National Kidneys Foundation Primer on Kidney Diseases

National Kidney Foundation’s
National Kidney Foundation’s
PRIMER ON
Elsevier
Contributors
Preface
Contents
1 - Overview of Kidney Structure and Function
	##
		The Kidney and Homeostasis
		Maintenance of Balance
		Body Fluid Composition
		Kidney Structure
	Renal Circulation
		Anatomy
		Two Capillary Beds in Series
		Medullary Blood Supply
	Glomerulus
		Factors That Influence Glomerular Filtration Rate
		Measurement of Glomerular Filtration Rate
		The Juxtaglomerular Apparatus
		Autoregulation of Renal Blood Flow and GFR
	Tubular Function
		Epithelial Cell Transport
	Nephron Segments
		Proximal Tubule
		Loop of Henle
		Distal Nephron
			Distal Convoluted Tubule
			Collecting Duct
	Salt and Volume Regulation
		The Cellular Basis for Tubular Sodium Reabsorption
		The Effective Arterial Blood Volume and Its Relationship to the Extracellular Fluid Volume
		The Clinical Assessment of ECF Volume and Total Body Sodium
		Renal Tubular Handling of Sodium
		Control of Sodium Excretion
			The Primacy of the Effective Arterial Blood Volume in Sodium Homeostasis
			The Integrated Compensatory Response
			The Sympathetic Nervous System
			The Renin-Angiotensin System
			Aldosterone
			Atrial Natriuretic Peptide
			Vasopressin (Antidiuretic Hormone)
	Water and Osmoregulation
		Regulation of Blood Fluid Osmolality
		Role of Vasopressin
		Medullary Hypertonicity
		Countercurrent Mechanism
		Tubular Osmolality Throughout the Nephron
		Comparison of Volume Versus Water Regulation
	Regulation of Body Fluid Acidity and Potassium
		Sources of Hydrogen Ion
		Regulation of Body Fluid Acidity
		The HCO3−/CO2 System
		Acid-Base Homeostasis and the Kidney
			Proximal Tubular Bicarbonate Reabsorption
			Urinary Acidification
			H+ Secretion
			Formation and Excretion of Titratable Acid
			Formation and Excretion of Ammonium (NH4+)
			Alkali Excretion
		Regulation of Body-Fluid Potassium
			Distribution of Potassium Ion in the Body
			K+ Homeostasis after K+ Intake
			Influence of Acid-Base Status on K+ Homeostasis
			Renal Handling of K+
	Renal Handling of Glucose, Amino Acids, Organic Anions, and Cations
	Bibliography
2 - Kidney Development
	Development of the Mammalian Kidney
		Overview of Kidney Development
		Repeating Branching Morphogenesis Establishes the Kidney Collecting System
		Formation of the Nephron (Nephrogenesis)
	Kidney Malformations
		Definition and Overview
		Etiology of Human Urinary Tract Malformation
	Clinical Management of Congenital Anomalies of the Kidney and Urinary Tract
		Major Considerations During the Antenatal Period
		Management after Birth
		Clinical Approach to Specific Malformations
			Fetal Echogenic Kidney
			Unilateral Kidney Agenesis
			Kidney Dysplasia
			Multicystic Dysplastic Kidney
			Kidney Ectopia
			Kidney Fusion
	Key Bibliography
		Bibliography
3 - Assessment of Kidney Function in Acute and Chronic Settings
	##
	Glomerular Filtration Rate
	Measurement of the Glomerular Filtration Rate
	Estimation of the Glomerular Filtration Rate
		Endogenous Filtration Markers
			Creatinine
				Metabolism and Excretion
				Creatinine Clearance
				Equations for Estimating Glomerular Filtration Rate from Serum Creatinine
			Cystatin C
				Metabolism and Excretion
				Equations for Estimating Glomerular Filtration Rate from Serum Cystatin C
			Urea
			Novel Filtration Markers and Panel eGFR
	Clinical Application of Estimated Glomerular Filtration Rate
		Routine Evaluation: Initial Testing With eGFRcr with Confirmation by Other Measures
		GFR Evaluation in Chronic Kidney Disease
		GFR Evaluation in Acute Kidney Disease
		GFR Evaluation in Reduced Muscle Mass
		GFR Evaluation in Drug Dosage Adjustment
		GFR Evaluation in Kidney Donor Evaluation
	Key Bibliography
		Bibliography
4 - Urinalysis and Urine Microscopy
	Specimen Collection and Handling
	Physical and Chemical Properties of the Urine
		Appearance and Odor
		Specific Gravity
		Routine Dipstick Methodology
			pH
			Protein
			Blood
			Specific Gravity
			Glucose
			Ketones
			Urobilinogen
			Bilirubin
			Nitrite
			Leukocyte Esterase
		Albumin Dipsticks
	Microscopic Examination of the Spun Urinary Sediment
		Specimen Preparation and Viewing
		Cellular Elements
			Erythrocytes
			Leukocytes
			Renal Tubular Epithelial Cells
			Other Cells
		Casts and Other Formed Elements
			Hyaline Casts
			Granular Casts
			Waxy Casts
			Red Blood Cell Casts
			White Blood Cell Casts
			Tubular Cell Casts
		Bacteria, Yeast, and Other Infectious Agents
		Lipiduria
		Crystals
		Characteristic Urine Sediments
	Bibliography
5 - Hematuria and Proteinuria
	##
	Hematuria
		Definition
		Etiology
		Detection
		Evaluation
		Management
	PROTEINURIA
		Definition
		Physiology
		Detection
			Semi-Quantitative Methods
			Quantitative Methods
		Evaluation
		Management
	Key Bibliography
		Bibliography
6 - Imaging of the Kidneys
	Introduction
	Imaging Modalities
		Conventional Radiography and Intravenous Urography/Pyelography (IVU/IVP)
		Computed Tomography (CT)
		Ultrasound (US)
		Magnetic Resonance Imaging (MRI)
		Kidney Scintigraphy
	Kidney Cysts and Masses
		Autosomal Dominant Polycystic Kidney Disease
		Acquired Cystic Disease of Dialysis
		Lithium-Induced Nephropathy
		Glomerulocystic Disease
		Angiomyolipoma
		Renal Cell Carcinoma
		Kidney Lymphoma
	Other Kidney Imaging Findings
		Nephrolithiasis
		Obstructive Uropathy
		Kidney Infection
			Imaging Features of Pyelonephritis
			Imaging Features of Kidney Abscess
	Radionuclide Kidney Evaluation and Obstruction
	Diffuse Kidney Parenchymal Disease
	Renal Artery Stenosis
	Imaging in Kidney Transplant
	Contrast Agents for Imaging
		Iodinated Contrast Agents
		Gadolinium-Based Contrast Agents
		Ultrasound Contrast Agents
	Key Bibliography
		Bibliography
7 - Hyponatremia and Hypoosmolar Disorders
	##
	Definitions
	Pathogenesis
	Differential Diagnosis
		Decreased Extracellular Fluid Volume (Hypovolemia)
		Normal Extracellular Fluid Volume (Euvolemia)
		Increased Extracellular Fluid Volume (Hypervolemia)
	Clinical Manifestations of Hyponatremia
	Treatment
		Goals and Limits of Serum [Na+] Correction
		Specific Current Therapies
		Chronic Hyponatremia Treatment
	Key Bibliography
		Bibliography
8 - Hypernatremia and Hyperosmolar Disorders
	##
	Definitions
		Dehydration and Volume Depletion
		Hyperosmolality and Hypertonicity
	Background
	Epidemiology
	Clinical Manifestations
		Symptoms
		Signs
	Pathophysiology
	Pathogenesis and Diagnostic Approach
		Negative Sodium Balance
		Normal Sodium Balance
		Positive Sodium Balance
	Treatment
		Step 1. Determine Sodium Balance.
		Step 2. Calculate Free Water Deficit.
		Step 3. Choose a Replacement Fluid.
		Step 4. Determine Rate of Repletion.
		Step 5. Estimate Ongoing “Sensible” Losses.
		Step 6. Estimate Ongoing “Insensible” Losses.
		Step 7. Identify and Treat Underlying Causes.
	Complications of Hypernatremia
	Key Bibliography
		Bibliography
9 - Volume, Edema, and the Clinical Use of Diuretics
	Diuretic Classes
		Carbonic Anhydrase Inhibitors
		SGLT-2 Inhibitors
		Distal Convoluted Tubule Diuretics
		Loop Diuretics
		Potassium-Sparing Diuretics
		Osmotic Diuretics
	Adaptation to Diuretic Therapy
		Neurohumoral Response to Diuretics
	Diuretic Treatment of Edema
	Diuretic Resistance: Causes and Treatment
		Special Diuretic Dosing Strategies
			High-Dose Oral Loop Diuretics
			Combination Diuretic Therapy
			Diuretic Infusions
			Albumin and Furosemide Coadministration
			Hypertonic Saline and Loop Diuretic Therapy
			Vasopressin Receptor Antagonists
	Special Considerations in Edema Management
		Isolated Ultrafiltration
		End-Stage Kidney Disease
		Hemodialytic Removal
	Diuretic-Related Adverse Events
		Hyponatremia
		Hypokalemia and Hyperkalemia
		Acid-Base Changes
		Hypomagnesemia
		Hyperuricemia
		Hyperglycemia
		Hyperlipidemia
		Ototoxicity
		Drug Hypersensitivity
		Adverse Drug Interactions
	Bibliography
10 - Disorders of Potassium Metabolism
	Introduction
	Potassium Homeostasis
		External Potassium Balance
			Kidney Handling of Potassium
			Physiologic Regulation of Kidney Potassium Excretion
			Adaptation in Chronic Kidney Disease
			Intestinal Potassium Excretion
		Internal Potassium Balance
			Effects of Insulin and Catecholamines on Extrarenal Potassium Disposal
			Effect of Acid-Base Disorders on Extrarenal Potassium Disposal
	Laboratory Tests to Evaluate Potassium Disorders
		Differential Diagnosis of Hypokalemia and Hyperkalemia
		Fractional Excretion of Potassium
	Hypokalemia
		Hypokalemia Versus Potassium Deficiency
		Clinical Disorders Associated with Hypokalemia
		Drug-Induced Hypokalemia
		Clinical Manifestations of Hypokalemia
		Treatment of Hypokalemia
	Hyperkalemia
		Drug-Induced Hyperkalemia
		Fasting Hyperkalemia in Patients Undergoing Dialysis
		Clinical Manifestations of Hyperkalemia
		Treatment of Hyperkalemia
	Key Bibliography
		Bibliography
11 - Disorders of Calcium, Phosphorus, and Magnesium Homeostasis
	Normal Physiology
		Parathyroid Hormone
		Vitamin D
		Fibroblast Growth Factor 23
		Klotho
		Calcium
		Phosphorus
		Magnesium
		Bone
	Disorders of Mineral Metabolism
		Hypercalcemia
			Clinical Manifestations of Hypercalcemia
			Differential Diagnosis of Hypercalcemia
				Malignancy
				Hyperparathyroidism
				Vitamin D Excess
				Familial Hypocalciuric Hypercalcemia
			Approach to the Patient With Hypercalcemia
				Parathyroid Glands
				Bone
				Intestine
				Kidneys
			Treatment of Symptomatic Hypercalcemia
		Hypocalcemia
			Clinical Manifestations of Hypocalcemia
			Differential Diagnosis of Hypocalcemia
				Vitamin D Deficiency
				Hypoparathyroidism
				Pseudohypoparathyroidism
				Tissue Consumption of Calcium
			Treatment of Hypocalcemia
		Hyperphosphatemia
		Hypophosphatemia
			Clinical Manifestations of Hypophosphatemia
			Differential Diagnosis of Hypophosphatemia
				Decreased Oral Intake
				Redistribution
				Increased Urinary Losses
				Rickets and Osteomalacia
			Treatment of Hypophosphatemia
		Hypermagnesemia
			Differential Diagnosis of Hypermagnesemia
			Treatment of Hypermagnesemia
		Hypomagnesemia
			Clinical Manifestations of Hypomagnesemia
			Differential Diagnosis of Hypomagnesemia
			Treatment of Hypomagnesemia
	Bibliography
12 - Approach to Acid-Base Disorders
	Acidemia, Alkalemia, Acidosis, and Alkalosis
	Simple (Single) Acid-Base Disturbances and Compensation
	Anion Gap
	Mixed Acid-Base Disturbances
		Inadequate or “Excessive” Compensation
		The Delta/Delta(ΔAG/ΔHCO3–)
		Clinical Examples
			Clinical Example 1
			Clinical Example 2
			Clinical Example 3
			Clinical Example 4
			Clinical Example 5
		Other Mixed Acid-Base Disorders
		Triple Acid-Base Disturbances
	Bibliography
13 - Metabolic Acidosis
	Overview of Acid-Base Balance
	Evaluation of Urinary Acidification
	Complications of Acidosis
	Approach to Metabolic Acidosis
	Anion Gap Acidosis
		Lactic Acidosis
			Type A Lactic Acidosis
			Type B Lactic Acidosis
				Sepsis
				Drugs
				Vitamin Deficiencies
				Systemic Disease
				Malignancy
				Alternate Sugars
				Propylene Glycol
			d-Lactic Acidosis
			Treatment of Lactic Acidosis
		Diabetic Ketoacidosis
			Treatment
		Alcoholic Ketoacidosis
			Treatment
		Starvation Ketosis
		Toxins and Drugs
			Ethylene Glycol
			Methanol
			Treatment of Toxic Alcohol Ingestions
			Salicylate Toxicity
			Pyroglutamic Acidosis
		Kidney Failure
	Hyperchloremic Metabolic Acidosis
		Kidney Causes of Hyperchloremic Metabolic Acidosis
			Defective Ammoniagenesis
			Hypoaldosteronism
			Proximal Renal Tubular Acidosis
			Distal Renal Tubular Acidosis
				Classic Distal Renal Tubular Acidosis With Hypokalemia
				Distal Renal Tubular Acidosis With Hyperkalemia
					Generalized Distal Tubule Defect
					Distal Sodium Transport Defects
			Combined Proximal and Distal Renal Tubular Acidosis
			Incomplete Distal Renal Tubular Acidosis
		Extrarenal Causes of Hyperchloremic Metabolic Acidosis
			Extrarenal Bicarbonate Loss
			Acid Load
			Urinary Loss of Anions
	Key Bibliography
	Bibliography
14 - Metabolic Alkalosis
	Pathogenesis
	Differential Diagnosis
	Metabolic Alkalosis Due to Exogenous Bicarbonate Loads
		Alkali Administration
		Milk-Alkali Syndrome
		Citrate-Based Continuous Kidney Replacement Therapy
	Metabolic Alkalosis Associated with Extracellular Fluid Volume Contraction, K+ Depletion, and Secondary Hyperreninemic H ...
		Metabolic Alkalosis of Gastrointestinal Origin
			Congenital Chloridorrhea
			Villous Adenoma
				Gastrocystoplasty
		Metabolic Alkalosis of Kidney Origin
			Diuretics
			Bartter Syndrome
			Gitelman Syndrome
			Pendred Syndrome
		Non-Reabsorbable Anions and Magnesium Deficiency
		Metabolic Alkalosis Due to Potassium Depletion
		Posttreatment of Lactic Acidosis or Ketoacidosis
		Posthypercapnia
	Metabolic Alkalosis Associated with Extracellular Fluid Volume Expansion, Hypertension, and Hyperaldosteronism
		Liddle Syndrome
		Glucocorticoid-Remediable Hyperaldosteronism
		Cushing Disease and Cushing Syndrome
		Miscellaneous Conditions
	Symptoms of Metabolic Alkalosis
	Treatment of Metabolic Alkalosis
	Bibliography
15 - Respiratory Acidosis and Alkalosis
	Respiratory Acidosis
		Pathophysiology
		Secondary Physiologic Response
		Etiology
		Clinical Manifestations
		Diagnosis
		Therapeutic Principles
	Respiratory Alkalosis
		Pathophysiology
		Secondary Physiologic Response
		Etiology
		Clinical Manifestations
		Diagnosis
		Therapeutic Principles
	Key Bibliography
	Bibliography
16 - Glomerular Clinicopathologic Syndromes
	Introduction
	Nephrotic Syndrome
		Minimal Change Disease
		Focal Segmental Glomerulosclerosis
		Membranous Nephropathy
		Diabetic Kidney Disease
	Nephritic Syndrome
		Rapidly Progressive Glomerulonephritis
		IgA Nephropathy
		Infection-Related Glomerulonephritis
		Fibrillary Glomerulonephritis
		Membranoproliferative Glomerulonephritis
		Lupus Nephritis
		Cryoglobulinemic Glomerulonephritis
		Antineutrophil Cytoplasmic Antibody-Associated Vasculitis
		Anti-Glomerular Basement Membrane Antibody-Mediated Glomerulonephritis
		Monoclonal Immunoglobulin-Associated Kidney Disease
		Amyloidosis
	C3 Glomerulopathy
	Thrombotic Microangiopathies
		Hemolytic Uremic Syndrome
		Thrombotic Thrombocytopenic Purpura
		Atypical Hemolytic Uremic Syndrome
	Inherited Glomerular Disorders with Basement Membrane Abnormalities
		Thin Basement Membrane Nephropathy
		Alport Syndrome
	Kidney Biopsy
	Key Bibliography
	Bibliography
17 - ANCA-Associated Kidney Disease and Vasculitis
	Classification of AAV
		Clinicopathologic Classification
		Serologic Classification
	Pathogenesis
		The Pathogenic Role of ANCAs
		Development of ANCAs
		Role of Complement
	Epidemiology
	Clinical Features
	Diagnosis
		ANCA Testing
		Interpretation of ANCA Testing
		Tissue Biopsy
	Kidney Pathology
	Drug-Induced AAV
	Concurrent Anti-Glomerular Basement Membrane Disease
	Treatment
		Induction of Remission
			Cyclophosphamide
			Rituximab
			Glucocorticoids
			Infection Prophylaxis
			Plasma Exchange
			Novel Induction of Remission Strategies
		Maintenance of Remission
			Rituximab
			Azathioprine
		Management of Patients with Advanced Kidney Disease
			Patients with Advanced Histologic Changes on Kidney Biopsy
			Maintenance Therapy for Dialysis-Dependent Patients
			Transplantation in AAV
		Side Effects of Immunosuppressive Therapy
	Bibliography
18 - Minimal Change Disease
	Terminology and Histopathology
	Pathophysiology
	Incidence
	Clinical Presentation
	Initial Treatment
	Short-Term Course
	Long-Term Treatment
		Immunosuppressive Therapy
		Supportive Care
	Prognosis
	Conclusion
	Key Bibliography
	Bibliography
19 - Focal Segmental Glomerulosclerosis
	##
	Clinical Features and Diagnosis
	The Six Focal Segmental Glomerulosclerosis Clinical Syndromes
	Shared Pathways of Glomerular Injury
	Pathology
	Clinical Course
	Therapy
	Acknowledgment
	Bibliography
20 - Membranous Nephropathy
	##
	Clinical Features
	Pathology
	Pathogenesis
		Neutral Endopeptidase
		Bovine Serum Albumin
		M-Type Phospholipase A2 Receptor
		Thrombospondin Type 1 Domain Containing 7A
		Neural Epidermal Growth Factor-Like 1 Protein
		Semaphorin 3B
		Exostosin 1 (EXT1) and Exostosin 2 (EXT2)
	Genetic Associations
	Diagnosis
	Prognosis of Primary Membranous Nephropathy
		Natural History
		Predicting Outcome
		Response Goals
	Treatment
		Nonspecific Non-Immunosuppressive Therapy
		Treatment Focused on the Secondary Effects of Membranous Nephropathy
		Immunosuppression
		Low Risk for Progression
		Moderate Risk for Progression
		High Risk for Progression
	Newer Therapies
	Complications of Therapy
	Management Plan for Primary Membranous Nephropathy
	Treatment of Secondary Membranous Nephropathy
	Key Bibliography
		Bibliography
21 - Immunoglobulin A Nephropathy and Related Disorders
	##
	Epidemiology
	Clinical Presentation
		Episodic Visible Hematuria
		Asymptomatic Nonvisible (Microscopic) Hematuria
		Nephrotic Syndrome
		Acute Kidney Injury
		Other Presentations
	Secondary Immunoglobulin A Nephropathy
	Pathology
		Light Microscopy
		Immunohistology
		Electron Microscopy
		The Oxford Classification of IgAN
	Pathogenesis
		Immunoglobulin A in IgAN
		Origins of Mesangial Immunoglobulin A
		Key Events in the Development of Kidney Scarring in Immunoglobulin A Nephropathy
	Genetics of Immunoglobulin A Nephropathy
	Natural History and Prognosis
	Treatment of Immunoglobulin A Nephropathy
		Nonvisible Hematuria and Less Than 0.5 g/Day Proteinuria
		Recurrent Visible Hematuria
		Above 0.5 g/Day Proteinuria
		Above 1g/Day Proteinuria Despite Maximal Supportive Care
			Corticosteroids
			Fish Oil
			Other Immunosuppressive Agents
			Emerging Therapies
		IgAN with Acute Kidney Injury
		Nephrotic Syndrome
	Follow-Up
	Kidney Transplant
	Immunoglobulin A Vasculitis (Henoch-Schönlein Purpura)
		Epidemiology
		Etiology and Pathogenesis
		Natural History
		Clinical Features
		Pathology
			Skin Biopsy
			Kidney Biopsy
		Management
		Follow-Up
		Transplantation
		Pregnancy
	Bibliography
		Immunoglobulin A Nephropathy
			Natural History, Epidemiology, and Diagnosis
			Pathogenesis
			Genetics
			Treatment
		IgA Vasculitis
22 - Complement-Mediated Glomerulonephritis and Thrombotic Microangiopathy
	##
	Brief Overview of the Complement System
		Complement Regulatory Proteins
	Complement in Immune-Complex Glomerulonephritis
	C3 Glomerulopathy
		Epidemiology
		Etiology and Pathogenesis
			Autoantibodies
			Genetic Causes
		Pathology
		Clinical and Laboratory Features
			Extrarenal Features
		Differential Diagnosis
		Treatment
		Transplantation
	Complement-Mediated Thrombotic Microangiopathy
		Epidemiology
		Etiology and Pathogenesis
			Genetic Causes
			Autoantibodies
			Triggers
		Pathology
		Clinical and Laboratory Features
		Treatment
			Kidney Transplantation
	Comparison of the Underlying Mechanisms of C3 Glomerulopathy and Atypical Hemolytic Uremic Syndrome
	Key Bibliography
		Bibliography
23 - Infection-Related Glomerulonephritis
	Clinical Features
	Epidemiology
	Histopathology
	Differential Diagnosis
	Pathogenesis
	Treatment and Prognosis
	Key Bibliography
	Bibliography
24 - Viral Nephropathies: Human Immunodeficiency Virus, Hepatitis C Virus, Hepatitis B Virus, and SARS-CoV-2
	##
	Human Immunodeficiency Virus
		Pathophysiology of HIVAN
		HIVAN Clinical Presentation and Kidney Biopsy Findings
		Treatment of HIVAN
		Immune Complex Diseases in Patients with HIV Infection
		ART Nephrotoxicity
		CKD in the Aging HIV-Infected Population
	Hepatitis C Virus
		Epidemiology
		Pathophysiology and Clinical Presentation of Cryoglobulinemic Glomerulonephritis
		Other Kidney Lesions Associated with HCV
		HCV-Associated CKD Progression
		Pathology
		Treatment
			Direct-Acting Antiviral Therapy for HCV Infection
			Immunosuppression
		Dialysis and Transplantation
	Hepatitis B
		Epidemiology
		Clinical Presentation and Pathogenesis of HBV-Associated Glomerular Disease
		Clinical Presentation and Pathogenesis of HBV-Associated Polyarteritis Nodosa
		Diagnosis
			Pathology
			Laboratory Data
		Treatment of HBV-Associated Glomerular Disease and PAN
		Dialysis and Transplantation
	SARS-CoV-2
	Key Bibliography
		Bibliography
25 - Systemic Lupus Erythematosus and the Kidney
	Presentation
	Evaluation
		Laboratory Findings
		Kidney Biopsy Findings
	Treatment
		Classes III and IV Lupus Nephritis
			Induction Therapy
		Maintenance Therapy
		Class V Lupus Nephritis
		Alternative and Future Therapies
	Prognosis
	Key Bibliography
	Bibliography
26 - Pathogenesis, Pathophysiology, and Treatment of Diabetic Kidney Disease
	##
	Pathophysiology
	Pathology
		Type 1 Diabetes
			Light Microscopy
			Immunofluorescence
			Electron Microscopy
		Type 2 Diabetes
	Structural–Functional Relationships in Diabetic Kidney Disease
	Reversal of Diabetic Kidney Disease Lesions
	Medical Management of Diabetes
		Traditional Therapeutic Strategies for Diabetic Kidney Disease
			Glycemic Control
				Rationale
				Medications of Choice
				Sodium-Glucose Cotransporter-2 Inhibition
				Glucagon-Like Peptide-1 Receptor Agonists
			Blood-Pressure Control
				Rationale
				Medication of Choice
				ACE Inhibitors
				Angiotensin Receptor Blockers
				Comparing ACE Inhibitors to ARBs
			Combinations of Blood Pressure–Lowering Drugs
				Rationale
				Combinations of Choice
			Combinations of RAAS-Interventions
				ACE Inhibitor plus ARB
				ACE Inhibitor/ARB and Direct Renin Inhibition
				ACE Inhibitor/ARB and Mineralocorticoid Receptor Antagonists (MRA)
			Lipid Management
				Rationale
				Choice of Lipid-Lowering Therapy
			Treatment of Type 2 Diabetes in Dialysis Patients
				Control of Hyperglycemia
				Blood Pressure Control
				Lipid Control
		Novel Strategies and Agents for Diabetic Kidney Disease
			Novel Blood Pressure- and Lipid-Lowering Agents
				Endothelin Antagonists
			Insulin Resistance and Lifestyle Modification
			Novel Targets
				Monocyte Chemoattractant Protein-1 Inhibitors
				Interleukin-1ß (1L-1ß) Antagonists
				Uric Acid (UA) Lowering
				Novel Biomarkers
	Conclusion
	Key Bibliography
		Bibliography
27 - Onconephrology
	Acute Kidney Injury
	Chemotherapeutic Agents
	Tumor Lysis Syndrome
	Thrombotic Microangiopathy
	Hematopoietic Stem Cell Transplantation
		Sinusoidal Obstruction Syndrome
	Glomerular Diseases and Paraneoplastic Syndromes
	Lymphoma and Leukemia
		Lymphoma
		Leukemia
	Radiation-Associated Kidney Injury
	Electrolyte Abnormalities
		Hyponatremia
		Hyperkalemia
		Hypokalemia
		Hypophosphatemia
		Hypercalcemia
	Chronic Kidney Disease and Malignancy
	Kidney Cysts and Kidney Cancer
	Key Bibliography
		Bibliography
28 - Myeloma, Amyloid, and Other Dysproteinemias
	Immunoglobulin Light-Chain Metabolism and Clinical Detection
	Glomerular Lesions of Plasma Cell Dyscrasias
		AL-Type Amyloidosis
		Pathology
		Clinical Features
		Pathogenesis
		Treatment and Prognosis
		Monoclonal Ig Deposition Disease
		Pathology
		Clinical Features
		Pathogenesis
		Treatment and Prognosis
	Fibrillary Glomerulonephritis and Immunotactoid Glomerulopathy
	Tubulointerstitial Lesions of Plasma Cell Dyscrasias
		Cast Nephropathy
			Pathology
			Clinical Features
			Pathogenesis
			Treatment and Prognosis
	Other Tubulointerstitial Kidney Lesions Including Proximal Tubulopathy
	Waldenström Macroglobulinemia
	Key Bibliography
		Bibliography
29 - Cardiorenal Syndrome
	The Challenge in Defining Cardiorenal Syndrome
	Prognostic Impact of Changes in Kidney Function in Heart Failure
	Pathophysiology of Cardiorenal Syndrome
	Therapeutic Strategies for Cardiorenal Syndrome
	Summary
	Bibliography
30 - Liver Disease, Acute Kidney Dysfunction, and the Hepatorenal Syndrome
	Pathophysiology of aki in Liver Disease and Hrs
		Splanchnic Vasodilation and Circulatory Dysfunction
		Kidney Microcirculatory Abnormalities
		Cirrhotic Cardiomyopathy
		Inflammation
		Intraabdominal Hypertension (IAH)
		Kidney Toxicity of Bile Acids
		Role of Adrenal Insufficiency
	Definitions and Diagnosis
	Prevention
	Treatment of Hepatorenal Syndrome
		General Approach
		Vasoconstrictors
		Transjugular Intrahepatic Portosystemic Shunt (TIPS)
		Kidney Replacement Therapy (KRT)
		Extracorporeal Liver Support
		Liver Transplantation
	Conclusion
	Key Bibliography
		Bibliography
31 - Clinical Approach to the Diagnosis of Acute Kidney Injury
	Pathophysiology
	Acute Kidney Injury Definition
	Tools for Diagnosis, Staging, and Evaluation of Acute Kidney Injury
		Standard Lab Tests
			Serum Creatinine
			Creatinine Clearance
			Blood Urea Nitrogen
			Cystatin C
		Urine Studies
			Urine Flow: Oliguria
			Urine Microscopy
			Urinary Chemical Indices
			Clearance Measurements
		New Biomarkers
		Kidney Function Reserve
		Imaging
		Kidney Biopsy
	Differential Diagnosis and Evaluation
		Diagnostic Approach
	Key Bibliography
		Bibliography
32 - Acute Tubular Injury and Acute Tubular Necrosis
	Ischemic Acute Tubular Injury
		Hypotension-Induced Ischemia
			Causes
			Diagnosis
		Cholesterol Atheroembolic Disease
			Clinical Presentation
			Diagnosis
			Pathology
			Therapy and Outcomes
		Kidney Infarction
			Clinical Presentation and Diagnosis
			Causes and Treatment
	Acute Tubular Injury by Endogenous Nephrotoxins
		Rhabdomyolysis
			Causes and Pathophysiology
			Diagnosis
			Risk Factors and Prognosis
			Treatment
		Heme Pigment Nephropathy
			Pathophysiology
			Prognosis and Management
		Acute Nephropathy Associated with Tumor Lysis Syndrome
			Pathophysiology
			Management
		Other Endogenous Toxins
	SARS-CoV-2-Related Acute Tubular Injury
	Key Bibliography
		Bibliography
33 - Acute Interstitial Nephritis
	Clinical Presentation
	Laboratory Findings
	Imaging
	Pathology
	Pathogenesis
	Causes of Acute Interstitial Nephritis
		Drug-Associated Interstitial Nephritis
			Antibiotics
				β-Lactam Antibiotics
				Non β-Lactam Antibiotics
			Nonsteroidal Antiinflammatory Agents
			Gastrointestinal Agents
			Diuretics
			Oncologic Agents
		Infections
			Invasive Infections
			Noninvasive Infections
		Systemic Diseases
			Tubulointerstitial Nephritis and Uveitis
			Immunologic Diseases
			Malignancy
	Treatment
	Key Bibliography
		Bibliography
34 - Kidney Disease Caused by Therapeutic Agents
	Kidney Susceptibility to Nephrotoxic Agents
	Kidney Injury Associated With Medications
	Diagnostic Agents
		Radiocontrast Agents
		Gadolinium-Based Contrast Agents
	Therapeutic Agents
		Analgesics
	Chemotherapeutic Agents
		Antiangiogenesis Drugs
		Interferon
		Bisphosphonates
		Gemcitabine
		Platinum Compounds
		Ifosfamide
		Pemetrexed
		Epidermal Growth Factor Receptor Antagonists
	Immune Checkpoint Inhibitors
	CAR-T Cell Therapy
		BRAF Inhibitors
	Antimicrobial Agents
		Antibiotics
			Aminoglycosides
			Vancomycin
			Polymyxins
			Sulfonamides
			Ciprofloxacin
		Antiviral Drugs
			Acyclovir
			Indinavir, Atazanavir, and Darunavir
			Tenofovir Disoproxil Fumarate
		Antifungal Agents
			Amphotericin B
	Miscellaneous
		Anticoagulant-Related Nephropathy
		Osmotic Agents
		Lithium
		Proton Pump Inhibitors
	Key Bibliography
	Bibliography
35 - Principles of Drug Therapy in Patients With Decreased Kidney Function
	Drug Absorption
	Drug Distribution
	Drug Metabolism and Transport
	Kidney Excretion of Drugs
	Estimation of Kidney Function for Drug-Dosing Purposes
	Strategies for Drug Therapy Individualization
		Patients Receiving Continuous Kidney Replacement Therapy
		Patients Receiving Chronic Hemodialysis
		Patients Receiving Chronic Peritoneal Dialysis
	Clinical Decision Support Tools
	Conclusions
	Bibliography
36 - APOL1-Mediated Kidney Disease
	Ancestry and Chronic Kidney Disease
	Clinical Implications of APOL1
	Second Hits and Modifying Factors
	APOL1 and Kidney Transplantation: Insights into Disease Pathogenesis
	Trypanosoma Sub-Species and APOL1 Kidney Risk Variants
	Mode of Inheritance
	Mechanism of Kidney Injury
	Genetic Testing and Involvement of Communities of African Descent
	Conclusions
	Bibliography
37 - Genetically Based Kidney Transport Disorders
	Disorders of Proximal Tubular Transport Function
		Selective Proximal Transport Defects
		Impaired Proximal Phosphate Reabsorption
		Excessive Proximal Phosphate Reabsorption
		Impaired Proximal Bicarbonate Transport
		Inherited Fanconi Syndrome: Hereditary Fructose Intolerance, Lowe Syndrome, and Dent Disease
	Disorders of Transport in the Medullary Thick Ascending Limb of Henle
		Bartter Syndrome
		Inherited Hypomagnesemic Hypercalciuria
		Familial Hypocalciuric Hypercalcemia
	Disorders of Transport in the Distal Convoluted Tubule
		Gitelman Syndrome
		Impaired Distal Magnesium Reabsorption
		Familial Hypomagnesemia with Secondary Hypocalcemia
		Isolated Recessive Renal Hypomagnesemia
		Autosomal-Dominant Hypomagnesemia with Hypocalciuria
		SeSAME/EAST Syndromes
		Isolated Hypomagnesemia with KCNA1 Mutation
		Hypomagnesemia with Mitochondrial Inheritance
		CNNM2 Mutations in Dominant Hypomagnesemia
		De Novo Mutation in ATP1A1 Causing Dominant Hypomagnesemia With Refractory Seizures and Intellectual Disability
	Disorders of Transport in the Collecting Tubule
		Liddle Syndrome
		Pseudohypoaldosteronism Types 1 and 2
		Other Disorders Resembling Primary Hyperaldosteronism
		Hereditary Renal Tubular Acidosis
		Nephrogenic Diabetes Insipidus
	Key Bibliography
		Bibliography
38 - Sickle Cell Nephropathy
	Pathophysiology
	Kidney Hemodynamics
	Tubulointerstitial Disease
		Impaired Urinary Concentration
		Hematuria
		Renal Papillary Necrosis
		Renal Medullary Carcinoma
		Acidification, Potassium Excretion, and Other Tubular Abnormalities
	Sickle Cell Glomerulopathy
		Albuminuria and Proteinuria
		Treatment
	Management of Chronic Kidney Disease in Sickle Cell Disease
	End-Stage Kidney Disease in Sickle Cell Disease
	Sickle Cell Trait
	Key Bibliography
		Bibliography
39 - Polycystic and Other Cystic Kidney Diseases
	Autosomal Dominant Polycystic Kidney Disease
		Pathogenesis
		Diagnosis
		Kidney Manifestations and Complications
		Extrarenal Manifestations
			Polycystic Liver Disease
			Cardiovascular Manifestations
			Effects on Fertility and Pregnancy
			Autosomal Dominant Polycystic Kidney Disease in Children
		Therapy
	Autosomal Recessive Polycystic Kidney Disease
	Tuberous Sclerosis Complex
	Von Hippel-Lindau Disease
	Acquired Cystic Kidney Disease
	Key Bibliography
		Bibliography
40 - Nephronophthisis and Medullary Cystic Kidney Disease
	Epidemiology
	Pathology
	Pathogenesis
	Clinical Features and Diagnosis
		Nephronophthisis
		Medullary Cystic Kidney Disease
	Treatment
	Bibliography
41 - Alport Syndrome and Related Disorders
	Phenotypic Variability in X-Linked Alport Syndrome
	Biochemistry
	Genetics
	Immunochemistry
	Pathology
	Clinical Features
		Kidney Features
		Extrarenal Features
			Hearing Loss
			Ocular Defects
			Leiomyomatosis
	Diagnosis
	Treatment
	Related Disorders
		Autosomal Recessive Alport Syndrome
		Autosomal Dominant Alport Syndrome
		Alport Syndrome with Thrombocytopathy: Epstein Syndrome and Fechtner Syndrome
		Familial Thin Basement Membrane Disease
		Familial Focal Segmental Glomerulosclerosis
	Approach to the Patient with ‘Hereditary Nephritis’
	Bibliography
42 - Fabry Disease
	Kidney Manifestations of Fabry Disease
	Pathology of Kidney Disease in Fabry Disease
		Gross Pathology
		Light Microscopy
		Electron Microscopy
			Differential Diagnosis
	Treatment Issues in Fabry Disease
		Renin-Angiotensin-Aldosterone System Blockade
		Kidney Replacement Therapy
		Specific Therapies
			Enzyme Replacement Therapy
			Pharmacologic Chaperones
	Key Bibliography
		Bibliography
43 - Chronic Tubulointerstitial Disease
	Histopathology
	Mechanisms of Tubulointerstitial Fibrosis
	Clinical Features
	Clinical Course and Therapy
	Distinct Causes of Chronic Tubulointerstitial Nephritis
		Analgesic Nephropathy
		Chronic Lead Nephropathy
		Aristolochic Acid Nephropathy and Balkan Nephropathy
		Sarcoidosis
		Sjögren Syndrome
		Tubulointerstitial Nephritis and Uveitis Syndrome
		IgG4-Related Tubulointerstitial Nephritis
		Chronic Kidney Disease of Unknown Origin (CKDu)
		Chronic Pyelonephritis
	Key Bibliography
		Bibliography
44 - Obstructive Uropathy
	Unilateral Ureteral Obstruction
	Bilateral Ureteral Obstruction
	Tubular Dysfunction
		Sodium Reabsorption
		Urinary Concentration
		Potassium
		Acidification
	Fibrosis
	Apoptosis
	Postobstructive Diuresis
	Specific Causes of Obstructions
		Nephrolithiasis
		Strictures
		Malignancy
		Benign Prostatic Hyperplasia/Prostate Cancer
		Neurogenic Bladder
		Congenital Defects in the Adult Population
		Congenital Defects in the Pediatric Population
		Pregnancy
	Obstruction With Infection
	Bibliography
45 - Nephrolithiasis
	Epidemiology
	Nephrolithiasis as a Systemic Disease
	Acute Renal Colic
	Types of Stones
	Pathogenesis
		General Pathophysiology
		Urinary Risk Factors
		Dietary Factors
		Nondietary Factors
	Clinical Evaluation
	Metabolic Evaluation
	Medical Treatments
		Dietary Recommendations
		Pharmacologic Options
	Hyperoxaluria-Related Disorders and Systemic Oxalosis
	Calcium Phosphate Stones
	Noncalcium Stones
		Uric Acid Stones
		Cystine Stones
		Struvite Stones
	Surgical Management of Stones
	Long-Term Follow-Up
	Acknowledgment
	Bibliography
46 - Kidney Diseases in Infants and Children
	Kidney Development and Maturation
	Acute Kidney Injury
		Introduction
		Diagnosis
		Treatment
	Chronic Kidney Disease
		Introduction
		Diagnosis
		Treatment
	Hypertension
		Diagnosis
		Treatment
	Key Bibliography
		Bibliography
47 - The Kidney in Pregnancy
	Kidney Anatomy and Physiology During Normal Pregnancy
		Anatomic Changes During Gestation
		Physiologic Changes During Gestation
			Systemic Hemodynamic Changes
			Renal Hemodynamic Changes
			Volume Regulation and Electrolyte Changes
			Tubular Changes
	Assessment of Kidney Function
		Glomerular Filtration Rate
		Proteinuria
	Hypertensive Disorders of Pregnancy
		Chronic Hypertension
		Management of Hypertension in Pregnancy
		Gestational Hypertension
		Preeclampsia
			Risk Factors
			Pathophysiology
			Definitions, Diagnosis, and Clinical Features
			Management and Prevention
			Long-Term Outcomes After Preeclampsia
			Superimposed Preeclampsia
		Secondary Hypertension
	Acute Kidney Injury in Pregnancy
		Differential Diagnosis of Acute Kidney Injury in Pregnancy
		Hemodynamic Kidney Injury and Bilateral Cortical Necrosis
		Preeclampsia/HELLP
		Acute Fatty Liver of Pregnancy
		Thrombotic Microangiopathies
		Pyelonephritis
		Obstruction-Related Acute Kidney Injury
	Pregnancy in Women With Chronic Kidney Disease
		Diabetes and Diabetic Kidney Disease
		Lupus Nephritis
		Other Glomerular Diseases
		Nephrotic Syndrome
		Autosomal Dominant Polycystic Kidney Disease
		Dialysis
		Kidney Transplantation
	Kidney Biopsy in Pregnancy
	Key Bibliography
		Bibliography
48 - Management of Kidney Disease in the Elderly
	Epidemiology of CKD in the Elderly
		The Clinical Significance of Moderately Reduced Estimated GFR
		Progression of CKD and Risk of Developing Kidney Failure
	Management of Older Adults with Chronic Kidney Disease
		Treatment Effects and Outcomes Among Older Adults
		Interventions in Older Adults with CKD
		Comorbid Conditions and Geriatric Syndromes
	Chronic Kidney Failure in Older Adults
		Outcomes in Elderly Dialysis Patients
		Dialysis Transitions, Palliative Care, and Hospice
		Transplantation
	Patient-Centered Approach to Treatment Decisions
	Key Bibliography
		Bibliography
49 - Global Kidney Disease
	Introduction
	Acute Kidney Injury
		Causes of Acute Kidney Injury
		Incidence of Acute Kidney Injury
		Mortality in Acute Kidney Injury
		Access to Care for AKI
	Chronic Kidney Disease
		Causes of Chronic Kidney Disease in LMICs
		Integrated CKD Screening within Existing or Developing Infrastructure
		Advancing Management of Chronic Kidney Disease Globally
	Kidney Failure
		Disparities in Access to Kidney Failure Therapy Worldwide
		Access to Kidney Replacement Therapy
		Kidney Transplantation
	Conclusions
	Key Bibliography
	Bibliography
50 - Development and Progression of Chronic Kidney Disease
	Pathophysiologic Mechanisms of Chronic Kidney Disease
		Hemodynamic Injury
		Nonhemodynamic Injury
		Risk Factors for Progression
		Predicting CKD Progression
	Treatment and Prevention of Chronic Kidney Disease Progression
		Antagonism of the Renin-Angiotensin-Aldosterone System
		SGLT2 Inhibition
		Selective Mineralocorticoid Receptor Antagonists (MRAs)
		Blood Pressure Control
		Management of Risk Factors and Complications
		Other Interventions
		Cardiovascular Risk Reduction
	Conclusion
	Key Bibliography
51 - Staging and Management of Chronic Kidney Disease
	Course, Definition, Classification, and Prevalence of Chronic Kidney Disease
		Course of Chronic Kidney Disease
		Definition of Chronic Kidney Disease
		Classification of Chronic Kidney Disease
		Prevalence
	Detection, Evaluation, Predicting Prognosis, and Management
		Detection
		Evaluation
			Evaluation of Duration
			Evaluation of Cause
			Evaluation of Glomerular Filtration Rate
			Evaluation of Albuminuria
		Predicting Prognosis
		Management
			Chronic Kidney Disease Care
			Nephrology Referral
	Key Bibliography
		Bibliography
52 - Nutrition and Kidney Disease
	Nutrient Metabolism in Kidney Disease
		Protein Metabolism and Requirements
			Amino Acid Metabolism
			Protein Intake in Nondialysis CKD Patients
			Protein Restriction in Nondialysis CKD
			Maintenance Dialysis Patients
			Chronic Inflammation
			Metabolic Acidosis
			Hormonal Derangements
		Energy Metabolism and Requirements
		Lipid Metabolism and Requirements
		Mineral, Vitamin, and Trace Element Requirements
	Assessment of Nutritional Status in Chronic Kidney Disease Patients
	Prevention and Treatment of Protein Energy Wasting
	Nutrition in Acute Kidney Injury
	Bibliography
53 - Bone and Mineral Disorders in Chronic Kidney Disease
	Pathogenesis of Abnormal Mineral Metabolism and Secondary Hyperparathyroidism in Chronic Kidney Disease
	Pathogenesis of Bone Disease Associated With Chronic Kidney Disease
	Histologic Classification of Bone Disease in Chronic Kidney Disease
		High-Turnover Bone Disease
		Osteomalacia
		Adynamic Bone Disease
	Epidemiology of Bone Disease
	Clinical Manifestations of Bone Diseases Associated With Chronic Kidney Disease
		Musculoskeletal Manifestations
		Extraskeletal Manifestations
			Calcemic Uremic Arteriolopathy
		Disordered Mineral Metabolism and Mortality in Chronic Kidney Disease
	Diagnosis of Bone Diseases Associated with Chronic Kidney Disease
		Biochemical Parameters
		Bone Biopsy
		Imaging
	Treatment of Mineral and Bone Disorder in Chronic Kidney Disease
		Controlling Serum Phosphorus
		Activating the Calcium-Sensing and Vitamin D Receptors to Suppress Parathyroid Hormone
			Vitamin D Analogues
			Calcimimetics
		Parathyroidectomy
		Chronic Kidney Disease Stages G3 and G4
		Osteoporosis
		Kidney Transplantation
	Key Bibliography
		Bibliography
54 - Cardiac Function and Cardiovascular Disease in Chronic Kidney Disease
	Epidemiology of Cardiovascular Disease in Chronic Kidney Disease
		Chronic Kidney Disease Stages G3 to G4
		Chronic Kidney Disease Stage G5/Dialysis
	Types of Cardiovascular Diseases
	Risk Factors for Cardiovascular Disease
	Ischemic Heart Disease
		Prediction of Ischemic Heart Disease
		Diagnosis
		Prevention and Treatment
			Chronic Kidney Disease Stages G3 to G4
			Chronic Kidney Disease Stage G5/Dialysis
	Left Ventricular Hypertrophy and Heart Failure
		Diagnosis
		Treatment
	Arrhythmia and Sudden Cardiac Death
	Stroke and Stroke Prevention
	Key Bibliography
		Bibliography
55 - Anemia and Other Hematologic Complications of Chronic Kidney Disease
	Anemia
		Epidemiology and Pathogenesis
		Clinical Manifestations
		Laboratory Evaluation
		Erythropoiesis-Stimulating Agents
		Pure Red Cell Aplasia
			Target Hemoglobin Level
		HIF-Prolyl Hydroxylase Inhibitors
		Iron Therapy
		Resistance to Erythropoiesis-Stimulating Agents and Adjuvant Therapy
	Other Hematologic Manifestations of Kidney Disease
		Abnormalities of Hemostasis
		Abnormalities of Leukocytes
	Key Bibliography
	Bibliography
56 - Hemodialysis and Hemofiltration
	##
	Principal Functions of Hemodialysis
	Dialyzer
		Structure
		Principal Functions of the Dialyzer
			Diffusion
			Convection
			Hemofiltration and Hemodiafiltration
			Net Clearance
			Assessing the Dialysis Dose
			Solute Clearance Other Than Urea
			Extracellular Volume Control (Ultrafiltration)
	Dialysate
		Bicarbonate
		Potassium
	Preparing Patients for Maintenance Hemodialysis
		Patient Education and Choice of Therapy
			30-20-10 Program for Dialysis Preparation
			Psychological Factors in Dialysis Initiation
			Choice of Treatment Modalities
		Vascular Access
			Preparation and Timing of Vascular Access
		Types of Arteriovenous Fistulas
			Radiocephalic Arteriovenous Fistulas
			Brachiocephalic and Brachiobasilic Fistulas
			Percutaneous Endovascular Arteriovenous Fistulas
			Alternative Accesses
				Grafts
				Catheters
	Initiation and Prescription of Hemodialysis
		Dialysis Time
		Residual Kidney Function
		Target or “Dry” Weight and Rate of Ultrafiltration
		Dose of Delivered Dialysis
			Potential Errors in Predialysis Urea Measurement
			Potential Errors in Postdialysis Urea Measurement
			Potential Errors in Treatment Time
		Anticoagulation Prescriptions
		Frequency of Dialysis and Alternative Modalities
			Nocturnal Dialysis
			Short Daily Hemodialysis
	Bibliography
57 - Peritoneal Dialysis
	Introduction
	Current State
	Anatomy of the Peritoneal Membrane
	Physiology of PD
		Three-Pore Model of Peritoneal Solute Transport
	Assessment of Peritoneal Solute and Water Transport
		Peritoneal Equilibration Test (PET) and Modifications
	PD Access
		PD Catheter Type and Configuration
		Methods of PD Catheter Placement
	PD Modalities
	PD Solutions
		Conventional Glucose-Based Solutions
		Neutral-pH, Low-GDP Solutions
		Glucose Polymer Solutions
		Amino Acid Solutions
	Prescribing PD
		Residual Kidney Function
		Determining an Initial PD Prescription
	PD Adequacy and Goal-Directed Dialysis
		Optimizing Solute Clearance and Fluid Removal
	Nutrition
	Complications of PD
		Infection
			Peritonitis
			Peritoneal Catheter Exit-Site and Tunnel Infection
		Noninfectious
			PD Catheter Malfunction
			Leaks
			Hernias
			Encapsulating Peritoneal Sclerosis (EPS)
	PD in Special Populations
		Frail and Elderly
		Obesity
		Anuria
		Polycystic Kidney Disease
		Diabetes
		Kidney Transplant Failure
		Ascites
	Key Bibliography
		Bibliography
58 - Conservative Kidney Management
	Introduction
	Elective Ckm Versus Choice-Restricted Care
	Why Patients Choose Ckm
	Discussing Ckm with Patients and Families
		Shared Decision Making
		SHARE Approach
		Prognostication in Advanced Kidney Disease
		Survival with CKM or Dialysis
		Quality of Life with CKM or Dialysis
		End of Life with CKM or Dialysis
	PROVIDING CKM
		Medical Management of CKD
		Symptom Assessment and Management
		Advance Care Planning
	Global Trends and Care Models for Ckm
		CKM Availability
		CKM Care Models
	Challenges and Opportunities in Ckm
	Bibliography
59 - Selection of Prospective Kidney Transplant Recipients and Donors
	Who Should Be Considered for Kidney Transplantation?
		Timing of Referral
	Medical Evaluation for Transplantation
		General Considerations
		Obesity
		Kidney Disease Etiology
		Infection
		Malignancy
		Cardiovascular Disease and Risk Factors
			Peripheral Arterial Disease
			Cerebrovascular Disease
		Liver Disease
		Pulmonary Disease
		Thrombotic Risk
		Urologic Evaluation
		Psychological Evaluation
		Immunologic Considerations Before Transplantation
	Deceased Donor Organs
		Allocation of Deceased Donor Organs in the United States
	Living Kidney Donation
		Living Donor Evaluation Process
			Age of the Living Kidney Donor
			Kidney Function
			Blood Pressure
			Proteinuria
			Hematuria
			Diabetes
			Obesity
			Nephrolithiasis
	Conclusion
	Key Bibliography
	Bibliography
60 - Posttransplantation Monitoring and Outcomes
	Introduction
	Routine Follow-Up
	Monitoring Allograft Function
		Assessment of Allograft Dysfunction
		Immediate (<1 Week) Posttransplant
		Surgical Complications
		Nonsurgical Complications
		Early (1 Week to 3 Months) and Late (>3 Months) Posttransplant Complications
		Alloantigen-Dependent Injury
			Acute Rejection
			Chronic Allograft Nephropathy
		Alloantigen-Independent Injury
			Calcineurin Inhibitor Toxicity
			Viral Infections
			Thrombotic Microangiopathy
			Recurrent and De Novo Glomerular Disease
	Immunosuppression
		Induction Therapy
		Maintenance Therapy
		Treatment of Acute Rejection
		Drug Dosing and Monitoring
		Adverse Effects and Drug Interactions
	Infectious Complications
		Basic Principles
		Vaccination, Prophylaxis, and Preemptive Therapy
	Malignancy
	Diabetes Mellitus
	Cardiovascular Disease
		Hypertension
		Dyslipidemia
		Obesity and Metabolic Syndrome
	Hematologic Complications
		Leukopenia
		Anemia
		Erythrocytosis
		Thrombocytopenia
	Mineral Bone Metabolism and Disease
		Persistent Hyperparathyroidism
		Osteoporosis
	Electrolyte and Acid-Base Disorders
	Hyperuricemia and Gout
	Sexual Function and Fertility
		Pregnancy
		Contraception
	Mental Health
	Key Bibliography
	Bibliography
61 - Immunosuppression in Transplantation
	Physiology of Immunorecognition
	Strategies for Immunosuppression
		Mechanisms of Action of Immunosuppressive Drugs
		Induction Immunosuppression
		Maintenance Immunosuppression
			Glucocorticoids
			Calcineurin Inhibitors
			Antiproliferative/Antimetabolite Agents
			Biologics for Maintenance Immunosuppression
			Small Molecules
		Targeting B Cells and Human Leukocyte Antigen Antibody
		Treatment of Rejection
		Tolerance
	Immune Monitoring
	Key Bibliography
	Bibliography
62 - Infectious Complications of Kidney Transplantation
	Timing of Infectious Complications in Kidney Transplantation
	Donor-Derived Infections and Risk Mitigation Strategies
	Infectious Disease Prevention Strategies
	Common Infectious Complications of Kidney Transplantation
		BK Virus Nephropathy
		Cytomegalovirus
		Diarrhea
		Urinary Tract Infections
	Key Bibliography
	Bibliography
63 - Pathogenesis of Hypertension
	Pathophysiology of Hypertension
		Integration of Cardiorenal Function
		Kidney Mechanisms and Salt Balance
		Total-Body Autoregulation
		Structural Components to Hypertension
		Sympathetic Nervous System, Brain, and Baroreflexes
		Endothelium and Oxidative Stress
		Genetic Contributions
	Implicated Mediators of Hypertension
		Renin, Angiotensin II, and Aldosterone
		Sympathetic Nervous System and Catecholamines
		Dopamine
		Arachidonate Metabolites
		l-Arginine–Nitric Oxide Pathway
		Reactive Oxygen Species
		Endothelins
		Atrial Natriuretic Peptide
		Plasminogen and Plasmin
	Pathogenesis of Hypertension in Chronic Kidney Disease
	Bibliography
64 - Evaluation and Management of Hypertension
	Evaluation of Hypertension
		Measuring Blood Pressure
		Assessing Cardiovascular Risk and End-Organ Damage
		Ambulatory and Home BP Monitoring
	Management of Hypertension
		Lifestyle Modifications
		Medication Nonadherence
		Principles of Pharmacologic Care
		Major Classes of Antihypertensive Agents and Associated Cardiovascular Benefits
			Diuretics
			Renin-Angiotensin-Aldosterone System (RAAS) Blockade
			Calcium Channel Blockers
			Beta-Blockers
			Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors
			Other Agents
		Novel Antihypertensive Therapies
			Baroreceptor Activation Therapy (BAT)
			Renal Denervation (RDN)
	Goal Blood Pressure Levels
		Special Populations
			Women
			Blacks
			Elderly
			Diabetes Mellitus
			Chronic Kidney Disease
			Heart Disease
			Stroke
			Resistant Hypertension
			Obstructive Sleep Apnea
			Obesity
	Conclusion
	Bibliography
65 - Secondary Hypertension
	Definition and Prevalence of Secondary Hypertension
	Clinical Opportunites To Diagnose Secondary Hypertension
	Clinical Syndromes Suggestive of Secondary Hypertension
		Hypertension and Hypokalemia
		Hypertension with a Strong Family History of Hypertension Early in Life
		Hypertension and Obesity
		Drug-Induced Hypertension
		Labile Hypertension or Hypertension With Symptoms of Catecholamine Excess
	Specific Causes of Secondary Hypertension
		Parenchymal Kidney Disease
		Renovascular Disease
			Diagnosis of RAS
			Management of Atherosclerotic RAS
			Fibromuscular Dysplasia
		Primary Aldosteronism
			Biochemical Diagnosis
			Subtype Differentiation
				Interpretation of AVS Results
				Other Testing
		Pheochromocytoma/Paraganglioma (PPGL)
			Biochemical Diagnosis and Imaging of PPGL
			Genetic Testing in PPGL
			Treatment of PPGL
		Other Endocrine Causes of Hypertension
			Cushing Syndrome
			Thyroid Disease
			Primary Hyperparathyroidism
			Acromegaly
		Obstructive Sleep Apnea
		Coarctation of the Aorta and Other Aortopathies
	Key Bibliography
		Bibliography