The prevalence of Diabetes Mellitus is increasing rapidly all over the world and more so in the developing countries. The global burden of diabetes is expected to double between 2000 and 2030, with the greatest increases in prevalence occurring in the Middle East, sub-Saharan Africa and India. Moreover, the development of type 2 diabetes during the childbearing years is also likely to increase, primarily in the developing countries. It has already been established that Diabetes is the most common primary cause leading to end stage renal disease (ESRD) and Diabetic Nephropathy is the leading cause of chronic kidney disease (CKD) in India. The cornerstones of management of Diabetic Kidney Diseases include early diagnosis of diabetic nephropathy, prevention of its progression and treatment of the co-morbid conditions. Substantial under-diagnosis of both diabetes and chronic kidney disease leads to lost opportunities for prevention. An inadequate or inappropriate care of patients with diabetic kidney disease contributes to disease progression eventually up to a stage that requires renal replacement therapy, which is not a feasible option for many on a long-term basis, especially in a developing country like ours. This book covers various aspects of diabetic kidney disease in detail and attempts to familiarize the reader with the existing aspects of the conditions as well as touch upon the new advances in the field. The first chapter outlines the extent to which the condition affects the population globally as well as in our country. The second chapter explores the underlying mechanism by which the disease starts and progresses and the pathological markers of the same. The third chapter delineates the clinical and diagnostic markers of the condition. The fourth and fifth chapters speak of the non-diabetic glomerular and non-glomerular diseases in diabetics. The sixth chapter addresses the most important and desirable goal of preventing the progression and ideally the onset of the disease. The seventh chapter puts together the various treatment modalities available and the subsequent chapter explores the management options for cases requiring renal replacement. In addition to the emphasis to Indian literature at the end of each chapter, the ninth chapter is specially included to highlight the salient aspects of this condition from the Indian perspective. This book will be beneficial not only for the nephrologists, but also for the epidemiologists, medical students, diabetologists and every doctor who deals with diabetes mellitus.

There are certain structural and functional changes that develop in the urinary tract during normal regnancy, which are significantly different than non-pregnant normal females. During pregnancy in women with underlying chronic kidney disease (CKD), the adaptation to these changes may not be optimal. Under these circumstances, the pregnancy outcome as well as maternal CKD may be affected. The issue focuses on the physiological changes in the kidney and assessment of proteinuria and GFR during pregnancy. The current update also details the cases of pregnancy in the setting of CKD describing the effect of CKD on pregnancy as well as effect of pregnancy on CKD. The chapter on pregnancy-induced hypertension―Pre-eclampsia focuses on the prevention and management of complications in the patient. The authors also give an insight into the pregnancy in cases after kidney transplantation.

Anemia in Chronic Kidney Disease - ECAB

Hypertension is fast becoming a pandemic of enormous proportions, and its sequelae of cardiovascular and cerebrovascular adverse events is making it a leading cause of morbidity and mortality worldwide. The interrelationship of hypertension and kidney changes though established for quite some time, the exact mechanisms and causality are still being discovered. The role of kidney as evidenced by subtle changes in the initiation of ‘primary hypertension’ is increasingly being scrutinized. The effects of established renal causes that induce hypertension such as renal artery stenosis are well established. Pediatric population is also no longer immune to this potentially debilitating condition. This book will help the readers to: Understand the intricacies of the genesis of hypertension and its effects on the kidney Explore the various established guidelines and newer promising aspects in diagnosis and management of hypertension and the kidney changes Know the newer emerging concepts in the treatment of hypertension in the pediatric population Enlighten them about the benefits of timely management of the condition to prevent its progression to end-stage kidney disease, which requires expensive and invasive interventions not suitable to majority of population in a developing country like ours. This book aims to guide the practitioner to diagnose and manage hypertension in the setting of suspected, diagnosed, or established kidney disease with special reference to practical experience in India.

Optimal nutrition is essential for maintaining the structural and functional integrity of all the organs and systems in the body. This is especially relevant in disease and dysfunctional states when the functioning of organ systems is compromised. This clinical update handbook aims to discuss and debate the impact of nutrition, describe methods for assessment of nutritional status and recommend the diet modifications helpful in managing various types of kidney diseases and dysfunctions. The first chapter of this book describes the various components of a healthy diet when there is no kidney disease or dysfunction. The chapter 2, 3, 4, and 5 provide a brief but relevant review of the dietary modifications and restrictions recommended in diabetic nephropathy, hypertensive nephropathy, renal stone disease, and nephrotic syndrome respectively. The two subsequent chapters 6 and 7 speak of the nutritional modifications indicated in management of acute injury of kidney and chronic kidney disease. The 8 and 9 chapters describe the dietary modifications that are compatible with the two types of dialysis, hemodialysis and peritoneal dialysis. The final chapter of the book describes the dietary recommendations and restrictions applicable before and after kidney transplantation. This book will help the readers understand the intricacies of the aspects mentioned above and guide the practitioner to diagnose and manage the nutritional aspect of various kidney diseases with special reference to practical experience in India. The authors have put together the most relevant facts about the disease for an easy comprehension and understanding of primary glomerular diseases by practitioners and students across the specialty.

With the increase in lifestyle-related diseases like diabetes and hypertension the prevalence of Chronic Kidney Disease (CKD) is increasing exponentially and with it is increasing the burden of its ominous consequence, End Stage Renal Disease (ESRD). While ESRD is no longer a death sentence with the advent of efficient renal replacement therapies and the success of renal transplantation, factors such as high cost of these procedures, limited availability of donated kidneys and not enough number of centers equipped with these facilities puts the effective management of ESRD beyond the reach of an average person many-a-times. Additionally the presence of co-existing diseases that contribute to and sometimes complicate the renal impairment as well as delayed referral of the patients to nephrologists also makes matters worse. ESRD is not just a medical but also a social and economic condition that devastates the person and his/her entire family. Hence, early detection and effective prevention of progression of CKD in early stages to advanced CKD and ESRD is the call of the day. In fact, understanding the pathophysiology of the condition and adopting methods of primordial prevention in populations at risk may be desirable to ensure reduction in the incidence of CKD. In those with established CKD, a proactive approach to manage the disease manifestations and limit the ravages of other comorbidities is desirable. For those in advanced stages of CKD, the institution of an appropriate renal replacement therapy individually suited to the patient keeping in view the medical status, lifestyle requirements, economic viability and social acceptability should be advised. This book will help the reader understand the intricacies of the aspects mentioned above and guide the practitioner to diagnose and manage End Stage Renal Disease with special reference to practical experience of the same in India. The authors have put together the most relevant facts about the disease for an easy comprehension and understanding of the same by practitioners and students across the specialty.

Renal cystic diseases include a large number of sporadic and genetically determined congenital, developmental, or acquired conditions. A cyst is a cavity lined by epithelium and filled with fluid. Cysts derive primarily from tubules (from Bowman’s capsule to the collecting duct). Cystic kidneys of different etiologies may appear morphologically similar, whereas the same etiologic entity may cause a wide spectrum of renal abnormalities. Simple renal cysts are acquired and are not associated with any disease. In contrast, polycystic kidney diseases can be complicated by renal failure or tumor development. Autosomal dominant polycystic kidney disease (ADPKD) is the most common potentially lethal single-gene disorder. Its prevalence at birth is between 1:400 and 1:1,000. It may progress to end stage renal disease by age 60 with 4.4% of patients requiring renal replacement therapy (dialysis or transplant) have ADPKD. The book is a comprehensive guide to diagnosis and management of the condition with special reference and experience around the same in India. The authors have put together the most relevant facts about the disease for an easy comprehension and understanding of the same by practitioners and students across the specialty.