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Fifth Edition
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Library of Congress Cataloging-in-Publication Data
Names: Rennke, Helmut G., author. | Denker, Bradley M., author.
Title: Renal pathophysiology : the essentials / Helmut G. Rennke, Bradley M. Denker.
Description: Fifth edition. | Philadelphia : Wolters Kluwer, [2020] | Includes bibliographical
references and index.
Identifiers: LCCN 2018054070 | ISBN 9781975109592 (paperback)
Subjects: | MESH: Kidney Diseases—physiopathology | Kidney—physiopathology
Classification: LCC RC903.9 | NLM WJ 300 | DDC 616.6/107—dc23 LC record
available at https://lccn.loc.gov/2018054070
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To our families, Stephanie and Christianne Mary, Brendan,
Jennifer, and Mackenzie
PREFACE
In this fifth edition of Renal Pathophysiology: The Essentials, we have
maintained the general principles that guided us in the design and approach
of the last four editions of the book. Over these last years, we have received
many comments and suggestions not only from our second-year medical
students but also from house staff, nephrology fellows, and colleagues; we
are most grateful for their feedback and encouraging words. As a
consequence of these suggestions, we have further expanded the sections on
molecular aspects of the mechanisms that result in kidney dysfunction and
the morphologic expression of the major diseases that affect the kidney; the
illustrations are in full color and inserted into the text. The list of suggested
readings has been updated and summaries are included at the end of
physiology chapters. We have also reviewed supplemental self-examination
questions that permit application of key concepts to clinical cases and to
develop more nuanced understanding. However, the core and the principal
aim of this book remain unchanged: to provide the student with a solid
understanding of the mechanisms that result in kidney dysfunction and
disease and to serve as the basic reading material and text for a course in
kidney pathophysiology.
HGR AND BMD
CONTENTS
Preface
1
CHAPTER Review of Renal Physiology
Introduction
Relationship between Filtration and Excretion
General Mechanism of Transtubular Sodium
Reabsorption
Tight Junctions and Membrane Polarity
Segmental Sodium Reabsorption
Proximal Tubule
Loop of Henle
Distal Tubule
Calcium Transport
Collecting Ducts
Water Transport
Countercurrent Mechanism
Glomerular Filtration Rate
Determinants of Glomerular Filtration
Arteriolar Resistance and Glomerular Filtration
Rate
Clinical Estimation of Glomerular Filtration Rate
Creatinine Clearance
Plasma Creatinine Concentration and Glomerular
Filtration Rate
Blood Urea Nitrogen and Glomerular Filtration Rate
2
CHAPTER Regulation of Salt and Water Balance
Introduction
Physiologic Role of Osmotic Pressure
Osmotic Pressure and Distribution of Body Water
Relationship between Plasma Osmolality and
Sodium Concentration
Osmoregulation and Volume Regulation
Hormonal Role in Water and Sodium Balance
Osmoregulation
Volume Regulation
Antidiuretic Hormone, Thirst, and Maintenance of
Water Balance
Actions
Vascular Resistance
Renal Prostaglandins
Control of Antidiuretic Hormone Secretion
Osmoreceptors
Thirst
Volume Receptors
Interactions of Osmotic and Volume Stimuli
Hormonal Regulation of Sodium Excretion
Definition of Effective Circulating Volume
Renin–Angiotensin System
Actions
Aldosterone
Actions
Control of Aldosterone Secretion
Maintenance of Sodium and Potassium Balance
Atrial Natriuretic Peptide
Actions
Control of Atrial Natriuretic Peptide Secretion
Physiologic Role of Atrial Natriuretic Peptide
Other Atrial Natriuretic Peptide-like Hormones
Pressure Natriuresis
Steady State
Role of Impaired Renal Excretion in Electrolyte
Disorders
Time Course of Diuretic Action
3
CHAPTER Disorders of Water Balance: Hyponatremia,
Hypernatremia, and Polyuria
Determinants of Plasma Sodium Concentration
Clinical Importance of Osmoregulation
Osmolytes and Cell Volume Regulation
Implications for Symptoms and Treatment
Hyponatremia
Etiology
Congestive Heart Failure
Syndrome of Inappropriate Antidiuretic Hormone
Reset Osmostat
Diagnosis
Plasma Osmolality
Urine Osmolality
Urine Sodium Concentration
Basic Principles of Therapy
Hypernatremia
