Manual of Pediatric Nephrology

Manual of Pediatric Nephrology
Kishore Phadke • Paul Goodyer
Martin Bitzan
Editors
Manual of Pediatric
Nephrology
Editors
Kishore Phadke
Department of Pediatric Nephrology
Children’s Kidney Care Center
St. John’s Medical College Hospital
Bangalore, KA
India
Martin Bitzan
Division of Pediatric Nephrology
Montreal Children’s Hospital
McGill University
Montreal, QC
Canada
Paul Goodyer
Division of Pediatric Nephrology
Montreal Children’s Hospital
McGill University
Montreal, QC
Canada
ISBN 978-3-642-12482-2
ISBN 978-3-642-12483-9
DOI 10.1007/978-3-642-12483-9
Springer Heidelberg New York Dordrecht London
(eBook)
Library of Congress Control Number: 2013948392
© Springer-Verlag Berlin Heidelberg 2014
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Foreword I
The International Society of Nephrology strives to improve access to the best possible
kidney care worldwide. An important step is the training of nephrologists and physicians
treating patients with renal diseases. These goals form the basis of the ISN “Global
Outreach” (GO) programs – to build health equality worldwide and improve kidney care
and prevention strategies around the globe by making the knowledge and experience of the
developed world accessible to kidney doctors and other specialists in emerging countries.
Children are a particularly vulnerable population. Unacceptable delays in the
recognition and treatment of (severe) renal disease due to lack of access to basic and
comprehensive care often leads to preventable, acute and chronic adverse effects
caused by malfunctioning kidneys. Kidney disease during infancy to adolescence
due to (intrauterine) malnutrition, genetic inheritance, nephrotoxic agents or poorly
treated primary diseases has devastating, often irreversible, effects on bone health,
growth and intellectual development.
Disparities in preventive and curative or supportive care arise from the lack of
knowledgeable health care professionals, lack of (public) health care resources and
lack of individual financial means to initiate and support therapies that are taken for
granted in more affluent countries.
To come to grips with the global challenge of rising numbers of patients with
renal diseases, the ISN created the Sister Renal Center program pairing emerging
and supporting (established) centers across all continents. As the chair and ardent
supporter of our GO programs, I am proud to witness the involvement of dedicated
pediatric nephrologists in this endeavor.
This Manual is the collaborative product of one of the few and successful pediatric sister center pairs, the Children’s Kidney Care Center at the St. John’s Medical
College Hospital in Bangalore, India, and the Nephrology Division at the Montreal
Children’s Hospital in Montreal, Canada. Written in a collaborative spirit, it emphasizes a global perspective.
May it serve health care professionals, trainees, and physicians to improve the
diagnosis and treatment of children with renal diseases worldwide.
Paul N. Harden
Professor of Nephrology
Chair, International Society of Nephrology Sister Renal Program
Oxford, UK
v
Foreword II
Today, kidney issues dramatically impact global health, especially the health of
children. In developing countries, millions of people – most of them children – die
each year from diseases that are preventable and treatable. For many of these children, kidney problems represent a serious threat to their survival.
Important examples include – but are not limited to – the delayed recognition and
treatment for congenital abnormalities of the kidney and urinary tract, which are a
major cause of chronic kidney disease and secondary health problems; severe fluid
and electrolyte disturbances and acute kidney injury due to diarrhea, the #2 cause of
death in children worldwide; infants with low birth weight in low income groups
due to malnutrition and lack of prenatal care, with an increased risk of small kidneys, hypertension in adolescence and chronic kidney disease; HIV associated
nephropathy, particularly in areas where highly active antiretroviral therapy is not
accessible.
A major goal of the International Pediatric Nephrology Association (IPNA) is to
reach physicians throughout the world through educational and fellowship programs
and enable them to care for children with kidney diseases. This Manual of Pediatric
Nephrology is designed to give pediatrician and general physicians as well as trainees and other health care professionals a quick and practical approach to the diagnosis and treatment of children with different types of kidney diseases. The
well-structured text is easy to read and covers all important areas in the field.
On behalf of IPNA, I welcome this new manual as a valuable resource for practitioners and trainees in (pediatric) nephrology alike. Its appeal lies in the combined
perspective provided by experienced nephrologists from different continents that
takes into account the realities in emerging countries. It corresponds well to IPNA’s
goals to “work to disseminate knowledge about kidney disease in children in the
areas where care is needed most”.
Isidro B, Salusky, M.D.
Secretary General IPNA
Distinguished Professor of Pediatrics
David Geffen School of Medicine at UCLA
Los Angeles, CA, USA
vii
Preface
This manual does not want to replace standard textbooks of nephrology or pediatric
nephrology. Rather, it offers a first, quick and practical approach for the care of
children with kidney disease. It is meant to serve practitioners, trainees, pediatricians, general physicians, and other health care professionals.
The manual is the product of a long-lasting collaboration between two pediatric
nephrology units, the Children’s Kidney Care Center at the Saint John’s Medical
College Hospital (St-John’s) in Bangalore, India, and the Division of Nephrology at
the Montreal Children’s Hospital (MCH) in Montreal, Canada.
The authors approached each chapter with the practical reality in emerging and
resource-poor countries in mind. We hope that this concept renders the manual useful and versatile in a variety of settings and diverse medical practices. To this end,
we are proud of the manual’s endorsement by the International Society of Nephrology
Global Outreach initiative and the support by the International Pediatric Nephrology
Association.
It is unavoidable in a practically oriented, abbreviated book like ours that topics
are missing or only mentioned cursorily. The editors purposefully focused on relatively frequent and clinically important disorders and practical, mainly diagnostic
and therapeutic, aspects. Detailed pathological and pathophysiological reviews
were omitted to keep the text short and lean. The reader is strongly encouraged to
seek in-depth information in more comprehensive textbooks.
The editors appreciate specific suggestions that help improve the utility and ameliorate the shortcomings of this manual. Please, email the editors your comments.
We hope that the global pediatric nephrology community will adopt the manual as
a dynamic, interactive project with input from trainees and practitioners alike.
The editors have an enduring commitment to research and education in pediatric
renal diseases locally and internationally with the ultimate goal of improving children’s access to renal care – irrespective of monetary resources, societal status, or
geography. They are connected through a long-standing collaboration within the
ISN Sister Renal Center program. Kishore Phadke, Professor of Pediatrics and
Nephrology, Director of the Children’s Kidney Care Center and former Chair of
Pediatrics at St-John’s was the driving force behind this manual. He established a
successful, internationally recognized Pediatric Nephrology Training Program,
whose trainees now work across India, and in Sri Lanka, Bangladesh and the Middle
ix
x
Preface
East. Paul R. Goodyer, McGill Professor, former Director of the Division of
Nephrology at the MCH, is a successful investigator of kidney development and
genetic renal diseases with a number of international collaborations, including
St-John’s. Martin Bitzan, Associate Professor of Pediatrics and Pediatric Nephrology
and current Director of the Division of Nephrology and of the Pediatric Nephrology
Training program at the MCH has a focused research and clinical interests in glomerular and systemic renal diseases and international education in pediatric
nephrology.
The editors wish to acknowledge their collaborators from the St-John’s and the
MCH. Their input and contributions were instrumental in the genesis of this manual. Not all of them are named individually. “Thank you” also to the associate/
publishing editors and “midwives” of this oeuvre, Sandra Lesny, Rosmarie Unger,
Marion Krämer, and Dr. Tobias Kemme from Springer, and project manager Steven
Muthu Raj Joe Arun from SPi Global, India, for their patient professionalism. We
apologize to our families, particularly our spouses, for enduring long absences and
distractions associated with this manual and with our clinical work. Last, but not
least, we thank our students and trainees for reminding us of our educational mission, and our patients and their families, who taught us so much and who continue
inspiring us.
Bangalore, India
Montreal, Canada
Montreal, Canada
Kishore Phadke
Paul Goodyer
Martin Bitzan
Contents
1 Evaluation of Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Paul Goodyer and Kishore Phadke
1
2 Fluids, Electrolytes, and Acid–Base Disorders . . . . . . . . . . . . . . . . . . .
Anil Vasudevan and Kishore Phadke
65
3 Glomerular Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Martin Bitzan
4 Tubular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Paul Goodyer
5 Cystic Renal Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Indra Gupta and Martin Bitzan
6 Issues Related to Pediatric Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Arpana A. Iyengar, John-Paul Capolicchio,
Mohamed El-Sherbiny, Roman Jednak,
and Konrad M. Szymanski
7 Hypertension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Martin Bitzan
8 Acute Kidney Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Indra Gupta and Martin Bitzan
9 Chronic Kidney Disease (CKD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Arpana A. Iyengar and Bethany J. Foster
10 Chronic Dialysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
Kishore Phadke, Martin Bitzan, and Sudarshan Shetty
11 Renal Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
Kishore Phadke, Paul Goodyer, and Arpana A. Iyengar
12 Oncology and Kidney. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Anand Prakash and David Mitchell
13 The Kidney and the Tropics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Anita Shet
xi
xii
Contents
14 HIV and the Kidney. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479
Anita Shet
15 Newborn and the Kidney. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
P.N. Suman Rao
16 Nephrotoxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Anil Vasudevan and Nivedita Kamath
17 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533
Jyoti Sharma and Anil Vasudevan
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611
Abbreviations
mg
ABG
ABPM
ACE
ADH
ADH rickets
ADPKD
AG
AKI
ANA
ANCA
anti-DsDNA
anti-GBM antibodies
APLA
ARB
ARH rickets
ARPKD
ATN
ATN
AVP
BE
BMD
BP
BUN
BUN
CAPD
CCPD
CDI
CHD
CKD
Cl
CNI
COX-2
Cr
Micrograms
Arterial blood gases
Ambulatory blood pressure monitoring
Angiotensin-converting enzyme
Anti diuretic hormone
Autosomal dominant hypophosphatemic rickets
Autosomal dominant polycystic kidney disease
Anion gap
Acute kidney injury
Antinuclear antibodies
Anti neutrophilic cytoplasmic antibodies
Anti-deoxyribonuclease B
Anti glomerular basement antibodies
Antiphospholipid antibodies
Angiotensin receptor blocker
Autosomal recessive hypophosphatemic rickets
Autosomal recessive polycystic kidney disease
Acute tubular necrosis
Acute interstitial nephritis
Arginine vasopressin
Base excess
Bone mineral density
Blood pressure
Blood urea nitrogen
Blood urea nitrogen
Continuous ambulatory peritoneal dialysis
Continuous cycling peritoneal dialysis
Central diabetes insipidus
Coronary heart disease
Chronic kidney disease
Chloride
Calcineurin inhibitors
Cyclooxygenase type 2
Creatinine
xiii
xiv
Cr
CTA
CVD
D5
DABP
DBP
DDS
DIC
DKA
DMSA
DRCG
DXA
e GFR
e.g.
EKG
ELBW
ESRD
ESWL
GBM
GCD
GFR
GI
gm
HAART
HBPM
HBPM
HCO3
HIVAN
HTN
HUS
IRIS
kDa
kDa
KIM-1
LDH
LVH
mL
MA
MAG 3
MCKD
mEq
mg
MH
MNE
mosm
Abbreviations
Creatinine clearance
CT angiography
Cerebrovascular disease
5 % dextrose
Diastolic ambulatory blood pressure
Diastolic blood pressure
Dialysis equilibrium syndrome
Disseminated intravascular coagulation
Diabetic ketoacidosis
Dimercaptosuccinic acid
Direct nuclide cystography
Dual-energy X-ray absorptiometry
Estimated GFR
For example
Electrocardiogram
Eextremely low birth weight
End-stage renal disease
Extracorporeal lithotripsy
Glomerular basement membrane
Glomerulocystic disease
Glomerular filtration rate
Gastrointestinal
Gram
Highly active antiretroviral therapy
Hemoglobin
Home blood pressure monitoring
Bicarbonate
HIV-associated nephropathy
Hypertension
Hemolytic uremic syndrome
Immune reconstitution inflammatory syndrome
Kilodaltons
Potassium
Kidney injury molecule −1
Lactic dehydrogenase
Left ventricular hypertrophy
Milliliters
Metabolic acidosis
Mercaptoacetyltriglycine 3
Multicystic kidney disease
Milliequivalent
Milligrams
Masked hypertension
Monosymptomatic enuresis
Milliosmoles
Abbreviations
xv
MRA
MRV
Na
NDI
NGAL
NHBPEP
NPHP
NRTI
NS
ORS
PCNL
PCO2
PET
PH
PI
PO2
PRA
PRA
RBC
rhGH
RPGN
RTA
RTA
SABP
SBP
SIAD
TIN
TmP
TRP
TTKG
UAG
UAG
UOG
UTI
VACTERL
VATER
VCUG
VUR
WBC
XLH rickets
MR angiography
MR venography
Sodium
Nephrogenic diabetes insipidus
Neutrophil gelatinase-associated lipocalin
National high blood pressure education program
Nephronophthisis
Nucleoside reverse transcriptase inhibitor
Normal saline
Oral rehydration solution
Percutaneous nephrolithotomy
Partial pressure of carbon dioxide
Peritoneal equilibration test
Primary hyperoxaluria
Protease inhibitors
Partial pressure of oxygen
Panel reactive antibodies
Plasma renin activity
Red blood cell
Human recombinant growth hormone
Rapidly progressive glomerulonephritis
Renal tubular acidosis
Renal tubular acidosis
Systolic ambulatory blood pressure
Systolic blood pressure
Syndrome of inappropriate antidiuresis
Tubulointerstitial nephritis
Renal tubular phosphate threshold maximum
Tubular reabsorption of phosphate
Transtubular potassium gradient
Urine anion gap
Urinary anion gap
Urine osmolal gap
Urinary tract infection
Vertebral, anorectal, cardiac, tracheoesophageal, renal, limb defects
Vertebral, anorectal, tracheal, esophageal, renal
Voiding cystourethrography
Vesicoureteral reflux
White blood cell
X-linked hypophosphatemic rickets