1. Fluid and Electrolyte Disturbances: Hypo- and Hypernatremia.- I. Normal Physiology of Urinary Dilution.- II. Etiology of Hyponatremia.- A. Factitious Hyponatremia.- B. Redistribution of Water.- C. Hyponatremia with Increased Total Body Salt and Water Content.- D. Hyponatremia with Decreased Total Body Salt and Water Content.- E. Hyponatremia and Normal Total Body Salt and Water Content.- F. Acute Water Intoxication.- III. Treatment of Hyponatremia.- A. Duration of Hyponatremia.- B. Hyponatremia and Diminished Extracellular Fluid Volume.- C. Assessment of Extracellular Fluid Volume and Sodium Deficit.- D. Hyponatremia and Expanded Extracellular Fluid Volume.- E. Inappropriate ADH Secretion.- F. Hypokalemia-Associated Hyponatremia.- IV. Clinical Disorders of Hypernatremia.- A. Sodium Gain.- B. Water Loss.- C. Water Loss in Excess of Sodium Loss.- D. Reset Osmostat.- V. Clinical Manifestations of Hypernatremia.- VI. Treatment of Hypernatremia.- A. Treatment of Hypernatremia Resulting from Sodium Gain.- B. Treatment of Hypernatremia Resulting from Pure Water Loss.- 2. Fluid and Electrolyte Disturbances: Hypo- and Hyperkalemia.- I. Postassium Distribution.- II. Renal Regulation of Potassium Excretion.- III. Extrarenal Potassium Homeostasis.- IV. Clinical Disorders of Hyperkalemia.- A. Factitious Hyperkalemia.- B. Acidemia.- C. Increased Potassium Intake or Release from Cells.- D. Inadequate Distal Delivery of Sodium and Fluid.- E. Renal Failure.- F. Impaired Renin-Aldosterone Axis.- G. Renal Tubular Secretory Defect.- H. Abnormal Potassium Distribution.- V. Treatment of Hyperkalemia.- A. Clinical Manifestations.- B. Acute Treatment of Hyperkalemia.- C. Treatment of Chronic Hyperkalemia.- VI. Hypokalemia: Estimation of Potassium Deficit.- VII. Clinical Manifestations.- A. Cardiac Toxicity.- B. Neuromuscular Manifestations.- C. Renal-Metabolic.- VIII. Etiology and Specific Therapy of Hypokalemia.- A. Diuretics.- B. Other Forms of Renal Losses.- IX. General Treatment of Hypokalemia.- A. Oral Potassium Replacement.- B. Intravenous Potassium Replacement.- C. Antagonists of Potassium Secretion.- 3. Fluid and Electrolyte Disturbances: Hypo- and Hypercalcemia.- I. Physiological Role of Calcium.- A. Physicochemical Aspects.- B. Functions in the Body.- C. Calcium Homeostasis.- II. Hypocalcemia.- A. Causes and Mechanisms.- B. Consequences.- III. Hypercalcemia.- IV. Treatment of Hypo- and Hypercalcemia.- A. Hypocalcemia.- B. Hypercalcemia.- 4. Fluid and Electrolyte Disturbances: Hypo- and Hypermagnesemia.- I. Physiological Role of Magnesium.- A. Physicochemical Aspects.- B. Functions in the Body.- C. Magnesium Homeostasis.- D. Interaction with Other Ions.- II. Hypomagnesemia.- A. Causes.- B. Consequences of Hypomagnesemia.- III. Hypermagnesemia.- A. Causes.- B. Consequences.- IV. Treatment of Hypo- and Hypermagnesemia.- A. Treatment of Magnesium Excess.- B. Treatment of Magnesium Deficiency.- 5. Fluid and Electrolyte Disturbances: Treatment of Hypophosphatemia and Phosphate Depletion.- I. Hypophosphatemia.- A. Relationship to Alcohol.- B. Role of Antacid.- C. Burns.- D. Role of Nutrients.- E. Diabetes Mellitus.- F. Nutritional Recovery Syndrome.- G. Acid-Base Alteration.- II. The Consequences of Acute Hypophosphatemia.- A. Rhabdomyolysis.- B. The Red Cell in Hypophosphatemia.- C. Myocardial Dysfunction.- D. Leukocyte Function during Hypophosphatemia.- E. Platelet Function during Hypophosphatemia.- F. Effects of Hypophosphatemia on the Central Nervous System.- G. Metabolic Acidosis.- H. Osteomalacia.- I. Unproved Consequences of Hypophosphatemia.- J. Mechanism of Cellular Injury in Hypophosphatemia.- III. Treatment of Acute Severe Hypophosphatemia.- A. Clinical Evidence.- B. Experimental Evidence.- IV. Therapeutic Considerations.- 6. Acid-Base Disturbances: Metabolic and Respiratory Acidoses.- I. Introductory Terms and Concepts.- A. Acidity.- B. Acidosis, Alkalosis, Acidemia, Alkalemia.- C. Bicarbonate Space.- D. The Acid-Base Equation.- E. Compensation, the Anion Gap, and Simple and Mixed Disorders.- II. The Acidoses.- A. Effects of Metabolic and Respiratory Acidoses.- B. Metabolic Acidosis.- C. Respiratory Acidosis.- 7. Acid-Base Disturbances: Metabolic and Respiratory Alkaloses.- I. Effects of Alkalosis.- II. Metabolic Alkalosis.- A. Pathogenesis.- B. Pathophysiology.- C. Differential Diagnosis.- D. Management.- III. Respiratory Alkalosis.- A. Pathogenesis.- B. Pathophysiology.- C. Diagnosis.- D. Management.- 8. Disturbances of Uric Acid Metabolism.- I. Introduction.- II. Regulation of Purine Metabolism in Man.- III. Origin of Uric Acid in Man.- A. Exogenous.- B. Endogenous.- IV. Disposition of Uric Acid.- A. Extrarenal.- B. Renal Handling of Uric Acid in Man.- V. Evaluation of Hyperuricemic States.- A. Etiology of Hyperuricemia.- B. Work-up for Hyperuricemia.- VI. Renal Complications of Hyperuricemia.- A. Chronic Gouty Nephropathy.- B. Uric Acid Nephropathy.- VII. Therapy of Hyperuricemic States.- A. Asymptomatic Hyperuricemia.- B. Uric Acid Nephrolithiasis.- C. Acute Uric Acid Nephropathy.- VIII. Hypouricemic States.- A. Decreased Production of Uric Acid.- B. Increased Excretion of Uric Acid.- 9. Management of Glomerulonephritis and Nephrotic Syndrome.- I. Pathogenesis of Glomerulonephritis.- II. Pathophysiology of Nephrotic Syndrome.- A. Proteinuria.- B. Hypoproteinemia.- C. Edema.- D. Hyperlipemia.- E. Lipiduria.- III. General Management of Nephrotic Syndrome and Glomerulonephritis.- A. Edema.- B. Hypoalbuminemia.- C. Hyperlipemia.- D. Drug Metabolism in the Nephrotic Syndrome.- E. Vitamin D, Thyroid, and Iron.- F. Thrombosis.- G. Infection.- H. Proteinuria.- I. Hypertension and Renal Failure.- J. Renal Biopsy.- IV. Treatment of Glomerular Diseases.- A. Minimal-Lesion Nephrosis.- B. Focal Segmental Glomerular Sclerosis.- C. Membranous Nephropathy.- D. Membranoproliferative Glomerulonephritis (Mesangiocapillary Glomerulonephritis, Chronic Hypocomplementemic Glomerulonephritis, MPGN).- E. Rapidly Progressive Glomerulonephritis.- F. Acute Proliferative Glomerulonephritis.- G. Mesangial Proliferative Glomerulonephritis [Including IgA Nephropathy (Berger's Disease), Benign Hematuria, and Some Varieties of Hereditary Glomerular Nephritis].- V. Conclusion.- 10. Drugs and the Kidney: Renal Contribution to Handling of Drugs.- I. Introduction.- II. Determinants of the Relationship between the Dose of a Drug and Its Concentration in Blood.- A. Absorption.- B. Distribution.- C. Elimination.- D. Dosing Interval.- III. Effect of the Kidney on the Distribution of Drugs to Tissues.- IV. Effect of Renal Function on Sensitivity to Drugs.- 11. Drugs and the Kidney: Adjusting Drug Regimens in Patients with Renal Disease.- I. Introduction.- II. Terminology.- III. Quantitative Dose Adjustment.- A. Determination of Creatinine Clearance as an Index of Renal Function.- B. Choice of an Appropriate Dosing Regimen with Selection of Dose and Dosing Interval.- IV. Conclusions.- 12. Infections and Antibiotic Usage in Patients with Renal Diseases.- I. Introduction.- II. The Predisposition to Infection.- A. Renal Failure and Dialysis.- B. Renal Transplant Recipients and Other Patients with Renal Disease Receiving Immunosuppressive Medications.- C. Other Renal Diseases with a Predisposition to Infection.- D. Pathogenesis of Urinary Tract Infections.- III. The Diagnosis of Infections in Patients with Renal Disease.- A. Skin, Mucosal, and Soft Tissue Infections.- B. Respiratory Infections.- C. Endovascular Infections.- D. Gastrointestinal Infections.- E. Urinary Tract Infections.- F. Central Nervous System Infections.- G. Other Sites of Infection.- IV. General Guidelines to Antibiotic Use In Patients with Renal Disease.- A. Pharmacodynamic Principles.- B. Route of Administration: Pharmacological and Drug Interactions.- C. Method of Drug Administration and Serum Concentrations.- V. Clinical Use of Antibiotics in Patients with Renal Disease.- VI. Therapy of Urinary Tract Infections.- A. Uncomplicated Acute Urinary Tract Infections.- B. Symptomatic Female Patient with No Bacteria Seen on Urinary Gram Stain.- C. Pyelonephritis, Upper Tract Disease.- D. Asymptomatic Bacteriuria.- E. Prophylaxis.- 13. Management of Hypertension: Management of Essential and Secondary Hypertension.- I. Introduction.- II. Mechanisms of Essential Hypertension.- III. Management of Essential Hypertension.- A. Nonpharmacological Treatment.- B. Dietary Restriction of Sodium.- C. Antihypertensive Drugs.- IV. Secondary Forms of Hypertension.- A. Oral Contraceptive Use.- B. Hypertension Associated with Renal Parenchymal Disease.- C. Renovascular Hypertension.- D. Primary Aldosteronism.- E. Pheochromocytoma.- F. Miscellaneous Causes.- 14. Management of Hypertension: Hypertensive Emergencies.- I. Introduction.- II. Accelerated and Malignant Hypertension.- A. Clinical Features.- B. Management.- III. Hypertensive Encephalopathy.- A. Clinical Features.- B. Management.- IV. Severe Hypertension Associated with Cerebrovascular Accidents.- V. Acute Aortic Dissection.- A. Clinical Features.- B. Physical Findings.- C. Initial Management.- D. Angiography.- E. Definitive Therapy.- VI. Acute Left Ventricular Failure.- VII. Severe Hypertension Associated with Ischemic Heart Disease.- VIII. Miscellaneous Causes.- A. Pheochromocytoma Crisis.- B. Clonidine Withdrawal Syndrome.- C. Hypertensive Crisis Associated with Drug and Food Interactions.- D. Postoperative Hypertensive Crisis.- E. Severe Hypertension Associated with Burns.- F. Hypertensive Crises in Quadriplegic Patients.- IX. Drugs Used in the Treatment of Hypertensive Crisis.- A. Diazoxide.- B. Nitroprusside.- C. Trimethaphan.- D. Phentolamine.- E. Other Agents.- F. Transition to Oral Therapy.- X. General Approach to the Management and Conclusions.- 15. Hypertension and Renal Disease during Pregnancy.- I. Physiological Changes in Pregnancy.- A. Blood Volume and Arterial Pressure.- B. Humoral Alterations.- C. Renal Blood Flow.- D. Glomerular Filtration Rate.- E. Renal Tubular Function.- F. Acid-Base Balance in Pregnancy.- G. Urinary Concentration and Dilution in Pregnancy.- H. Serum Tonicity during Pregnancy.- II. Anatomic Changes of the Urinary Tract.- III. Renal Disease and Pregnancy.- A. Acute Renal Diseases.- B. Chronic Renal Diseases.- C. Renal Diseases Associated with Systemic Disease.- D. Hereditary Renal Diseases.- E. Renal Calculi.- F. Hemodialysis during Pregnancy.- G. Pregnancy following Renal Transplantation.- IV. Diagnosis of Renal Disorders during Pregnancy.- A. Proteinuria.- B. Hematuria.- C. Pyuria.- D. Renal Biopsy.- E. Other Laboratory Studies.- V. Hypertension during Pregnancy.- A. Essential Hypertension.- B. Primary Aldosteronism (Conn's Syndrome).- C. Renal Artery Stenosis.- D. Coarctation of the Aorta.- E. Pheochromocytoma.- VI. Antihypertensive Drugs.- A. Diuretics.- B. Adrenergic Blocking Drugs.- C. ?- and ?-Adrenergic Blockers.- D. Arteriolar Dilators.- 16. Nutrition in Renal Disease.- I. Introduction.- II. Dietary Protein.- A. Minimum Requirements.- B. Deviations from Minimal Requirements.- III. Nitrogen Metabolism.- A. Nitrogen Balance.- B. Urea.- C. Urea Appearance Rate.- D. Urea Appearance and Nitrogen Balance.- E. Steady-State SUN.- F. Urea Degradation.- IV. Metabolism of Creatine and Creatinine.- A. Creatine Conversion to Creatinine.- B. Other Determinants of Creatinine Production.- C. Chronic Renal Failure.- D. Daily Creatinine Production.- V. Other Nitrogen Waste Products.- A. Ammonia.- B. Uric Acid.- C. Proteinuria.- D. Intestinal Nitrogen Losses.- E. Nonurea Nitrogen.- VI. Importance of Calories.- A. Consequence of Anorexia.- B. Energy Requirements.- VII. Metabolic and Endocrine Abnormalities.- A. Glucose Intolerance.- B. Insulin Metabolism.- C. Hypertriglyceridemia.- D. Treatment of Hypertriglyceridemia.- VIII. Minerals and Electrolytes.- A. Body Fluid Volumes.- B. Sodium.- C. Dietary Salt.- D. Potassium.- E. Divalent Ions.- IX. Vitamins and Trace Metals.- A. Folic Acid and Vitamin C.- B. Pyridoxine and B Vitamins.- C. Vitamin A.- D. Iron.- E. Zinc and Copper.- X. Design of the Diet.- A. Protein Restriction.- B. Representative Diet.- XI. Progression of Renal Insufficiency.- A. Serum Urea Nitrogen Concentration.- B. Serum Creatinine Concentration.- C. Creatinine Clearance.- D. Reciprocal of the Serum Creatinine Concentration.- XII. Nutritional Therapy and Progression of Chronic Renal Failure.- 17. Diagnosis and Therapy of Nephrolithiasis.- I. Introduction.- II. Diagnostic Considerations.- A. Heterogeneity of Chemical Composition of Calculi.- B. Metabolic Classification of Nephrolithiasis.- III. Pathogenesis of Different Causes of Nephrolithiasis.- A. Hypercalciuria.- B. Hyperuricosuria.- C. Hyperoxaluria.- D. Inhibitor Deficiency.- E. Uric Acid Stones.- F. Cystine Stones.- G. Infection Stones.- H. No Metabolic Abnormality.- IV. Diagnosis of Different Causes of Nephrolithiasis.- A. History and Physical Examination.- B. Stone Analysis and Roentgenologic Examination.- C. Description of Ambulatory Diagnostic Protocol.- D.Diagnostic Criteria.- V. Therapeutic Considerations.- A. Mechanism of Action of Therapeutic Modalities.- B. Selective Treatment Programs.- C. General Treatment Measures.- 18. Bone and Mineral Disturbances in Renal Insufficiency.- I. Introduction.- II. Pathogenesis of Renal Osteodystrophy.- A. Secondary Hyperparathyroidism.- B. Phosphate Retention.- C. Alterations in Vitamin D Metabolism.- D. Skeletal Resistance to the Action of Parathyroid Hormone.- E. Impaired Degradation of PTH Secondary to Reduced Renal Function.- F. Altered Feedback Regulation between Ionized Calcium and the Secretion of Parathyroid Hormone.- G. Osteomalacia.- H. Clinical and Biochemical Features of Altered Divalent Ion Metabolism.- I. Bone Histology.- J. X-Ray Features of Secondary Hyperparathyroidism.- K. Radiographic Features of Osteomalacia.- L. Extraskeletal Calcifications.- M. Miscellaneous Determinations of Bone Mineral Content.- III. Prevention and Treatment.- A. Control of Phosphate.- B. Control of Calcium.- C. Use of Vitamin D.- D. Subtotal Parathyroidectomy.- E. Other Treatment Considerations.- 19. Therapy of the Acute Renal Failure Syndrome.- I. Introduction.- II. Prerenal Failure.- A. Evaluation.- B. Diagnostic Challenge.- III. Postrenal Failure.- IV. Renal Failure.- A. Initiating Phase.- B. Oliguric Phase.- C. Diuretic Phase.- D. Recovery Phase.- V. Treatment of Specific Types of Acute Renal Failure.- A. Myoglobinuric Acute Renal Failure.- B. Radiocontrast-Induced Acute Renal Failure.- C. Acute Uric Acid Nephropathy.- D. Multiple Myeloma.- 20. Care of the Chronic Hemodialysis Patient.- I. Introduction.- II. Organ System Disturbances in Chronic Dialysis Patients.- A. Cardiovascular Disturbances.- B. Immunologic Disturbances.- C. Nutrition.- D. Hematological and Coagulation Disturbances.- E. Gastrointestinal Disturbances.- F. Nervous System and Psychiatric Disturbances.- G. Bone and Joint Involvement.- H. Other Endocrine and Metabolic Disturbances.- I. Dermatological Complications.- J. Special Problems.- III. Acute Complications of Hemodialysis.- A. General.- B. Mechanisms of Acute Complications during Hemodialysis.- C. Specific Symptoms.- D. Accidents during Dialysis.- 21. Care of the Patient on Acute and Chronic Peritoneal Dialysis.- I. Introduction.- II. Peritoneal Membrane.- A. Anatomy.- B. Transport.- III. Access to the Peritoneal Cavity.- A. Catheter for Acute Dialysis.- B. Chronic Indwelling Catheters.- C. Complications of Catheter Insertions.- IV. Peritoneal Dialysate Solutions, Accessories, and Machines.- A. Composition of Solutions.- B. Manual Drainage Systems.- C. Automated Peritoneal Dialysis Delivery Systems.- V. Acute Peritoneal Dialysis.- A. Indications.- B. Contraindications.- C. Patient Management during Acute Peritoneal Dialysis.- VI. Chronic Intermittent Peritoneal Dialaysis.- VII. Continuous Ambulatory Peritoneal Dialysis.- A. Definition.- B. Patient Selection.- C. Training and Follow-up.- D. Some Aspects of Medical Management on CAPD.- VIII. Peritonitis and Catheter Tunnel Infections.- A. Incidence.- B. Diagnosis.- C. Cultures and Gram Stains.- D. Treatment.- IX. Complications of Peritoneal Dialysis.- X. Summary.- 22. Care of the Transplant Recipient.- I. Introduction.- II. Preparation of the Transplant Recipient.- A. Immunologic Preparation.- B. Prophylactic Measures against Infectious Complications.- C. Prophylaxis against Gastrointestinal Complications.- D. Bilateral Nephrectomy, Ileal Bladder.- E. Pretransplant Hemo- and Peritoneal Dialysis.- III. Evaluation of the Donor.- A. The Living Related Donor.- B. The Cadaver Donor.- IV. Management of Immediate Posttransplant Complications.- A. Acute Renal Failure.- B. Surgical Complications.- V. Immunosuppression and Rejection.- A. Prophylactic Immunosuppression.- B. Antirejection Therapy.- VI. Infectious Complications.- A. General Causes and Timing of Infections.- B. Viral Infections.- C. Bacterial Infections.- D. Fungal Infections.- E. Protozoan and Parasitic Infections.- VII. Infections-Organ System Involvement.- A. Pulmonary Infection.- B. Central Nervous System Involvement.- C. Oropharynx and the Gastrointestinal Tract.- D. Bacteremia.- E. Hepatitis.- F. Urinary Tract Infections.- G. Skin.- VIII. Intermediate Surgical Problems.- A. Vascular.- B. Renal.- C. Gastrointestinal.- IX. Long-Term Complications.- A. Vascular Complications and Hypertension.- B. Infections.- C. Liver Disorders.- D. Neoplasms.- E. Suicide.- F. Other Medical Problems.- G. Late Loss of the Transplanted Kidney.- H. Return to Dialysis.- I. Causes of Death.