Main description:

This text aids medical students and trainee doctors in developing their knowledge of the conditions covered and improving their ability to clinically assess patients and formulate a management plan. Once doctors are comfortable in interpreting these graphs, they can use them in consultations with patients about their kidney condition and so support self-management by patients, an increasingly important aspect of healthcare. Kidney diseases and the speciality of nephrology have traditionally been regarded as difficult to understand. This is compounded by the use of complex definitions and terminology.  These complex definitions result from a need to categorise kidney diseases according to the way kidney function changes over time, and then to express this in numbers and words.  Central to the assessment of patients is the measurement of kidney function. In our teaching of medical students and trainee doctors, as well as in our clinical practice and interaction with GPs and consultant colleagues, we have found that viewing graphs of patients’ kidney function (estimated glomerular filtration rate, or eGFR) against time is a much easier way of understanding kidney diseases. It provides the patient’s ‘kidney history’ and leads into a description of the natural history and management of their condition.   We were surprised to find that this graphical approach is not used routinely in teaching or in daily clinical practice. We therefore believe there is a need for a book that uses this approach and we thus sought to compile a collection of illustrative case studies covering an array of disease categories, together with patients’ eGFR readings.

Feature:

​Provides a systematic approach to kidney disease management

Presents a collection of illustrative case studies together with graphical representations of patients kidney function against time to aid trainees in the understanding of kidney diseases, clinical assessment of patients and formulation of management plans

Covers all major clinical issues affecting kidney function in adults that a non-specialist doctor is likely to encounter  

Back cover:

This book provides the essential understanding needed for the assessment of patients with kidney disease. The chapters follow the sequence taken during a clinic consultation and when clerking a patient. At each stage, the principles and concepts underlying aspects of renal medicine that may seem difficult are clearly explained.

Understanding Kidney Diseases includes numerous case studies and charts based upon patients’ data to help students, residents and fellows develop their knowledge and skill in managing patients.

Contents:

​Introduction.- The purpose of the book – understanding the natural history of kidney disease.- how displaying a GFR history is a fundamental part of the clinical assessment of kidney diseases.- how the eGFR graph is used to inform patients and plan treatment.-principles but not details of treatment.- The basics of creatinine measurement and eGFR equations in adults.- Simple guide to the classification of AKI, AKD and CKD.- Stages of CKD – including proteinuria.- The meaning of ‘stability’ in an eGFR graph – variation over time.- Cases.- Section 1: Acute kidney injury – changes over 50% drop, assuming no asymmetry).- Recurrent AKI leading to CKD.- Section 2: AKD – changes >48 hours 3months.- Patterns of progression – Linear and Non-linear.- Monitoring response to treatment – e.g. immunosuppression for GN, BP control in malignant hypertension.- Section 4: CKD – changes over years.- non-progressive (stable) CKD  - e.g. obstructive uropathy.- progressive CKD – e.g. transplant nephropathy, lithium nephrotoxicity, role of proteinuria as risk marker.- Use of graphs to plan future renal replacement therapy – e.g. linear progression in ADPKD.- Section 5: Acute-on-chronic kidney disease.- Chronic slowly progressive diabetic nephropathy with superimposed acute pathology, e.g. response to ACEI/ARB, contrast nephropathy, glomerulonephritis, interstitial nephritis.- Transplant rejection.- Pregnancy in women with CKD.- Section 6: Nephrotic syndrome.- GFR, serum albumin and urinary PCR graphs – use to monitor treatment and relapses, and to plan treatment.- Section 7: Other graphs.- 24 hour BP measurement – importance of nocturnal dip and timing of antihypertensives in CKD care.- Diabetes mellitus - HbA1c – colour coding as patient education tool; role of glucose control in preventing diabetic nephropathy (but no impact once CKD established).- Serum free light chains and myeloma kidney/light chain nephropathy/immune GN.- Conclusions.- eGFR graphs – an essential tool in patient assessment which tells the story of kidney disease.- The role of graphs (eGFR, 24 hour BP, and HbA1c) in patient education and support of self-management.- Role of eGFR graphs in systematic CKD surveillance by renal units and pathology labs – evidence of benefit.