Renal Failure

Kidney failure represents a major health economic burden for all people and all nations. Despite the immense number of factors which can cause the initial injury to the kidneys, common response pathways are triggered which, unless broken, will ultimately lead to irreversible fibrosis within the kidneys. Unfortunately, early injuries to the kidneys can frequently be asymptomatic and chronic kidney disease has often developed before the patient has become aware there is a problem. Once established, chronic kidney disease is associated with a high morbidity and mortality for those affected. There has been a large amount of work in recent years focused on the early diagnosis and management of kidney disease to prevent its progression. The purpose of this book is to review the mechanisms which underlie both acute and chronic kidney injury, discuss their diagnosis, complications and management. The first section of this book covers the causes and complications of chronic kidney disease. Initially we review the mechanisms which underlie the progressive fibrosis by which chronic kidney disease progresses. There are then detailed discussions of the cardiovascular complications of chronic kidney disease. The second section of the book focuses on established end stage renal disease. Reviewing access to renal replacement therapies across ethnicities, the role of home therapies and how their use can be increased and finally we discuss the preparation and maintenance of access for dialysis. The third and final section of the book provides an update for the clinician into the diagnosis and management of acute kidney injury. Specifically the diagnosis and management of renal impairment in patients with plasma cell dyscrasias is reviewed and the prevention of acute kidney injury in the critically ill patient is discussed in detail.