THERAPY OF RENAL DISEASES AND RELATED DISORDERS
THERAPY OF RENAL DISEASES AND
RELATED DISORDERS
Edited by WADI N. SUKl and SHAUL G. MASSRY
1984 MARTINUS NUHOFF PUBLISHING a member of the KLUWER ACADEMIC PUBLISHERS GROUP
DORDRECHTI BOSTON I LANCASTER
Distributors
for the United States and Canada: Kluwer Boston, Inc., 190 Old Derby Street, Hingham, MA 02043, USA for all other countries: Kluwer Academic Publishers Group, Distribution Center, P.O. Box 322, 300 AH Dordrecht, The Netherlands
Library of Congress Cataloging in Publication Data
Main entry under title:
Therapy of renal diseases and related disorders.
Includes index. 1. Kidneys-Diseases--Treatment. I. Sllki, Walii N.,
1934- • II. Massry, Shaul G. (DNIM: 1. Kidney Diseases--therapy. WJ 300 T398J RC903.T47 1984 616.6'106 84-6130 ISBN·13: 978·1-4613·3809-3 e-ISBN-13: 978-1-4613-3807-9
DOl: 10.1007/978-1-4613-3807-9
Copyright
© 1984 by Martinus Nijhoff Publishing, Boston.
Softcover reprint of the hardcover 1 st edition 1984
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publishers, Martinus Nijhoff Publishing, 190 Old Derby Street, Hingham, MA 02043, USA.
FOREWORD
'Where are all these kidney patients coming from? A few years ago we 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 1960's, 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 cheek' 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 uremia * 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 are want to think of the uremia 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 nephro-logy was inactive. Quite to the contrary, many cases of fruitful science relating to the kidney area not only existed but 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
* Schreiner GE, Maher JF: Uremia, Chemistry and Pathogenesis & Treatment. Charles C Thomas Publisher, Springfield, IL, 1961, p. 24.
v
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 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 didn't 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 physiological substances. In the metabolic school of Nephrology represented perhaps most billiantly 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. erythroproietin, renin, aldosterone, etc.), and indeed the very survival of the human organism. Postwar technology rushed to the fore and supplied nephrologists with such wonderful tools as the flamephotometer, electrophoresis, microchemistry, immunoassay, sonography, renal biopsy, immunofluorescence, electronmicroscopy, nuclear magnetic resonance and permitted a total integration of form, histological 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 rationally 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, with the book
VI Foreword
to follow, Dr. Suki and Dr. Massry have fulfilled that hope with a book 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 'The 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 acid-base 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 counselling 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.
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 today there are in excess of 200,000 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. These 200,000 plus persons and their families, who have intimate, repetitive personal experiences with uremia, serve as living witnesses 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, and 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 patient 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 which is unique among many books available today. This is a book which thinks positively. This is a book which 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. Professor of Medicine Director, Division of Nephrology Georgetown University School of Medicine
PREFACE
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 state-of-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.
Wadi N. Suki Shaul G. Massry
Foreword ..
Preface ...
Contributors
CONTENTS
PART ONE: DISORDERS OF FLUID, ELECTROLYTE, AND ACID-BASE BALANCE
1. Treatment of hypoosmolar and hyperosmolar states MOSHE LEVI, DANIEL G. BICHET and TOMAS BERL
2. Polyuric syndromes DOUGLAS R. WILSON . . . . . . . . . . . . .
3. Treatment of edematous states JULES B. PUSCHETT and ARTHUR GREENBERG
4. Therapy and management of acute renal failure DONALD F. NORTMAN and STANLEY S. FRANKLIN
5. Disorders of potassium metabolism JEROME P. KASSIRER and JAY B. WISH
6. Hypocalcemia and hypercalcemia MARK R. HUGHES and WADI N. SUKI
7. Hypomagnesemia and hypermagnesemia SHAUL G. MASSRY ........ .
8. Hyper- and hypophosphatemia NACHMAN BRAUTBAR and CHARLES R. KLEEMAN
9. Metabolic alkalosis SANDRA SABATINI and NEIL A. KURTZMAN ....
10. Metabolic acidosis MANUEL A. CRUZ-SOTO and MANUEL MARTINEZ-MALDONADO
11. Renal tubular acidosis ELISABETH M. McSHERRY ....... .
12. Respiratory acid-base disorders HORACIO 1. ADROGUE and WADI N. SUKI
PART TWO: INTRINSIC PARENCHYMAL DISEASE
A. Glomerular 13. The acute glomerulonephritis syndrome
V
VII
XIII
23
31
47
63
83
101
105
131
145
155
173
JOEL NEUGARTEN and DAVIS S. BALDWIN 183
14. The management of the nephrotic syndrome WAYNE A. BORDER and RICHARD 1. GLASSOCK 195
15. The treatment of rapidly progressive crescentic glomerulonephritis and of Goodpasture's syndrome J. STEWART CAMERON ...... .................... 209
IX
X Contents
B. Tubulo-interstitial
16. The management of urinary tract infections MARVIN FORLAND ..... .
17. Vesicoureteral reflux and reflux nephropathy PRISCILLA KINCAID-SMITH .
18. Management of genitourinary tuberculosis HERMAN WECHSLER
PART THREE: RENAL INVOLVEMENT IN SYSTEMIC DISEASE
19. Systemic lupus erythematosus DAVID P. HUSTON
20. Vasculitic diseases of the kidney
221
235
255
259
JAMES E. BALOW and HOWARD A. AUSTIN III 273
21. Noninflammatory vascular diseases of the kidney GARABED EKNOYAN ............ 283
22. Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura EDWARD D. GOMPERTS and ELLIN LIEBERMAN 297
23. Renal involvement in dysproteinemias FRANCISCO LLACH and SOLOMON PAPPER 315
24. The hyperuricemic nephropathies WILLIAM E. SMITH and THOMAS H. STEELE 327
25. Therapy of renal disorders in liver disease MURRAY EPSTEIN ............ 335
26. Management of renal complications of pregnancy: Management of pregnancy in renal disease, in patients undergoing chronic haemodialysis and in renal transplant patients
JOHN M. DAVISON, ADRIAN I. KATZ and MARSHALL D. LINDHEIMER 347
27. Therapy of diabetic renal disease ELI A. FRIEDMAN . . . . . . . . . . . . . . . . . . . . . . . . . . 371
PART FOUR: HEREDITARY AND CONGENITAL DISEASE
28. Management of renal cystic disorders JARED J. GRANTHAM and SHARON L. SLUSHER
29. Therapy of renal disorders in sickle hemoglobinemia ROBERT M. ROSA .............. .
PART FIVE: NEOPLASIA
30. Neoplasia: Cancers of the kidney, renal pelvis and ureter, bladder and prostate PETER T. SCARDINO and C. EUGENE CARLTON, Jr. . ....
PART SIX: CHEMICAL AND PHYSICAL INJURIES
31. Therapy of toxic nephropathies JOHN F. MAHER
32. Treatment of acute drug intoxications with hemodialysis and hemoperfusion WARREN D. DAVIDSON . . . . . . . . . . . . . . . . . .
383
405
413
429
451
Contents XI
PART SEVEN: UREMIA
33. Nutritional management .. ANDERS ALVESTRAND and JONAS BERGSTROM . 459
34. Cardiovascular complications of uremia and dialysis J. CARLOS A YUS, J. PEDRO FROMMER and JAMES B. YOUNG 481
35. The management of renal insufficiency WOLFGANG TSCHOPE and EBERHARD RITZ 495
36. Management of renal osteodystrophy KIYOSHI KUROKA WA . . . . . . . . . . . 505
37. Peritoneal dialysis RAMESH KHANNA and DIMITRIOS G. OREOPOULOS 515
A. Hemodialysis
38. Dialysis access surgery GEORGE P. NOON and H. DAVID SHORT 533
39. Dialyzers and water treatment N.K. MAN and J.L. FUNCK-BRENTANO 545
40. Dialysis, ultrafiltration and hemofiltration N. A. HOENICH and S. RINGOIR ... 555
41. Use of drugs in uremia and dialysis WILLIAM A. BRIGGS, FRANKLIN D. McDONALD, DALE H. SILLIX and MARGARET L. MacDOUGALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 567
B. Transplantation and transplantation complications
42. Donor and recipient selection in renal transplantation JEAN CROSNIER and HENRI KREIS . . . . . . . . . . .
43. Immunosuppression and treatment of rejection in renal transplantation YVES F. Ch: VANRENTERGHEM and MARK J.A. WAER
44. Renal tubular and metabolic dysfunction following kidney homotransplantation J. GREEN, D. AGMON and O.S. BETTER . . . . .
45. Transplantation complications: Infectious, malignant, surgical ISRAEL PENN . . . . . . . . . . . .
46. Nephrolithiasis and nephrocalcinosis JOAN H. PARKS and FREDRIC L. COE
PART EIGHT: MISCELLANEOUS
47. The catheter JOHN A. HEANEY and EDWIN M. MEARES, Jr.
48. Non-surgical management of vesicourethral dysfunction LEONARD D. GAUM and WILLIAM R. FAIR
Index
587
595
617
631
651
669
681
695
Horacio J. Adrogue, M.D. Associate Professor of Medicine Renal Section Baylor College of Medicine The Methodist Hospital Houston, TX 77030, USA Chapter 12
D. Agrnon, M.D. Department of Nephrology Rambam Medical Center Technicon, School of Medicine Haifa, Israel Chapter 44
Anders Alvestrand, M.D. Karolinska Institute Huddinge University Hospital 141 86 Huddinge, Sweden Chapter 33
Howard A. Austin III, M.D. Attending Nephrologist Clinical Nephrology Service National Institutes of Health Bethesda, MD 20205, USA Chapter 20
Juan Carlos Ayus, M.D., F.A.C.P. Assistant Professor Chief Renal Service Ben Taub General Hospital Baylor College of Medicine Houston, TX 77030, USA Chapter 35
David S. Baldwin, M.D. Professor of Medicine Director, Hypertension & Renal Disease Section New York University Medical Center New York, NY 10016, USA Chapter 13
James E. Balow, M.D. Chief, Clinical Nephrology Service Senior Investigator, NIADDK National Institutes of Health Bethesda, MD 20205, USA Chapter 20
Jonas Bergstrom, M.D. Professor of Renal Medicine Director the Department of Renal Medicine Karolinska Institute Huddinge University Hospital 86 Huddinge, Sweden Chapter 33
CONTRIBUTORS
Tomas Berl, M.D. Associate Professor of Medicine University of Colorado Health Sciences Center Denver, CO 80262, USA Chapter 1
O.S. Better, M.D. Dean Faculty of Medicine Technicon-Israel Institute of Technology and the B. Rappapor Institute for Research in the Medical Sciences Chief Department of Neprhology Rambam Hospital Haifa, Israel Chapter 44
Daniel G. Bichet, M.D. Assistant Professor of Medicine Hopital du Sacre-Creur Montreal PQ, Canada Chapter 1
Wayne A. Border, M.D. Chief, Department of Nephrology University of Utah Salt Lake City, UT 84113, USA Chapter 14
Nachman Brautbar, M.D. Associate Professor of Medicine and Pharmacology Director of Renal Research Laboratory University of Southern California School of Medicine Los Angeles County Medical Center Los Angeles, CA 90033, USA Chapter 8
William A. Briggs, M.D. Byrnes Medical Center Petosky, MI 49770, USA Chapter 41
XIII
XIV Contributors
1. Stewart Cameron, M.D. Professor of Renal Medicine Consultant Physician Director of Clinical Science Laboratories Guy's Hospital Medical School London Bridge London SEI 9RT, UK Chapter 15
C. Eugene Carlton, Jr., M.D. Professor and Chairman Department of Urology Baylor College of Medicine Houston, TX 77030, USA Chapter 30
Fredric L. Coe, M.D. Professor, Medicine & Physiology Director, Nephrology University of Chicago Billings & Michael Reese Hospitals 29th Street and Ellis Ave Chicago, IL 60616, USA Chapter 46
Jean R. Crosnier, M.D. Professor Head, Department of Nephrology Universite Rene Descartes Hopital Necker 161 rue de Sevres F-75730 Paris, France Chapter 42
Manuel A. Cruz-Soto, M.D. Assistant Professor of Medicine Staff Nephrologist University of Puerto Rico School of Medicine V A Medical & Regional Office Center San Juan, Puerte Rico 00936 Chapter 10
Warren D. Davidson, M.D. Professor of Medicine UCLA School of Medicine Director, Dialysis Facilities Harbor-UCLA Medical Center Los Angeles, CA 90033, USA Chapter 32
1.M. Davison, M.D. Scientific Staff, Medical Research Council Human Reproduction Group Consultant Obstetrician and Gynaecologist Princess Mary Maternity Hospital and Royal Victory Infirmary Newcastle upon Tyne, NE2 3BD, UK Chapter 26
Garabed Eknoyan, M.D. Professor of Medicine Department of Medicine Section of Nephrology Baylor College of Medicine Houston, TX 77030, USA Chapter 21
Murray Epstein, M.D. Professor of Medicine Associate Chief Nephrology Section University of Miami School of Medicine Miami, FL 33125, USA Chapter 25
William R. Fair, M.D. Professor and Chairman Division of Urology Washington University School of Medicine 4960 Audubon Drive S1. Louis, MI 63110, USA Chapter 48
Sidney S. Franklin, M.D. Adjunct Professor of Medicine University of California at Los Angeles School of Medicine Associate Director of Hypertension UCLA Center for the Health Sciences Los Angeles, CA 90033, USA Chapter 4
Marvin Forland, M.D. Professor of Medicine Deputy Chairman for Clinical Activities Associate Dean for Clinical Affairs University of Texas Health Science Center San Antonio, TX 78284, USA Chapter 16
Eli A. Friedman, M.D. Professor of Medicine Renal Diseases Division Downstate Medical Center Brooklyn, NY 11203, USA Chapter 27
1. Pedro Frommer, M.D. Instructor of Medicine Section of Nephrology University of Illinois Chicago, IL 60612, USA Chapter 34
Jean-Louis Funck-Brentano, M.D. Professor of Nephrology Director INSERM Research Laboratory on Renal Diseases Universite Rene Descartes Faculte de Medecine Necker-Enfants-Malades Hopital Necker 161 rue de Sevres F-7S730 Paris, France Chapter 39
Leonard D. Gaum, M.D., F.R.C.S.(c) Assistant Professor of Surgery/Urology Washington University School of Medicine The Jewish Hospital of S1. Louis 4960 Auduban Drive S1. Louis, MI 63110, USA Chapter 48
Richard 1. Glassock, M.D. Professor of Medicine Chairman, Department of Medicine UCLA School of Medicine Harbor-UCLA Medical Center Torrance, CA 90509, USA Chapter 14
Edward D. Gomperts, M.D. Associate Hematologist Division of Hematology/Oncology Childrens Hospital of Los Angeles and Associate Professor of Clinical Pediatrics & Pathology University of Southern California School of Medicine Los Angeles, CA 90054, USA Chapter 22
Jared 1. Grantham, M.D. Professor of Medicine Director Division of Nephrology University of Kansas School of Medicine College of Health Sciences and Hospital Kansas City, KS 66103, USA Chapter 28
1. Green, M.D. Department of Nephrology Rambam Medical Center Technion, School of Medicine Haifa, Israel Chapter 44
Arthur Greenberg, M.D. Assistant Professor of Medicine Univesity of Pittsburgh School of Medicine Pittsburg, PA 15260, USA Chapter 3
John A. Heaney, M.D. Associate Professor Divison of Urology Tufts University School of Medicine New England Medical Center Boston, MA 02111, USA Chapter 47
Nicholas Hoenich, Ph.D Lecturer in Clinical Science Department of Medicine University of Newcastle-upon-Tyne Newcastle upon Tyne, NEI 4LP, UK Chapter 40
Mark Hughes Assistant Professor of Cell Biology Department of Cell Biology Baylor College of Medicine Houston, TX 77030, USA Chapter 6
David P. Huston, M.D. Assistant Professor of Medicine, Microbiology and Immunulogy Director, Immunotherapy Unit Baylor College of Medicine The Methodist Hospital Houston, TX 77030, USA Chapter 19
Jerome P. Kassirer, M.D.
Contributors XV
Professor of Medicine and Associate Chairman Department of Medicine Associate Physician-in-Chief Department of Medicine and Senior Physician Renal Division and Clinical Decision Making Division Tufts University School of Medicine New England Medical Center Boston, MA 02111, USA Chapter 5
Adrian I. Katz, M.D. Professor of Medicine The University of Chicago Chicago, IL 60637, USA Chapter 26
Ramesh Khanna, M.D. Associate Professor of Medicine Department of Medicine University of Missouri Health Science Columbia, MO 65212, USA Chapter 37
Priscilla Kincaid-Smith, M.D. Professor Department of Medicine University of Melbourne and Director of Nephrology Royal Melbourne Hospital Parkville, Victoria, Australia 3050 Chapter 17
Charles R. Kleeman, M.D. Professor of Medicine Director of the Center for Health Enhancement Factor Family Foundation UCLA School of Medicine The Center for the Health Sciences Los Angeles, CA 90024, USA Chapter 8
Henri A. Kreis, M.D. Associate Professor Director of Transplantation Unit Department of Nephrology Universite Rene Descartes Hopital Necker 161 rue de Sevres F-75730 Paris, France Chapter 42
XVI Contributors
Kiyoshi Kurokawa, M.D. Professor of Medicine Chief, Nephrology Section UCLA School of Medicine V A Wadsworth Hospital Los Angeles, CA 90073, USA Chapter 36
Neil A. Kurtzman, M.D. Professor of Medicine & Physiology Chief, Section of Nephrology University of Illinois College of Medicine Chicago, IL 60612, USA Chapter 9
Moshe Levi, M.D. Assistant Professor of Medicine V A Medical Center Dallas, TX 75216, USA Chapter 1
Ellin Lieberman, M.D. Head, Division of Nephrology, Dialysis and Transplantation Childrens Hospital of Los Angeles and Professor of Pediatrics University of Southern California School of Medicine Los Angeles, CA 90054, USA Chapter 22
Marshall D. Lindheimer, M.D. Professor of Medicine and Obstetrics & Gynecology University of Chicago Pritzker School of Medicine University of Chicago Hospitals and Clinics Chicago, IL 60637, USA Chapter 26
Francisco Llach, M.D. Professor of Medicine Chief, Nephrology University of Oklahoma Health Science Center Chief, Nephrology VA Hospital Oklahoma City, OK 73190, USA Chapter 23
Margaret L. MacDougall, M.D., Ph.D. Assistant Professor of Medicine University of Kansas Medical Center Kansas City, Kansas Assistant Chief of Nephrology Veteran's Administration Kansas City, MS 66103, USA Chapter 41
John F. Maher, M.D. Professor of Medicine Director, Nephrology Division Uniformed Services University of the Health Sciences Bethesda, MD 20814, USA Chapter 31
N.K. Mann, M.D. Department of Nephrology Hopital Necker 161 rue de SCvres F-75730 Paris, France Chapter 39
Manuel Martinez- Maldonado, M.D. Professor of Medicine & Physiology Chief, Medical Service University of Puerto Rico School of Medicine V A Medical & Regional Office Center San Juan, Puerte Rico 00936 Chapter 10
Shaul G. Massry, M.D. The Bernard J. Hanley Professor of Medicine Professor of Physiology and Biophysics Chief, Division of Nephrology University of Southern California School of Medicine Los Angeles, CA 90033, USA Chapter 7
Franklin D. McDonald, M.D. Professor and Vice-Chairman Department of Internal Medicine Wayne State University School of Medicine Chief of Medicine Hutzel Hospital Detroit, MI 48201, USA Chapter 41
Elisabeth McSherry, M.D. HSRD V A Hospital 1400 VFW Parkway West Roxbury, MA 02132, USA Chapter 11
Edwin M. Meares, Jr., M.D. Professor and Chairman Department of Urology Tufts University School of Medicine New England Medical Center 171 Harison Ave Boston, MA 02111, USA Chapter 47
Joel Neugarten, M.D. Asistant Professor of Medicine New York University Medical Center School of Medicine Department of Medicine New York, NY 10016, USA Chapter 13
George P. Noon, M.D. Professor of Surgery Baylor College of Medicine The Methodist Hospital 1200 Moursund Houston, TX 77030, USA Chapter 38
Donald F. Nortman, M.D. Assistant Oinical Professor of Medicine University of California at Los Angeles School of Medicine Los Angeles, CA 90033, USA Chapter 4
Dimitrios G. Oreopoulos, M.D., Ph.D. Professor of Medicine University of Toronto Director, Peritoneal Dialysis Program Toronto Western Hospital Toronto, Ontario, Canada Chapter 37
Solomon Papper, M.D. Distinguished Professor of Medicine Head, Department of Medicine University of Oklahoma College of Medicine VA Medical Center Oklahoma City, OK 73190, USA Chapter 23
Joan H. Parks, M.B.A. Project Coordinator Nephrolithiasis Program University of Chicago Billings & Michael Reese Hospitals 29th Street and Ellis Ave Chicago, IL 60616, USA Chapter 46
Israel Penn, M.D. Professor of Surgery Chief of Surgery V A Medical Center University of Cincinnati Cincinnati, OH 45267, USA Chapter 45
Jules B. Puschett, M.D. Professor of Medicine Director, Renal-Electrolyte Division University of Pittsburgh School of Medicine Presbyterian-University & V A Hospitals Pittsburgh, PA 15260, USA Chapter 3
S. Ringoir, M.D., Ph.D. Professor of Medicine Chairman of Medicine Director Renal Division University of Gent University Hospital De Pintelaan 135 B-9000 Gent, Belgium Chapter 40
Professor Dr. Med. Eberhard Ritz Chief Department of Nephrology University of Heidelberg D-69oo Heidelberg, FRG Chapter 35
Robert M. Rosa, M.D. Assistant Professor of Medicine Associate Director Clinical Research Center Harvard Medical School Beth Israel Hospital Boston, MA 02215, USA Chapter 29
Sandra Sabatini, Ph.D., M.D. Assistant Professor of Medicine Medical Director, Hemodialysis Unit University of Illinois College of Medicine Chicago, IL 60612, USA Chapter 9
Peter T. Scardino, M.D. Associate Professor of Urology Department of Urology Baylor College of Medicine Houston, TX 77030, USA Chapter 30
H. David Short, M.D. Assistant Professor of Surgery Baylor College of Medicine 1200 Moursand Houston, TX 77030, USA Chapter 38
Dale H. Sillix, M.D. Nephrology Research Fellow Wayne State University School of Medicine Detroit, MI 48201, USA Chapter 41
Sharon Slusher, R.N., B.S.N. Nephrology Nurse Oinician University of Kansas School of Medicine College of Health Sciences & Hospital Kansas City, KS 66103, USA Chapter 28
William E. Smith, M.D. Fellow in Nephrology University of Wisconsin Department of Medicine Madison, WI 53792, USA Chapter 24
Thomas H. Steele, M.D. Professor of Medicine University of Wisconsin Department of Medicine Madison, WI 53792, USA Chapter 24
Wadi N. Suki, M.D. Professor of Medicine and Physiology Chief, Renal Section Baylor College of Medicine The Methodist Hospital Houston, TX 77030, USA Chapter 12
Contributors XVII
XVIII Contributors
PD Dr. Med. Wolfgang Tschope Department of Internal Medicine Division of Nephrology University of Heidelberg (Ruperto Carola) Heidelberg, FRG Chapter 35
Yves Vanrenterghem, M.D. Joint Clinical Head Department of Nephrology and Renal Transplantation Universitair Ziekenhuis St. Rafael K.u. Leuven Kapucijnenvoer 33-35 B-3ooo Leuven, Belgium Chapter 43
Mark J.A. Waer, M.D. Department of Nephrology and Renal Transplantation Universitair Ziekenhuis St. Rafael K.U. Leuven Kapucijnenvoer 33-35 B-30oo Leuven, Belgium Chapter 43
Herman Wechsler, M.D. Clinical Associate Professor of Urology Albert Einstein School of Medicine Einstein College Hospital Bronx, NY 10468, USA Chapter 18
Douglas R. Wilson, M.D., F.R.C.P. Professor of Medicine University of Toronto Head, Division of Nephrology Toronto General Hospital 101 College Street Toronto, Ontario M5G IL7, Canada Chapter 2
Jay Wish, M.D. Nephrology Division Case Western Medical School Cleveland, OH 44106, USA Chapter 5
James B. Young, M.D. Assistant Professor of Medicine Baylor College of Medicine Chief, Cardiology Section Ben Taub General Hospital Houston, TX 77030, USA Chapter 34