Decreased kidney function may be observed in many settings, including patients with chronic kidney disease (CKD), the elderly with age-related decline in glomerular filtration rate (GFR), and patients with acute kidney injury (AKI). In adults, these conditions are associated with…
Medications are an essential intervention to provide appropriate patient care, and new agents are being introduced into clinical practice at a rapid pace. Although most drugs are well tolerated, kidney injury remains an unfortunate and relatively frequent adverse consequence. Some…
In 1898, W. T. Councilman defined acute interstitial nephritis (AIN) as “an acute inflammation of the kidney characterized by cellular and fluid exudation in the interstitial tissue, accompanied by, but not dependent on, degeneration of the epithelium; the exudation is…
Acute tubular injury (ATI) characterizes damage to renal tubular epithelial cells and is the leading cause of acute kidney injury (AKI) in hospitalized patients. ATI is defined by a sudden decline in kidney function from ischemic or toxic insults and…
Pathophysiology The main causes of acute kidney injury (AKI) are associated with decreased kidney perfusion. A decrease in oxygen delivery severe or prolonged enough to impair cellular function can cause tubular or vascular endothelial dysfunction. The mismatch between oxygen delivery…
Systemic homeostasis is normally maintained by a neurohumoral communication-feedback loop between major organs. Any dysregulation of this organ cross talk can contribute to organ dysfunction during times of illness; that is, injury to one organ can have direct or indirect…
Cardiorenal syndrome (CRS) is a heterogenous disorder that is broadly characterized as interrelated dysfunction of the heart and kidneys. It is predominantly thought of as an entity that occurs in the setting of heart failure, although other cardiac abnormalities such…
Paraproteinemic kidney diseases are typically the result of deposition of immunoglobulins or immunoglobulin fragments (heavy chains and light chains; Fig. 28.1 ) in specific parts of the nephron, and they can be divided generally into those diseases that manifest primarily…
Onconephrology is a growing field within nephrology, with many malignancies and their treatments affecting the kidneys and kidney disease impacting the management of many cancers. Although patients with malignancy can develop kidney diseases similar to other acutely and chronically ill…
## Diabetic kidney disease (DKD) is the leading cause of kidney failure in adults. In the United States, approximately half of patients initiating dialysis have diabetes mellitus, and most of these have type 2 diabetes; patients with youth-onset type 2…