By J. Larry Jameson, Joseph Loscalzo
Nephrology and Acid-Base issues – as simply Harrison’s can hide it
Featuring an excellent compilation of chapters relating to kidney functionality that seem in Harrison’s rules of inner drugs, Eighteenth Edition, this concise, full-color scientific significant other grants the most recent wisdom within the box sponsored through the clinical rigor and authority that experience outlined Harrison’s. you'll find content material from popular editors and participants in a carry-anywhere presentation that's perfect for the school room, medical institution, ward, or exam/certification preparation.
- Sections that mirror the scope of nephrology: advent to the Renal process; changes of Renal functionality and Electrolytes; Acute Kidney harm and persistent Renal Failure; Glomerular and Tubular issues; Renal Vascular affliction; Urinary Tract Infections and Obstruction; and melanoma of the Kidney and Urinary Tract
- Complete insurance of a wide spectrum of themes, together with acid-base and electrolyte issues, vascular damage to the kidney, and particular ailments of the kidney
- Integration of pathophysiology with scientific administration
- 41 high-yield questions and solutions drawn from Harrison’s rules of inner medication Self-Assessment and Board evaluation, 18e
- Content updates and new advancements because the booklet of Harrison’s ideas of inner drugs, 18e
- 22 chapters written by way of physicians who're well-known specialists within the box of nephrology and acid-base issues
- Helpful appendix of laboratory values of medical importance
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Additional info for Harrison's Nephrology and Acid-Base Disorders, 2e
Azotemia Urinary tract obstruction accounts for <5% of cases of acute renal failure, but it is usually reversible and must be ruled out early in the evaluation (Fig. 3-1). Since a single kidney is capable of adequate clearance, obstructive acute renal failure requires obstruction at the urethra or bladder outlet, bilateral ureteral obstruction, or unilateral obstruction in a patient with a single functioning kidney. Obstruction usually is diagnosed by the presence of ureteral and renal pelvic dilation on renal ultrasound.
This circumstance could arise from polydipsia, inadequate secretion of vasopressin (central diabetes insipidus), or failure of renal tubules to respond to vasopressin (nephrogenic diabetes insipidus). If the urine volume is >3 L/d and urine osmolality is >300 mosmol/L, a solute diuresis is clearly present and a search for the responsible solute(s) is mandatory. Excessive filtration of a poorly reabsorbed solute such as glucose, mannitol, or urea can depress reabsorption of NaCl and water in the proximal tubule and lead to enhanced excretion in the urine.
Acutely, there is fibrinoid necrosis of interlobular and larger vessels, with intervening normal vessels and ischemic change in the glomeruli (A). Chronically, this injury leads to intimal proliferation, the so-called onion-skinning appearance (B). ) Atlas of Urinary Sediments and Renal Biopsies B CHAPTER 4 A Figure 4-23 Hemolytic uremic syndrome. There are characteristic intraglomerular fibrin thrombi, with a chunky pink appearance (thrombotic microangiopathy). The remaining portion of the capillary tuft shows corrugation of the glomerular basement membrane due to ischemia.