LLC.

Printed on acid-free paper.

CONTENTS

Foreword ix 10. Therapy of lactic acidosis 211 Preface to the First Edition xi CHRISTINE P. BASTL, MICHAEL Preface to the Second Edition xiii HEIFETS & LOUIS J. RILEY, JR. Preface to the Third Edition and Dedication xv 11. Diabetic ketoacidosis and hyperosmolar List of Contributors xvii

non ketotic syndrome 233 HORACIO J. ADROGUE

PART ONE: DISORDERS OF FLUID, 12. Metabolic acidosis 253 ELECTROLYTE, AND ACID-BASE BALANCE MARTIN SCHREIBER, ROBERT M.A. RICHARDSON & MITCHELL

l. Pathogenesis and treatment of hypoosmolar L. HALPERIN and hyperosmolar states

13. Renal tubular acidosis 275 J. CARLOS A YUS & ALLEN 1. ARIEFF BRUCE KAPLAN & DANIEL BATLLE

2. Polyuric syndromes 21 14. Respiratory acid-base disorders 293 KIRBY GABRYS & MATTHEW D. BREYER HORACIO J. AD ROGUE &

NICOLAOS E. MADIAS 3. Edematous states 35 15. Mixed acid-base disorders 307 JULES B. PUSCHETT &

NICOLAOS E. MADIAS & N. KEVIN KRANE HORACIO J. ADROGUE

4. Disorders of potassium metabolism 53 16. Fluid and electrolyte abnormalities in children 319 F. JOHN GENNARI CHARLES L. STEWART, FREDERICK

5. Disorders of calcium metabolism 85 J. KASKEL, & RICHARD N. FINE THERESA A. GUISE &

17. Fluid and electrolyte disorders in the surgical GREGORY R. MUNDY patient 335

6. Disorders of magnesium homeostasis and KHALIL U. RAHMAN & WADI N. SUKI magnesium in therapy 115 18. Fluid and electrolyte disorders in the JACK W. COBURN & BARTON S. LEVINE thermally injured 351

CHARLES BAXTER & 7. Disorders of phosphate metabolism 143 GEORGE J. KALOY ANIDES

NORIMOTO YANAGAWA & 19. Acute renal failure 359 MOUFID NEMEH GEORGE J. KALOYANIDES

8. Nephrolithiasis and nephrocalcinosis 167 JOAN H. PARKS & FREDRIC L. COE PART TWO: INTRINSIC PARENCHYMAL DISEASE

9. Metabolic alkalosis: biochemical mechanisms, A. GLOMERULAR pathophysiology, and treatment 189

SANDRA SABATINI & 20. Acute glomerulonephritis 387 NEIL A. KURTZMAN FRANK G. BOINEAU & JOHN E. LEWY

VI Contents

21. Glomerulonephritis in bacterial endocarditis 395 37. Renal complications of intravenous drug abuse DAVID S. BALDWIN & and human immunodeficiency virus infection 619 JOEL NEUGARTEN JACQUES J. BOURGOIGNIE

22. Goodpasture's syndrome 401 PART FOUR: HEREDITARY AND CONGENITAL DA VID I. CHARNEY & DISEASES WAYNE A. BORDER'

23. Nephrotic syndrome 413 38. Renal cystic disease 639 P A TRIZIA P ASSERINI & R. DAVID GILE, BENJAMIN D. COWLEY, CLAUDIO PONTICELLI JR. & JARED J. GRANTHAM

24. Hematuria and IgA nephropathy 429 39. Therapy of the renal complications of sickle GIUSEPPE D'AMICO cell hemoglobinopathy 663

CARLOS A. V AAMONDE & B. TUBULOINTERSTITIAL JAMES R. OSTER 25. Infections of the urinary tract 435 40. Inherited renal tubular disorders 671

NINA TOLKOFF-RUBIN & DONALD L. BATISKY & ROBERT H. RUBIN RUSSELL W. CHESNEY

26. Vesicoureteral reflux and reflux nephropathy 441 41. Genetic diagnosis and counseling in inherited ROBERT A. WEISS & ADRIAN SPITZER renal diseases 685

27. Genitourinary tuberculosis 451 JEAN-PIERRE GRUNFELD,

JAMESG. GOW GABRIEL CHOUKROUN & BERTRAND KNEBELMANN

PART THREE: RENAL INVOLVEMENT IN SYSTEMIC DISEASE P ART FIVE: NEOPLASIA

28. Systemic lupus erythematosus 459 42. Cancers of the urinary tract 695 STEPHEN MARK OLMSTEAD, SETH P. LERNER & JAMES EASTHAM JOE VENZOR & DAVID P. HUSTON

29. Vasculitic diseases of the kidney 479 PART SIX: CHEMICAL AND PHYSICAL INJURIES

JAMES E. BALOW & 43. Toxic nephropathy 723 HOWARD A. AUSTIN III WILLIAM M. BENNETT

30. Noninflammatory vascular disease of the 44. Acute drug intoxications 747 kidney 489 GARABED EKNOY AN

JAMES F. WINCHESTER

31. Thrombotic microangiopathy 513 PART SEVEN: CHRONIC RENAL FAILURE PIERO RUGGENENTI & GIUSEPPE REMUZZ A. MEDICAL THERAPY

32. Multiple myeloma and plasma cell dyscrasias 529 PIETRO ZUCCHELLI & 45. Prevention of progression of renal disease 757 SONIA PASQUALI SAULO KLAHR

33. Hyperuricemic nephropathy 541 46. Renal insufficiency 767 MOUFID N. NEMEH & FADI G. LAKKIS & EDWARD J. WEINMAN MANUEL MARTINEZ-MALDONADO

34. The effects of jaundice and cholemia on 47. Anesthesia and surgery in the patient with kidney function and the cardiovascular system 547 renal failure 777 JACOB GREEN & ORI S. BETTER DAVID R. BEVAN

35. Renal complications of pregnancy 561 48. Nutritional management of the uremic patient 783 JOHN M. DAVISON, ADRIAN I. KATZ & AUGUST HEIDLAND, KATARINA MARSHALL D. LINDHEIMER SEBEKOV A & MARKUS TESCHNER

36. Prevention and early treatment of diabetic 49. Treatment of hyperlipidemia in the nephrotic renal disease 605 syndrome 803 CARL ERIK MOGENSEN GEORGE A. KA YSEN

Contents VB

50. Cardiovascular complications in uremia and 62. Hemodialysis, ultrafiltration, and dialysis 817 hemofiltration 1043 MIROSLA W SMOGORZEWSKI RAYMOND C. V ANDERHOLDER,

51. Renal osteodystrophy: prevention and ANN A. VANLOO & SEVERIN M. RINGOIR

management 841 63. Use of l1rugs in uremia and dialysis 1065 ESTHER A. GONZALEZ & D. CRAIG BRATER KEVIN J. MARTIN D. TRANSPLANTATION

52. Neurologic and psychiatric disorders in renal 64. Donor and recipient selection 1079 diseases 855

ALBERTO ALBERTAZZI, STUART M. FLECHNER

MARIO BONOMINI & PAOLO CAPPELLI 65. Immunosuppression and treatment of

53. Hematologic disorders in renal failure 875 rejection 1107

J. RADERMACHER & M. ROY FIRST

KARLM. KOCH 66. Tubular and metabolic dysfunction following

54. Hepatitis in the renal patient 893 transplantation 1139 LILIANA GRADOWSKA & DAVID ROTH & GUIDO PEREZ LESZEK P ~ CZEK

B. PERITONEAL DIALYSIS 67. Transplantation in inherited systemic and metabolic diseases 1153

55. Acute, intermittent, and cycled peritoneal ELEANOR D. LEDERER dialysis 915 68. Complications of renal transplantation 1169 JOSE A. DIAZ-BUXO

PETER J. MORRIS 56. Continuous ambulatory peritoneal dialysis 935

RAMESH KHANNA, PART EIGHT: HYPERTENSION ROBERT MACTIER & KARL D. NOLPH

57. Peritoneal catheter placement and 69. Essential hypertension 1183 management 953 MICHAEL A. WEBER ZBYLUT J. TWARDOWSKI

70. Renal and renovascular hypertension 1195 58. Peritonitis and other complications 981 GEORGES MOURAD,

CHARLES E. HALSTENSON & JEAN-MICHEL HALIMI, WILLIAM F. KEANE JEAN RIB STEIN & ALBERT MIMRAN

C. HEMODIALYSIS 71. Posttransplant hypertension 1207 DAVID A. LASKOW & JOHN J. CURTIS

59. Dialysis access: temporary and permanent 989 PART NINE: UROLOGIC DISORDERS H. DAVID SHORT,

WADE R. ROSENBERG & 72. The catheter 1219 GEORGE P. NOON

GRANNUM R. SANT & 60. Dialyzers, dialysates, and water treatment 1005 EDWIN M. MEARES, JR.

NUHAD ISMAIL, BRYAN BECKER & 73. Nonsurgical management of vesicourethral RAYMOND M. HAKIM

dysfunction 1233 61. Membrane biocompatibility 1021 J. KEITH LIGHT

DANIEL F. WALTON & Index 1241 ALFRED K. CHEUNG

Foreword!

"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 I once 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

1 Revised for the second edition.

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

flourished and had a profound impact on many young clini­cians. Thomas Addis raised to a state of applied 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 inter­relationships comprising calcium/phosphorous homeosta­sis, bone growth, and bone repair were only mistily appre­ciated and became one of the great metabolic success

x Foreword

stories of postwar nephrology and metabolism. Postwar nephrology rushed to the fore and supplied nephrologists with such wonderful tools as the flamephotometer, electro­phoresis, 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 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.

WadiN. 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 monetary 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

Preface to the Third Edition and Dedication

A discipline that stands still is lifeless. Anyone even pe­ripherally involved in nephrology will know that this dis­cipline is vigorous, vibrant, and very much alive. With vibrancy and life comes evolution, and one thing people who work in the field of nephrology will agree upon is that nephrology has been evolving and taking major strides forward. The revolution in the biological sciences has touched nephrology, just as it has other disciplines, and left an indelible mark. More importantly, it has energized this discipline and resulted in an outpouring of exciting new data and new concepts about renal disease and its therapy. These new concepts have already begun to have an impact on clinical nephrology practice and will do so even more in the years to come.

We began in 1984 to publish a treatise on the therapy of renal diseases and related disorders in order to catalogue for the student of nephrology what was known in this field. We subsequently published in 1991 another edition of this work to update it and to chronicle the changes that had come about in the interval. But since the discipline of nephrology has not stood still, it became necessary to fol­low up with yet another update, and it is our prediction that future updates will also become necessary as the old gives way to the new.

It is easy for one seeking information to reach to a shelf for a reference book such as this and leaf through the pages until one finds the information one seeks. Few people ap­preciate the time and effort that each author has put into each individual chapter. We as authors and editors have a

1. Professor Henri Jahn was until 1994 Professeur Titulaire and Chef du Service de Nephrologie et Hemodialyse at the Faculte de Medccinc ct H6pitaux de Strasbourg, France.

deep appreciation for the arduousness of this task of writ­ing and editing. No honorarium from the publisher can fully compensate an author for the effort that goes into preparing one of these chapters. One can only conclude then that each author is engaged in a selfless mission to share with, and to transmit to, others the knowledge that they have gained and the innovations in therapy that they have made. We hope that a word of very sincere thanks from the editors to each and every author will constitute sufficient recognition of the Herculean effort each has put into this final product.

The august group of contributors to this edition was to have been joined by Professor Henri Jahnl-a dear friend , an astute clinician, and a rigorous scientist who was also a master communicator. To those who knew him personally, Professor Jahn was a man who exuded warmth and friend­liness. To those who knew him only as a physician scientist, he was a man with a keen intellect, whose excitement about a broad array of subjects was infectious. He was a serious student of human biology and made numerous contribu­tions to nephrology as he journeyed through a career span­ning more than a quarter of a century. His untimely death while this book was in preparation brought deep sadness to us. We would like to dedicate this volume to the memory of our warm, generous, and hospitable friend, Henri Jahn.

Wadi N. Suki Shaul G. Massry

List of Contributors

Chapter 1 J. CARLOS A YUS, M.D., F.A.C.P. Clinical Professor of Medicine Baylor College of Medicine Houston, TX 77024

ALLEN 1. ARIEFF, M.D., F.A.C.P. Chief, Geriatrics Research & Education San Francisco V.A. Medical Center Professor of Medicine University of California School of Medicine San Francisco, CA 94121

Chapter 2 KIRBY GABRYS, M.D. Division of Nephrology Vanderbilt University Medical Center Nashville, TN 37232

MATTHEW D. BREYER, M.D. Associate Professor Departments of Medicine and Molecular Physiology and

Biophysics Vanderbilt University Medical Center Nashville, TN 37232

Chapter 3 JULES B. PUSCHETT, M.D. Professor and Chairman Department of Medicine Tulane University Medical Center New Orleans, LA 70112-2699

N. KEVIN KRANE, M.D. Associate Professor of Medicine Chief, Clinical Nephrology Section of Nephrology Tulane University Medical Center New Orleans, LA 70112-2699

Chapter 4 F. JOHN GENNARI, M.D. Professor of Medicine Director, Nephrology Unit University of Vermont College of Medicine Burlington, VT 05405

Chapter 5 THERESA A. GUISE, M.D. Assistant Professor of Medicine Division of Endocrinology University of Texas Health Science Center at San

Antonio San Antonio, TX 78284

GREGORY R. MUNDY, M.D., F.R.A.C.P. Professor and Head Division of Endocrinology Department of Medicine University of Texas Health Science Center at San

Antonio San Antonio, TX 78284

Chapter 6 JACK W. COBURN, M.D. Professor of Medicine The Medical and Research Services Veterans Affairs Medical Center, West Los Angeles

(Wadsworth Division) Department of Medicine Nephrology Section (W111L) UCLA School of Medicine Los Angeles, CA 90073

BARTON S. LEVINE, M.D. The Medical and Research Services Veterans Affairs Medical Center, West Los Angeles

(Wadsworth Division) The Department of Medicine Nephrology Section (WI11L) UCLA School of Medicine Los Angeles, CA 90073

XV1ll List of Contributors

Chapter 7 NORIMOTO Y ANAGA WA, M.D. Professor of Medicine UCLA/San Fernando Valley Program Nephrology Section, Sepulveda V AMC Sepulveda, CA 91343

MOUFID NEMEH, M.D. Assistant Professor of Medicine UCLA/San Fernando Valley Program Nephrology Section, Sepulveda V AMC Sepulveda, CA 91343

Chapter 8 JOAN H. PARKS, M.B.A. Program in Nephrology Department of Medicine The University of Chicago Chicago, IL 60637

FREDRIC L. COE, M.D. Professor of Medicine and Physiology Director, Program in Nephrology Department of Medicine The University of Chicago Chicago, IL 60637

Chapter 9 SANDRA SABATINI, Ph.D., M.D. Chairman, Department of Physiology 0

Texas Tech University Health Sciences Center Lubbock, TX 79430

NEIL A. KURTZMAN, M.D. Chairman, Department of Medicine Texas Tech University Health Sciences Center Lubbock, TX 79430

Chapter 10 CHRISTINE P. BASTL, M.D. Professor of Medicine Chief of Nephrology Temple University Health Sciences Center Philadelphia, P A 19140

MICHAEL HEIFETS, M.D. Associate Professor of Medicine Division of Nephrology Temple University Health Sciences Center Philadelphia, PA 19140

LOUIS J. RILEY, JR., M.D. Associate Professor of Medicine Division of Nephrology Temple University Health Sciences Center Philadelphia, P A 19140

Chapter 11 HORACIO J. ADROGUE, M.D., F.A.C.P. Professor of Medicine Baylor College of Medicine Chief, Renal Section Department of Veterans Affairs Medical Center Houston, TX 77030

Chapter 12 MARTIN SCHREIBER, M.D. Renal Division St. Michael's Hospital and The Toronto Hospital University of Toronto Toronto, CANADA M5B 1A6

ROBERT M.A. RICHARDSON, M.D. Renal Division St. Michael's Hospital and The Toronto Hospital University of Toronto Toronto, CANADA M5B 1A6

MITCHELL L. HALPERIN, M.D., F.R.C.P.(C) Professor of Medicine Division of Nephrology St. Michael's Hospital and The Toronto Hospital University of Toronto Toronto, CANADA M5B 1A6

Chapter 13 BRUCE KAPLAN, M.D. The University, Fexas Health Science Centr & Housth

Division of Benal Disease and Hypertension 6431 Faxnin M5B 4.148. Housth TX 77030

DANIEL BATLLE, M.D. Division of Nephrology and Hypertension Northwestern University Medical School Chicago, IL 60611

Chapter 14 HORACIO J. AD ROGUE, M.D. Professor of Medicine Baylor College of Medicine Chief, Renal Section Department of Veterans Affairs Medical Center Houston, TX 77030

NICOLAOS E. MADIAS, M.D. Professor of Medicine Tufts University School of Medicine Chief, Division of Nephrology New England Medical Center Boston, MA 02111

Chapter 15 NICOLAOS E. MADIAS, M.D. Professor of Medicine Tufts University School of Medicine Chief, Division of Nephrology New England Medical Center Boston, MA 02111

HORACIO J. ADROGUE, M.D. Professor of Medicine Baylor College of Medicine Chief, Renal Section Department of Veterans Affairs Medical Center Houston, TX 77030

Chapter 16 CHARLES L. STEWART, M.D. Department of Pediatrics University Medical Center at Stony Brook Stony Brook, NY 11794-8111

FREDERICK J. KASKEL, M.D., Ph.D. Department of Pediatrics University Medical Center at Stony Brook Stony Brook, NY 11794-8111

RICHARD N. FINE, M.D. Professor and Chairman Department of Pediatrics University Medical Center at Stony Brook Stony Brook, NY 11794-8111

Chapter 17 KHALIL U. RAHMAN, M.D. Nephrology Assoc Department, KY 40503

WADI N. SUKI, M.D. Professor of Medicine and of Molecular Physiology and

Biophysics Department of Medicine Chief, Renal Section Baylor College of Medicine Houston, TX 77030

Chapter 18 CHARLES BAXTER, M.D. Professor of Surgery Department of Surgery University of Texas Health Sciences Center at Dallas Dallas, TX 75235

Chapter 19 GEORGE J. KALOYANIDES, M.D. Professor of Medicine Division of Nephrology and Hypertension Health Scinences Center, CST15-020 State University of New York at Stony Brook Stony Brook, NY 11794-8152

Chapter 20 FRANK G. BOINEAU, M.D. Professor of Pediatrics

List of Contributors XIX

Chief, Section of Pediatric Nephrology Tulane University Medical Center New Orleans, LA 70112-2699

JOHN E. LEWY, M.D. Reily Professor and Chairman Department of Pediatrics Tulane University Medical Center New Orleans, LA 70112-2699

Chapter 21 DAVID S. BALDWIN, M.D. Professor of Medicine New York University School of Medicine Co-Director, Renal Section New York University and Bellevue Medical Centers New York, NY 10016

JOEL NEUGARTEN, M.D., J.D. Associate Professor of Medicine Albert Einstein College of Medicine Associate Director, Renal and Hypertension Division Montefiore Medical Center Bronx, NY 10467

Chapter 22 DAVID I. CHARNEY, M.D. Assistant Professor of Medicine Division of Nephrology Department of Medicine University of Utah School of Medicine Salt Lake City, UT 84132

WAYNE A. BORDER, M.D. Professor of Medicine Chief, Division of Nephrology University of Utah School of Medicine Salt Lake City, UT 84132

Chapter 23 PATRIZIA PASSERINI, M.D. Ospedale Maggiore di Milano Instituto di Ricovero e Cura a Carattere Scientifico Divisione di Nefrologia e Dialisi-Pad. Croff 20122 Milano ITALY

CLAUDIO PONTI CELLI, M.D. Ospedale Maggiore di Milano Instituto di Ricovero e Cura a Carattere Scientifico Divisione di Nefrologia e Dialisi-Pad. Croff 20122 Milano ITALY

xx List of Contributors

Chapter 24 GIUSEPPE D'AMICO, M.D. Divisione di Nefrologia Ospedale San Carlo Borromeo-Milano 20153 Milano ITALY

Chapter 25 NINA TOLKOFF-RUBIN, M.D., F.A.C.P. Director, End-Stage Renal Disease Program Chief, Hemodialysis and CAPD Units Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School Boston, MA 02114

ROBERT H. RUBIN, M.D., F.A.C.P. Director, Center for Experimental Pharmacology and

Therapeutics Harvard-M.I.T. Division of Health Sciences and

Technology Chief, Transplantation Infectious Disease Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School Boston, MA 02114

Chapter 26 ROBERT A. WEISS, M.D. Associate Professor of Pediatrics New York Medical College Valhalla, NY 10595

ADRIAN SPITZER, M.D. Professor of Pediatrics Director, Division of Pediatric Nephrology Albert Einstein College of Medicine Bronx, NY 10461

Chapter 27 JAMES G. GOW, M.D. "Ingerthorpe" 25 Merrilocks Road Liverpool L23 6UL ENGLAND

Chapter 28 STEPHEN MARK OLMSTEAD, D.O. 760 N. Shiloh Garland, TX 75042 JOE VENZOR, M.D. Immunology Section Department of Medicine Baylor College of Medicine Houston, TX 77030

DAVID P. HUSTON, M.D. Associate Professor of Medicine and Microbiology and

Immunology Chief, Immunology Section Department of Medicine Baylor College of Medicine Houston, TX 77030

Chapter 29 JAMES E. BALOW, M.D. Clinical Director Kidney Disease Section National Institute of Diabetes and Digestive and Kidney

Disease National Institutes of Health Bethesda, MD 20892-1818

HOWARD A. AUSTIN III, M.D. Kidney Disease Section National Institute of Diabetes and Digestive and Kidney

Disease National Institutes of Health Bethesda, MD 20892-1818

Chapter 30 GARABED EKNOYAN, M.D. Professor of Medicine Department of Medicine Baylor College of Medicine Houston, TX 77030

Chapter 31 PIERO RUGGENENTI, M.D. Mario Negri Institute for Pharmacological Research Division of Nephrology and Dialysis Ospedali Riuniti de Bergamo 24125 Bergamo, ITALY

GIUSEPPE REMUZZI, M.D. Mario Negri Institute for Pharmacological Research Division of Nephrology and Dialysis Ospedali Riuniti de Bergamo 24125 Bergamo, ITALY

Chapter 32 PIETRO ZUCCHELLI, M.D. Malpighi Department of Nephrology Policlinico S. Orsola-Malpighi Bologna, ITALY

SONIA PASQUALI, M.D. Malpighi Department of Nephrology Policlinico S. Orsola-Malpighi Bologna, IT AL Y

Chapter 33 MOUFID N. NEMEH, M.D. Assistant Clinical Professor Department of Medicine UCLA/San Fernando Valley Program V A Medical Center Sepulveda, CA 91343

EDWARD J. WEINMAN, M.D. Professor and Chair Department of Medicine UCLA/San Fernando Valley Program V A Medical Center Sepulveda, CA 91343

Chapter 34 JACOB GREEN, M.D. Department of Nephrology Rambam Medical Center Haifa, ISRAEL 31096

ORI S. BElTER, M.D. Department of Nephrology Rambam Medical Center The B. Rappaport Faculty of Medicine Technion, Israel Institute of Technology Bat Galim Haifa, ISRAEL 31096

Chapter 35 JOHN M. DAVISON, M.D. Department of Obstetrics and Gynaecology University of Newcastle Royal Victoria Infirmary Newcastle upon Tyne NE1 4LP ENGLAND

ADRIAN 1. KATZ, M.D. The University of Chicago Departments of Obstetrics and of Gynecology and

Medicine Sections of Nephrology and of Maternal Fetal Medicine Chicago, IL 60637

MARSHALL D. LINDHEIMER, M.D. Professor of Medicine and of Obstetrics and Gynecology The University of Chicago Departments of Obstetrics and of Gynecology and

Medicine Sections of Nephrology and of Maternal Fetal Medicine Chicago, IL 60637

Chapter 36 CARL ERIK MOGENSEN, M.D. Professor of Medicine Medical Department M (Diabetes and Endocrinology) Kommunehospitalet, University Hospital in Aarhus DL-8000 Aarhus C, DENMARK

List of Contributors XXI

Chapter 37 JACQUES J. BOURGOIGNIE, M.D. Professor of Medicine Chief, Division of Nephrology (R-126) University of Miami School of Medicine Miami, FL 33101

Chapter 38 R. DAVID GILE, M.D. Wichita Nephrology Group Wichita, KS 67214-3766

BENJAMIN D. COWLEY, JR., M.D. Division of Nephrology and Hypertension Department of Medicine Kansas University Medical Center Kansas City, KS 66106

JARED 1. GRANTHAM, M.D. Division of Nephrology and Hypertension Department of Medicine Kansas University Medical Center Kansas City, KS 66106

Chapter 39 CARLOS A. V AAMONDE, M.D. Professor of Medicine Chief, Nephrology Section Nephrology Section and Research Services Veterans Affairs Medical Center Department of Medicine University of Miami School of Medicine Miami, FL 33125

JAMES R. OSTER, M.D. Nephrology Section and Research Services Veterans Affairs Medical Center Department of Medicine University of Miami School of Medicine Miami, FL 33125

Chapter 40 DONALD L. BATISKY, M.D. Division of Pediatric Nephrology Department of Pediatrics The University of Tennessee, Memphis LeBonheur Children's Medical Center Memphis, TN 38103

RUSSELL W. CHESNEY, M.D. Division of Pediatric Nephrology Department of Pediatrics The University of Tennessee, Memphis LeBonheur Children's Medical Center Memphis, TN 38103

XXll List of Contributors

Chapter 41 JEAN-PIERRE GRUNFELD, M.D. Universite Rene Descartes-Paris V Service de Nephrologie H6pital Necker 75015 Paris, FRANCE

GABRIEL CHOUKROUN, M.D. Universite Rene Descartes-Paris V Service de Nephrologie H6pital Necker 75015 Paris, FRANCE

BERTRAND KNEBELMANN, M.D. Universite Rene Descartes-Paris V Service de Nephrologie H6pital Necker 75015 Paris, FRANCE

Chapter 42 SETH P. LERNER, M.D. Assistant Professor of Medicine Scott Department of Urology Baylor College of Medicine Houston, TX 77030

JAMES EASTHAM, M.D. Scott Department of Urology Baylor College of Medicine Houston, TX 77030

Chapter 43 WILLIAM M. BENNETT, M.D. Professor of Medicine and Pharmacology Division of Nephrology, Hypertension, and Clinical

Pharmacology Oregon Health Sciences University Portland, OR 97201

Chapter 44 JAMES F. WINCHESTER, M.D. Professor of Medicine Georgetown University Medical Center PHC 6003 Washington, DC 20007

Chapter 45 SAULO KLAHR, M.D. Simon Professor of Medicine and Co-Chairman Department of Medicine Washington University School of Medicine Physician-in-Chief The Jewish Hospital of St. Louis S1. Louis, MO 63110

Chapter 46 FAD! G. LAKKIS, M.D. Nephrology Division Department of Medicine Emory University School of Medicine and The Medical

and Research Services Atlanta Department of Veterans Affairs Medical Center Decatur, GA 30033

MANUEL MARTINEZ-MALDONADO, M.D. Professor and Vice Chairman Emory University School of Medicine and The Medical

and Research Services Chief, Medical Service Atlanta Department of Veterans Affairs Medical Center Decatur, GA 30033

Chapter 47 DAVID R. BEVAN, M.D., M.R.C.P., F.R.C.A. Professor and Head Department of Anaesthesia University of British Columbia Vancouver General Hospital Vancouver, B.C. CANADA V5Z 4E3

Chapter 48 AUGUST HEIDLAND, M.D. Professor of Medicine Kuratorium flir Dialyse und Nierentransplantation 97080 Wiirzburg GERMANY

KATARINA SEBEKOVA, M.D. Kuratorium fiir Dialyse und Nierentransplantation 97080 Wiirzburg GERMANY

MARKUS TESCHNER, M.D. Kuratorium flir Dialyse und Nierentransplantation 97080 Wiirzburg GERMANY

Chapter 49 GEORGE A. KA YSEN, M.D., Ph.D. Professor of Medicine Chief, Division of Nephrology University of California, Davis School of Medicine Department of Veterans Affairs Northern California

System of Clinics Sacramento, CA 95817

Chapter 50 MIROSLA W SMOGORZEWSKI, M.D. Assistant Professor of Medicine Division of Nephrology University of Southern California School of Medicine Los Angeles, CA 90033

Chapter 51 ESTHER A. GONZALEZ, M.D. Division of Nephrology Department of Internal Medicine St. Louis University Health Sciences Center St. Louis, MO 63110

KEVIN J. MARTIN, M.D. Professor of Medicine Director, Division of Nephrology Department of Internal Medicine St. Louis University Health Scineces Center St. Louis, MO 63110

Chapter 52 ALBERTO ALBERTAZZI, M.D. Professor of Medicine and Nephrology Chief, Department of Nephrology and Dialysis G. D'Annunzio University Institute of Nephrology University of Chieti S. Camillo De Lellis Hospital 66100 Chieti, ITALY

MARIO BONO MINI, M.D. Institute of Nephrology University of Chieti S. Camillo De Lellis Hospital 66100 Chieti, ITALY

PAOLO CAPPELLI, M.D. Institute of Nephrology University of Chieti S. Camillo De Lellis Hospital 66100 Chieti, ITALY

Chapter 53 J. RADERMACHER, M.D. Medizinische Hochschule Hannover Abteilung Nephrologie Zentrum Innere Medizin und Dermatologie W-3000 Hannover 61 GERMANY

KARL M. KOCH. M.D. Medizinische Hochschule Hannover Abteilung Nephrologie Zentrum Innere Medizin und Dermatologie W-3OO0 Hannover 61 GERMANY

Chapter 54 DAVID ROTH, M.D. Professor of Medicine University of Miami School of Medicine The Veterans Administration Medical Center Division of Nephrology (R-126) Miami, FL 33101

GUIDO PEREZ, M.D. Professor of Medicine

List of Contributors xxiii

University of Miami School of Medicine The Veterans Administration Medical Center Division of Nephrology (R-126) Miami, FL 33101

Chapter 55 JOSE A. DIAZ-BUXO, M.D., F.A.C.P. Director Home Dialysis, Metrolina Kidney Center Charlotte, NC 28204

Chapter 56 RAMESH KHANNA, M.D. Professor of Medicine Division of Nephrology School of Medicine University of Missouri-Columbia Columbia, MO 65212

ROBERT MACTIER, M.D. Division of Nephrology School of Medicine University of Missouri-Columbia Columbia, MO 65212

KARL D. NOLPH, M.D. Professor of Medicine Director, Division of Nephrology School of Medicine University of Missouri-Columbia Columbia, MO 65212

Chapter 57 ZBYLUT J. TWARDOWSKI, M.D. Division of Nephrology Department of Medicine University of Missouri Harry S. Truman Veterans Administration Hospital Dalton Research Center MA 436 Health Sciences Center Columbia, MO 65212

Chapter 58 CHARLES E. HALSTENSON, Pharm.D., F.c.P.,

F.C.C.P. Professor of Pharmacy University of Minnesota College of Pharmacy Co-director, The Drug Evaluation Unit Hennepin County Medical Center Minneapolis, MN 55415

WILLIAM F. KEANE, M.D., F.A.C.P. Professor of Medicine University of Minnesota Medical School Co-Director, The Drug Evaluation Unit Chairman, Department of Medicine Hennepin County Medical Center Minneapolis, MN 55415

xxiv List of Contributors

Chapter 59 H. DAVID SHORT, M.D. Assistant Professor of Surgery Department of Surgery Baylor College of Medicine Houston, TX 77030

WADE R. ROSENBERG, M.D. Assistant Professor of Surgery Department of Surgery Baylor College of Medicine Houston, TX 77030

GEORGE P. NOON, M.D. Professor of Surgery Department of Surgery Baylor College of Medicine Houston, TX 77030

Chapter 60 NUHAD ISMAIL, M.D., F.A.C.P. Assistant Professor of Medicine Division of Nephrology Vanderbilt University Medical Center Nashville, TN 37232-2372

BRYAN BECKER, M.D. Division of Nephrology, Vanderbilt University Medical Center Nashville, TN 37232-2372

RAYMOND M. HAKIM, M.D., PH.D. Professor of Medicine Division of Nephrology Vanderbilt University Medical Center Nashville, TN 37232-2372

Chapter 61 DANIEL F. WALTON, D.O. Division of Nephrology and Hypertension Oceania Kidney Disease of Hypertension Center Phoenix, AZ 85006

ALFRED K. CHEUNG, M,D. Associate Professor of Medicine Division of Nephrology and Hypertension University of Utah School of Medicine and Veterans Affairs Medical Center Salt Lake City, UT 84148

Chapter 62 RAYMOND C. V ANHOLDER, M.D. Professor of Medicine Nephrology Department University Hospital De Pintelaan, 185 B9000 Ghent, BELGIUM

ANN A. VAN LOO, M.D. Nephrology Department University Hospital De Pintelaan, 185 B9000 Ghent, BELGIUM

SEVERIN M. RINGOIR, M.D. Professor of Medicine Director, Nephrology Department University Hospital De Pintelaan, 185 B9000 Ghent, BELGIUM

Chapter 63 D. CRAIG BRATER, M.D. Chairman, Department of Medicine Professor of Medicine and of Pharmacology and

Toxicology Indiana University School of Medicine WOP 316, Wishard Memorial Hospital Indianapolis, IN 46202

Chapter 64 STUART M. FLECHNER, M.D. Department of Urology/AWO Section of Renal Transplantation Cleveland, Clinic Foundation Cleveland, OH 44195

Chapter 65 M. ROY FIRST, M.D. Professor of Medicine University of Cincinnati Medical Center Division of Nephrology and Hypertension Cincinnati, OH 45267-0585

Chapter 66 LILIANA GRADOWSKA, M.D. Professor of Medicine Chief, Department of Immunotherapy The Transplantation Institute School of Medicine 02006 Warsaw Nowogrodzka 59, POLAND

LESZEK PACZEK, M.D. Associate Professor of Medicine The Transplantation Institute School of Medicine 02006 Warsaw Nowogrodzka 59, POLAND

Chapter 67 ELEANOR D. LEDERER, M.D. Assistant Professor of Medicine Kidney Disease Program University of Louisville Louisville, KY 40292

Chapter 68 PETER J. MORRIS, M.D., Ph.D., F.R.C.S., F.R.A.C.S.,

F.A.C.S. (hon), F.R.S. Nuffield Professor of Surgery Chairman, Nuffield Department of Surgery University of Oxford Oxford Radcliffe Hospital The John Radcliffe Headington, Oxford OX3 9DU UNITED KINGDOM

Chapter 69 MICHAEL A. WEBER, M.D. Professor of Medicine Hypertension Center-W130 Veterans Affairs Medical Center, Long Beach and the

University of California, Irvine Long Beach, CA 90822

Chapter 70 GEORGES MOURAD, M.D. Medecine Interne et Hypertension Arterielle Centre Hospitalier Universitaire Hopital Lapeyronie 34295 Montpellier Cedex 5, FRANCE

JEAN-MICHEL HALIMI, M.D. Medecine Interne et Hypertension Arterielle Centre Hospitalier Universitaire Hopital Lapeyronie 34295 Montpellier Cedex 5, FRANCE

JEAN RIB STEIN, M.D. Professor of Medicine Medecine Interne et Hypertension Arterielle Centre Hospitalier Universitaire Hopital Lapeyronie 34295 Montpellier Cedex 5, FRANCE

ALBERT MIMRAN, M.D. Professor of Medicine

List of Contributors xxv

Medecine Interne et Hypertension Arterielle Centre Hospitalier Universitatire Hopital Lapeyronie 34295 Montpellier Cedex 5, FRANCE

Chapter 71 DAVID A. LASKOW, M.D. Department of Surgery University of Alabama-Birmingham Birmingham, AL 35294-0006

JOHN J. CURTIS, M.D. Department of Medicine University of Alabama-Birmingham Birmingham, AL 35294-0006

Chapter 72 GRANNUM R. SANT, M.D. Professor and Vice-Chairman Associate Urologist in Chief Tufts University School of Medicine and New England Medical Center Hospitals Boston, MA 02111

EDWIN M. MEARES, JR., M.D. Charles M. Whitney Professor and Chairman Tufts University School of Medicine and New England Medical Center Hospitals Boston, MA 02111

Chapter 73 J. KEITH LIGHT, M.D. Professor and Chairman Department of Urology State University of New York Health Science Center-Syracuse College of Medicine Syracuse, NY 13210