Cover: Lecture Notes: Nephrology by Dr Surjit Tarafdar

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Lecture Notes: Nephrology

A Comprehensive Guide to Renal Medicine


Edited by

Dr Surjit Tarafdar

General Physician and Nephrologist

Blacktown and Mt Druitt Hospital

Blacktown

New South Wales, Sydney, Australia


Conjoint Senior Lecturer

Department of Medicine

Western Sydney University

Sydney, Australia




No alt text required.

To my family for their patience and support. Their belief in my ability helped me to go through those days when I was overwhelmed and exhausted.

List of Contributors

Edwin Anand
Assistant Professor
Jacobs School of Medicine & Biomedical Sciences
The State University of New York at Buffalo
Buffalo, NY, USA

Anthea Anantharajah
Clinical Immunologist / Immunopathologist
The Canberra Hospital, Garran, ACT;
Clinical Lecturer, Australian National Univeresity
Acton, Australia

Dipankar Bhattacharjee
MD(Calcutta), FRCP (Edin), FRCP (Lon), FCPS (B’Desh)
Consultant physician and Nephrologist, NHS, UK
Honorary Senior Lecturer (Ex) United Kingdom

Robert Carroll
Consultant Nephrologist, Central Northern Adelaide
Renal and Transplantation Service, Central Adelaide
LHN, SA Health, Adelaide, Australia

Philip Clayton
Consultant Nephrologist, Central Northern Adelaide
Renal and Transplantation Service, Central Adelaide
LHN, SA Health
Adelaide, Australia

Alexander Gilbert
Advances Trainee in Nephrology, Royal Prince Alfred
Hospital, Sydney, Australia

Pankaj Hari
Professor, Department of Paediatrics, All India
Institute of Medical Sciences, New Delhi, India

Yena Hye
Department of Geriatric Medicine
Nepean‐Blue Mountains Hospital
Penrith, Australia

Rajini Jayaballa
MBChB, FRACP, Staff Specialist in Diabetes and
Endocrinology, Western Sydney Diabetes, Blacktown &
Mount Druitt Hospitals, Sydney, Australia

R. Jayasurya
Consultant Nephrologist, Apollo Gleneagles Hospital
Kolkata, India

Lukas Kairaitis
Head of Renal Services, Blacktown & Mount Druitt
Hospitals, Sydney; Sub‐Dean, Blacktown & Mount
Druitt Clinical School, School of Medicine
Western Sydney University
Sydney, Australia

Amanda Mather
Staff Specialist Renal Physician, Royal North Shore
Hospital
Sydney, Australia

Stephen McDonald
Consultant Nephrologist, Central Northern Adelaide
Renal and Transplantation service, Central Adelaide
LHN, SA Health, Adelaide;
South Australia Executive Officer, ANZDATA Registry,
SA Health and Medical Research Institute;
Clinical Professor, Adelaide Medical School,
University of Adelaide, Adelaide, Australia

Mark McLean
Staff Specialist in Diabetes and Endocrinology,
Blacktown & Mount Druitt Hospitals, Westmead
Hospital, Sydney; Conjoint Professor of Medicine –
Western Sydney University
Sydney, Australia

Karumathil Murali
FRACP, MD Senior Staff specialist in Renal Medicine
Wollongong Hospital; Clinical Associate Professor
Graduate School of Medicine, University of
Wollongong
Wollongong, Australia

M.K. Phanish
Consultant Nephrologist, Renal Services; Lead consultant,
Living Donor Kidney Transplantation, Epsom;
St.Helier University Hospitals NHS Trust; Lead
consultant, Diabetes‐Renal Services, CUH, Epsom, UK

Priyamvada P.S.
Additional Professor, Department of Nephrology
JIPMER, Puducherry, India

Richard J. Quigg
Arthur M. Morris Professor of Medicine and
Biomedical Informatics Chief, Division of Nephrology Jacobs School of Medicine & Biomedical Sciences
The State University of New York, The State University
of New York, Buffalo, NY, USA

Gowri Raman
Current Palliative Care Advanced Trainee, University
of Newcastle
Australia

Wayne Rankin
Chemical Pathologist, SA Pathology and Clinical
Senior Lecturer, Discipline of Medicine, University of
Adelaide
Adelaide, Australia

Vinay Sakhuja
Emeritus Professor, Department of Nephrology, Post
Graduate Institute of Medical Education & Research
Chandigarh, India

Sarah So
Renal Advanced Trainee
Westmead and Blacktown Hospitals
Sydney, Australia

Kamal Sud
Department Head of Renal Medicine, Clinical
Associate Professor
University of Sydney ‐ Nepean Clinical School
Nepean Hospital
Kingswood, Australia

Sanjay Swaminathan
Professor, Clinical Dean, Blacktown & Mount Druitt
Clinical School, Western Sydney University; Clinical
Immunologist, Westmead and Blacktown Hospital
Sydney, Australia

Surjit Tarafdar
Consultant Nephrologist and General Physician,
Blacktown and Mount Druitt Hospital
Blacktown, NSW, Sydney; Conjoint Senior Lecturer
Department of Medicine, Western Sydney University
Sydney, Australia

Muh Geot Wong MBBS, PhD, FRACP
Staff Specialist, Department of Renal Medicine, Royal
North Shore Hospital; Senior Clinical Lecturer
University of Sydney
Sydney, Australia

Foreword

The title ‘Lecture Notes’ undersells the comprehensive nature of this textbook, which fills a largely vacant niche in nephrology bookshelves, between lecture notes for medical students and junior trainees usually covering specific aspects of nephrology, and comprehensive speciality tomes targeted at those requiring specialized knowledge about any or all aspects of nephrology. Lecture Notes: Nephrology is aimed specifically at early‐stage physician trainees who in the Australian system are preparing to undertake the basic physician trainee examination, or more senior trainees who have completed that exam, but are seeking expert knowledge as a trainee in general medicine, or are just starting specialized training in nephrology. However, its reach is much broader than that and it will appeal to anyone wanting to understand nephrology at a level greater than that found in general medical textbooks, including more advanced nephrology trainees, subspecialty nephrologists seeking knowledge beyond their subspecialty, general physicians and nephrologists wishing to brush up on all aspects of nephrology, and teachers of nephrology at any level. Whereas its reach is broad, it does not pretend to cater to those seeking highly specialized knowledge of particular aspects of nephrology. It is full of practical, contemporary information useful for day‐to‐day application on any aspect and at any level of renal diagnosis, investigation and management. Even the nephrologist who has been practising his or her craft for many years will find exciting new gems. In reviewing the book I found myself looking forward to reading each of the chapters at a more leisurely pace, and to applying its new knowledge for teaching and clinical practise.

The authors of Lecture Notes: Nephrology range from international, national and local experts on particular aspects of renal science and its clinical application, to advanced trainees in nephrology who under the supervision of senior colleagues need to have this level of expertise and knowledge for their day‐to‐day supervision of nephrology patients. Each chapter has been reviewed thoroughly by other authors and content experts, and achieves high standards of readability, immediacy and clinical applicability. The chapters cover all aspects of nephrology, including physiology appropriately linked to clinical disease, general nephrology, dialysis and transplantation. Of particular relevance to those preparing for nephrology examinations, and others wishing to test how well they have assimilated the book's new knowledge, is a comprehensive set of multiple choice questions, which have been written by those well placed to do so; that is, trainees preparing for or having recently completed general physician and nephrology examinations.

Surjit Tarafdar and his colleagues have produced a renal textbook of high utility, which will occupy a place of honour on nephrology bookshelves.

Signature of David CH Harris.

David CH Harris
AM, MD (USyd), BS, FRACP
Professor of Medicine,
University of Sydney
Director of Nephrology & Dialysis,
Western Sydney Renal Service
Past‐President, International Society of Nephrology

Acknowledgements

I am indebted to the following groups and individuals for their contributions:

  • The Histopathology Department at ICPMR, Westmead Hospital, Sydney, Australia.
  • Dr Pei Dai, Advanced Trainee in Immunology at Westmead Hospital, Sydney, for the Immunofluorescence slides.
  • Dr Simon Gruenewald, Consultant Nuclear Physician at Westmead Public Hospital, Sydney, and Dr Basim Alqutawneh, Consultant Radiologist at Blacktown Hospital, Sydney, for the radiographs and imaging material.
  • Professor Jeremy Chapman, Associate Professor Gopala Rangan and Dr Brian Nankivell from the Department of Renal Medicine of Westmead Hospital, Sydney, and Professor Ravindra Prabhu A, Department of Nephrology at Kasturba Medical College, Manipal, India, for reviewing portions of the book.
  • Dr Alexander Gilbert, renal Advanced Trainee at Prince Alfred Hospital, Sydney, for proofreading almost the entire book in addition to co‐writing Chapter 14.
  • Lashnika Bandaranayake and Thilan Pasanjith Subasinghe, the wonderful team of fifth‐year medical students from Western Sydney University, who helped with most of the diagrams and illustrations.
  • To the lovely librarians at Blacktown Hospital, Sydney, for letting me stay back in the Peter Zelas Library many a day past closing time.
  • To the following junior doctors and registrars who reviewed the book and provided valuable feedback on the language and content:
    • Dr Shrikar Tummala
    • Dr Tu Hao Tran
    • Dr Hannah Jsu
    • Dr Shaun Khanna
    • Dr Sumreen Nawaz
    • Dr Ye Min Kuang
    • Dr Marlies Pinzon
    • Dr Serge Geara
  • To Yogalakshmi Mohanakrishnan, the project editor from the publisher's office, for her patience, guidance and prompt responses.
  • Finally, I am extremely thankful to Professor David Harris from Westmead Hospital, Sydney. Despite being the President of the International Society of Nephrology at a time when the World Congress of Nephrology was being held in Australia, Professor Harris found time to review the book and provide pearls of wisdom which added immensely to the quality of the finished work.