oxford handook of nephrology and hypertension 2nd ed

OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Nephrology and
Hypertension
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Oxford Handbook of
Nephrology and
Hypertension
Second edition
Simon Steddon
Consultant Nephrologist
Guy’s and St Thomas’ Hospitals
London, UK
and
Neil Ashman

Consultant Nephrologist
St Bartholomew’s and the Royal London Hospitals
London, UK
With
Alistair Chesser
Consultant Nephrologist
St Bartholomew’s and the Royal London Hospitals
London, UK
and
John Cunningham
Professor of Nephrology
Royal Free & University College Hospitals
London, UK

1
3
Great Clarendon Street, Oxford, OX2 6DP,
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© Oxford University Press, 2014
The moral rights of the authors have been asserted
First edition published 2006
Second edition published 2014
All rights reserved. No part of this publication may be reproduced,
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without the prior permission in writing of Oxford University Press,
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ISBN 978–0–19–965161–0
Printed in China by
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Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check the
product information and clinical procedures with the most up-to-date published
product information and data sheets provided by the manufacturers and the most
recent codes of conduct and safety regulations. The authors and the publishers do
not accept responsibility or legal liability for any errors in the text or for the misuse
or misapplication of material in this work. Except where otherwise stated, drug
dosages and recommendations are for the non-pregnant adult who is not
breast-feeding.
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for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
v
Preface to the
second edition
Much has changed in our specialty since the appearance of the fi rst edi-
tion of this Handbook. Chronic Kidney Disease, a fl edgling classifi cation at

the time, is now well established internationally and, more recently, acute
renal failure has emerged from a comparable makeover as Acute Kidney
Injury. Although not without detractors, these re-imaginations have
helped to raise general awareness of kidney disease and provided a wel-
come platform from which nephrologists have re-engaged with colleagues
in both primary and secondary care. International efforts to produce con-
sensus guidelines (albeit from disappointingly thin evidence) must also be
applauded. However, whilst we may inexplicably struggle to complete
suffi cient RCTs of good quality, we remain admirable innovators of clinical
services. It is a great privilege to be part of a global renal community best
characterized by its restlessness to do things better.
You’ll fi nd a little more depth to the information in this edition, although
this remains balanced with the more pragmatic advice that was so well
received last time out. With unlimited knowledge just a few keyboard
strokes away, it seemed even more important to bring essential infor-
mation to the fore and present it in as palatable and practical a way as
possible. We hope the additional detail will also prove useful during prep-
aration for postgraduate examinations and assessments.
This Handbook now sits in a larger family, having been joined by
the excellent Oxford Specialist Handbooks of Renal Transplantation and
Paediatric Nephrology . Along with the well-established Oxford Handbook of
Dialysis and the newer Oxford Desktop Reference of Nephrology , we believe
these represent a formidable resource across our entire specialty.
The fi rst edition was the idea of a few enthusiastic London trainees,
cultivated through animated caffeine-fuelled discussions as their lab
experiments simmered nearby. Whilst still enthusiastic (on the whole),
said trainees are now undeniably greyer, balder, rounder and grumpier
(we’ll let those of you who know us decide which adjective fi ts each of us
best) and it has inevitably proved challenging to complete this new ver-
sion around the demands of busy professional and personal lives. We are

therefore extremely grateful to all our contributors as well as to OUP for
(almost) being as patient as our families. But, ultimately, it is the support
and good humour of the latter that has really allowed us to complete the
text you are about to read.
It had always been our intention to create a Handbook that makes the
practice of renal medicine a little easier and a lot more enjoyable. And
on that thought, we offer this new edition to you as meagre thanks for
the wonderful fortune that brought our good friend and colleague Shaun
Summers, all too briefl y, into our lives.
SS & NA, London, 2013


vii
Preface to the
fi rst edition
The ability to recognize and understand renal disease and hypertension is
an important part of practice in almost any area of medicine. Acute renal
failure, often preventable, occurs in up to 7% of all hospital admissions
and remains responsible for much morbidity and mortality. The recent
reclassifi cation of chronic kidney disease (CKD) has exposed the scale of a
serious public health issue, relevant to all medical practitioners both in pri-
mary and secondary care. Furthermore, irrespective of specialist interest,
regular clinical contact with patients who are dialysis-dependent or who
have undergone renal transplantation is now the norm, not the exception.
Hypertension needs no introduction as the most common indication for
prescription drug therapy and the most important cause of premature
death in the developed world.
Many doctors are nervous of renal disease—there persists a belief that
renal patients suffer exclusively from complex, esoteric conditions that
can only be managed in a specialist environment and by specialists who

are often more diffi cult and demanding than their patients. Our intention
has been to write a concise but robust handbook that is fi rst and fore-
most practical: what needs to be done in a busy casualty department or
GP surgery several miles from the nearest renal unit. We hope it will
be a useful resource not only to doctors, nurses, and other members of
the multiprofessional team already engaged in the care of renal patients
but also to a broader audience. For those interested in how renal dis-
ease evolves, we’ve provided a good grounding in the fundamentals of
nephrology—hopefully dismantling some myths along the way, and giving
readers the confi dence to manage the day-to-day associated with kidney
disease.
In line with existing Oxford Handbooks we have attempted to strike a
balance between practical information, helpful to those working ‘at the
coal face’, and the more detailed knowledge that enables effective ongo-
ing care. The authors are all consultants working in busy renal units where
theory and practice are balanced to provide effective and effi cient care.
The book is as up-to-date as possible and a conscious mix of evidence
and reality-based medicine.
The book is laid out in twelve chapters, allowing easy access to infor-
mation on a particular clinical theme. Clinical importance is measured in
space, so diabetic nephropathy is given more attention than, for example,
Fanconi’s syndrome. The section on renal replacement therapies gives an
overview of the essential elements of both dialysis and transplantation.
Those looking for more detailed notes on all aspects of dialysis therapy
are referred to our sister volume The Oxford Handbook of Dialysis , or,
for general nephrology and transplant topics, our parent text The Oxford
Textbook of Nephrology . For completeness, we have included practical pro-
cedures but would ask that these pages are used for guidance only—all
must be taught by experienced operators and cannot be learnt solely from
a book.

viii
PREFACE TO THE FIRST EDITION
We make no apology for emphasizing the importance of clinical assess-
ment. Yes, tubular physiology is here (we are nephrologists after all), but
this book is aimed principally at clinicians in training and we still believe
that without a detailed history and thorough physical examination it is
impossible to order and interpret appropriate laboratory tests or imag-
ing, let alone provide good quality care. This seems more important than
ever at a time when many lament a diminished sense of enjoyment in the
practice of medicine.
We are grateful to all of our colleagues who helped bring this project to
fruition as well as to our families for tolerating so many lost evenings and
weekends with such good grace. We hope that we have produced a book
with personality, and one that brings its subject matter alive. We would
like readers to enjoy the highways and byways of renal medicine and that
we have avoided, in the words of Mark Twain, a book that ‘everyone
wants to have read, but no-one wants to read’.
SS, NA, AC, JC
London, July 2006
ix
Contributors x
Symbols and Abbreviations xi
1 Clinical assessment of the renal patient
1

2 Acute kidney injury (AKI)
87

3 Chronic kidney disease (CKD)
191

4 Dialysis
273

5 Transplantation
335

6 Hypertension
449

7 Diseases of the kidney
529

8 The kidney in systemic disease
603

9 Essential urology
705

10 Fluids and electrolytes
777

11 Pregnancy and the kidney
839

12 Drugs and the kidney
869

13 Renal physiology
913

14 Appendices
935

Index 957
Contents
x
Contributors
Conor Byrne
Bart’s and the Royal London
Hospitals
London, UK
Ananda Chapagain
Specialist Registrar
London, UK
Paramit Chowdhury
Guy’s and St Thomas’ Hospitals
London, UK
Partha Das
Specialist Registrar
London, UK
Stanley Fan
Bart’s and the Royal London
Hospitals
London, UK
Suzanne Forbes
Specialist Registrar
London, UK
Scott Henderson
Specialist Registrar

London, UK
Chris Kirwan
Bart’s and the Royal London
Hospitals
London, UK
Nicola Kumar
Guy’s and St Thomas’ Hospitals
London, UK
Kieran McCafferty
Bart’s and the Royal London
Hospitals
London, UK
Emma O’Lone
Specialist Registrar
London, UK
Marlies Ostermann
Guy’s and St Thomas’ Hospitals
London, UK
Taryn Pile
Guy’s and St Thomas’ Hospitals
London, UK
Ben Pullar
Specialist Registrar
London, UK
Michael Robson
Guy’s and St Thomas’ Hospitals
London, UK
Claire Sharpe
King’s College Hospital
London, UK

Rebecca Suckling
Epsom and St Helier University
Hospitals
Surrey, UK
Matt Varrier
Specialist Registrar
London, UK
Thanks also to Heather Brown, Simon Chowdhury, Sue Cox, Rachel Hilton,
Jonathon Olsburgh, Ed Sharples, and Raj Thuraisingham for their expert help
and advice.
xi
α alpha
β beta
♂ male
♀ female
1° primary
2° secondary
i increased
d decreased
2 important
22 don ’ t dawdle
ƽ warning
X controversial topic
6 therefore
l leading to
n normal
° degree
7 approximately
8 equal to

®
registered trademark
> greater than
< less than
ē equal to or greater than
≤ equal to or less than
= equal to
& and
£ pound sterling
$ US dollar
+ ve positive
– ve negative
AAA abdominal aortic aneurysm
Ab antibody
ABD adynamic bone disease
ABPM ambulatory blood pressure monitoring
ACE-I angiotensin-converting enzyme inhibitor
ACR albumin/creatinine ratio
Symbols and
Abbreviations

SYMBOLS AND ABBREVIATIONS
xii
ACS abdominal compartment syndrome; acute coronary
syndrome
ACT activated clotting time
ACTH adrenocorticotrophin hormone
AD autosomal dominant
ADH antidiuretic hormone
ADMA asymmetric dimethyl arginine

ADPKD autosomal dominant polycystic kidney disease
AF atrial fi brillation
AFB acid-fast bacilli
AG anion gap
AGE advanced glycation end-product
A2 angiotensin II
AIDS acquired immunodefi ciency syndrome
AIN acute interstitial nephritis
AKD acute kidney disease
AKI acute kidney injury
AKIN Acute Kidney Injury Network
Al aluminium
Alb albumin
ALP
alkaline phosphatase
ALT alanine transaminase
a.m. ante meridian
AMR antibody-mediated rejection
AN analgesic nephropathy
ANA anti-nuclear antibodies
ANCA anti-neutrophil cytoplasmic antibodies
ANP atrial natriuretic peptide
APC antigen-presenting cell
APD automated peritoneal dialysis
APS antiphospholipid syndrome
APTT activated partial thromboplastin time
AR autosomal recessive
ARAS atherosclerotic renal artery stenosis
ARB aldosterone receptor blocker
ARDS acute respiratory distress syndrome

ARPKD autosomal recessive polycystic kidney disease
ARR aldosterone–renin ratio
ARVD atherosclerotic renovascular disease
ASAP as soon as possible
SYMBOLS AND ABBREVIATIONS
xiii
ASCT autologous stem cell transplantation
ASOT anti-streptolysin O titre
AST aspartate aminotransferase
ATG anti-thymocyte globulin
ATI acute tubular injury
ATN acute tubular necrosis
ATP adenosine triphosphate
AV atrioventricular; arteriovenous
AVF arteriovenous fi stula
AVM arteriovenous malformation
AVP arginine vasopressin
AXR abdominal X-ray
AZA azathioprine
BAL bronchoalveolar lavage
BAT baroreceptor activation therapy
BBV blood-borne viruses
BC blood culture
BCG basal cell carcinoma; bacille Calmette–Guérin
BCR B cell receptor
bd twice daily
BE base excess
BEN Balkan endemic nephropathy
BHS British Hypertension Society
BM basement membrane

B
2
M beta 2 microglobulin
BMD bone mineral density
BMI body mass index
BMT bone marrow transplantation
BNP brain natriuretic peptide
BOO bladder outlet obstruction
BP blood pressure
BPH benign prostatic hyperplasia
BVAS Birmingham vasculitis activity score
BVM blood volume monitoring
Ca
2+
calcium ion
CaCl
2
calcium chloride
CAD coronary artery disease
CAH congenital adrenal hyperplasia
CAKUT congenital abnormalities of the kidney and urinary tract
CAN chronic allograft nephropathy
SYMBOLS AND ABBREVIATIONS
xiv
CAPD continuous ambulatory peritoneal dialysis
CAPS catastrophic antiphospholipid syndrome
CaR calcium-sensing receptor
CaxP calcium phosphate product
CBPM clinic BP monitoring
Cbsa cationic bovine serum albumin

CCB calcium channel blocker
CCF congestive cardiac failure
CCPB calcium-containing phosphate binder
CCPD continuous cycling peritoneal dialysis
CD collecting duct
CDC complement-dependent cytotoxicity; Centers for Disease
Control
CEPD continuous equilibrium peritoneal dialysis
CERA continuous EPO receptor activator
cfu colony-forming unit
CG Cockcroft–Gault
CHCC Chapel Hill Consensus Conference
CHD coronary heart disease
C
2
H
5
OH ethanol
CHr reticulocyte haemoglobin content
CIC ciclosporin
CIS carcinoma in situ
CIT cold ischaemic time
CK creatine kinase
CKD chronic kidney disease
Cl
–
chloride ion
CLL chronic lymphocytic leukaemia
cm centimetre
CMI cell-mediated immune

CMV cytomegalovirus
CN cranial nerve
CNI calcineurin inhibitor
CNS central nervous system
cTnI cardiac troponin I
cTnT cardiac troponin T
CO cardiac output
CO
2
carbon dioxide
COC combined oral contraceptive
COP colloid osmotic pressure
SYMBOLS AND ABBREVIATIONS
xv
COX cyclo-oxygenase
CPAP continuous positive airway pressure
CPET cardiopulmonary exercise testing
CPM central pontine myelinosis
CPS calcium polystyrene sulphate
Cr creatinine
CRB catheter-related bacteraemia
CrCl creatinine clearance
CRF chronic renal failure
CRH corticotrophin-releasing hormone
CRP C-reactive protein
CRRT continuous renal replacement therapy
CRS cardiorenal syndrome
C+S culture and sensitivity
CT computed tomography
CTA computed tomography angiography

CTS carpal tunnel syndrome
CUA calfi cic uraemic arteriolopathy
CV cardiovascular
CVA cerebrovascular accident
CVC central venous catheter
CVD cardiovascular disease
CVP central venous pressure
CVVHD continuous veno-venous haemodialysis
CVVHDF continuous veno-venous haemodiafi ltration
CVVHF continuous veno-venous haemofi ltration
CXR chest X-ray
d day
3D three-dimensional
Da dalton
DA dopamine
DBD donation after brain death
DBP diastolic blood pressure
DCD donation after cardiac death
DCT distal convoluted tubule
DDAVP desmopressin
DEXA dual-energy X-ray absorptiometry
DFO desferrioxamine
DGF delayed graft function
DHT dihydrotestosterone
SYMBOLS AND ABBREVIATIONS
xvi
DIC disseminated intravascular coagulation
DKA diabetic ketoacidosis
dL decilitre
DM diabetes mellitus

DMARD disease-modifying anti-rheumatic drug
DN diabetic nephropathy
DNA deoxyribonucleic acid
DRA dialysis-related amyloidosis
DRE digital rectal examination
DSA donor-specifi c antibody
dsDNA double-stranded deoxyribonucleic acid
DSE dobutamine stress echocardiography
DT distal tubule
DTT dithiothreitol
D&V diarrhoea and vomiting
DVT deep vein thrombosis
DW dry weight
EABV effective arterial blood volume
EBCT electron beam CT
EBV Epstein–Barr virus
ECD extended criteria donors
ECF extracellular fl uid
ECG electrocardiogram
ECHO echocardiography
EEG electroencephalogram
EF ejection fraction
EG ethylene glycol
eGFR estimated glomerular fi ltration
rate

EGPA eosinophilic granulomatosis with polyangiitis
ELISA enzyme-linked immunosorbent assay
EM electron microscopy
EMA European Medicines Agency

EMT epithelial to mesenchymal transition
EMU early morning urine
ENA extractable nuclear antigen
ENaC epithelial Na
+
channel
eNOS endogenous nitric oxide synthase
ENT ear, nose, and throat
EPO erythropoietin
EPO-R erythropoietin receptor
SYMBOLS AND ABBREVIATIONS
xvii
ERT enzyme replacement therapy
ESA erythropoiesis-stimulating agent
ESRD end-stage renal disease
EST exercise stress testing
ESWL extracorporeal shock wave lithotripsy
FBC full blood count
FDA Food and Drug Administration
FFP fresh frozen plasma
FFR fractional fl ow reserve
FFS fi ve factor score
FH family history
FISH fl uorescence in situ hybridization
FMD fi bromuscular dysplasia
FMF familial Mediterranean fever
FOB faecal occult blood
FPG fasting plasma glucose
FSGS focal and segmental glomerulosclerosis
FSH follicle-stimulating hormone

g gram
GA general anaesthesia
GBM glomerular basement membrane
GCS Glasgow Coma Score
Gd gadolinium
GDP glucose degradation product
GFR glomerular fi ltration
rate

GH growth hormone
GI gastrointestinal
GN glomerulonephritis
GnRH gonadotropin-releasing hormone
GP general practitioner
GPA granulomatosis with polyangiitis
G6PD glucose-6-phosphate defi ciency
G6PDH glucose-6-phosphate dehydrogenase
GRA glucocorticoid-remediable aldosteronism
G&S group and save
GST glutathione S-transferase
GTN glyceryl trinitrate
GUTB genitourinary tuberculosis
h hour
H
+
hydrogen ion
SYMBOLS AND ABBREVIATIONS
xviii
HAART highly active antiretroviral therapy
Hb haemoglobin

HBPM home blood pressure measurement
HBV hepatitis B virus
HC hydroxycarbamide
HCDD heavy chain deposition disease
HCO
3

–
bicarbonate ion
H
2
CO
3
carbonic acid
HCP haemopoietic cell phosphatase
Hct haematocrit
HCV hepatitis C virus
HD haemodialysis
HDF haemodiafi ltration
HDL high-density lipoprotein
H+E haematoxylin and eosin
HELLP haemolysis, elevated liver enzymes, and low platelet
HF haemofi ltration; heart failure
HIT heparin-induced thrombocytopenia
HIV human immunodefi ciency virus
HIVAN HIV-associated nephropathy
HIVICK HIV immune complex kidney disease
HIV-TMA HIV-associated thrombotic microangiopathy
HLA human leucocyte antigen
H

2
O water
HoLEP holmium laser enucleation of the prostate
hpf high-powered fi eld
HR heart rate
HRBC hypochromic red blood cell
HRCT high-resolution computed tomography
HRE hypoxia response element
hrEPO human recombinant erythropoietin
HRS hepatorenal syndrome
HRT hormone replacement therapy
HSP Henoch–Schönlein purpura
HSV herpes simplex virus
HTA Human Tissue Authority
HTLV human T lymphotropic virus
HUS haemolytic uraemic syndrome
IAH intra-abdominal hypertension
IAP intra-abdominal pressure
SYMBOLS AND ABBREVIATIONS
xix
IBD infl ammatory bowel disease
IBW ideal body weight
IC immune complex
iCa
2+
ionized calcium
ICA intracranial aneurysms
ICAM-1 intercellular adhesion molecule-1
IDH intradialytic hypotension
IDL intermediate density lipoprotein

IDPN intradialytic parenteral nutrition
IE infective endocarditis
IF interstitial fi brosis
IFN interferon
Ig immunoglobulin
IgAN IgA nephropathy
IGF insulin-like growth factor
IGFBP insulin-like growth factor-binding protein
IGRA interferon gamma release assays
IHD ischaemic heart disease; intermittent haemodialysis
IL interleukin
IM intramuscular
IMN idiopathic membranous nephropathy
IMPDH inosine monophosphate dehydrogenase
IMWG International Myeloma Working Group

INHD in-hospital nocturnal haemodialysis
iNOS inducible nitric oxide synthase
INR international normalized ratio
IP intraperitoneal
IPSS international prostate symptom score
ITP idiopathic thrombocytopenic purpura
ITU intensive treatment unit
IU international unit
IUGR intrauterine growth restriction
IV intravenous
IVC inferior vena cava
IVDSA intravenous digital subtraction angiography
IVDU intravenous drug user
IVI intravenous infusion

IVIg intravenous immunoglobulin
IVU intravenous urogram
JBS Joint British Societies
SYMBOLS AND ABBREVIATIONS
xx
JNC Joint National Committee
JVP jugular venous pressure
K
+
potassium ion
kcal kilocalorie
KCl potassium chloride
KCO diffusion capacity for carbon monoxide
kDa kilodalton
KDIGO Kidney Disease Improving Global Outcomes
kg kilogram
kPa kilopascal
KUB kidneys–ureter–bladder
L litre
LA local anaesthesia; lupus anticoagulant
LAKIN London AKI Network
LDH lactic acid dehydrogenase
LDL low-density lipoprotein
L-FABP liver-type fatty acid-binding protein
LFT liver function test
LH luteinizing hormone; loop of Henle
LIDD light chain deposition disease
LMW low molecular weight
LMWH low molecular weight heparin
LN

lymph node
LP lumbar puncture
LPS lipopolysaccharide
LUTS lower urinary tract symptoms
LV left ventricular
LVF left ventricular failure
LVH left ventricular hypertrophy
m metre
mAb monoclonal antibody
MAC membrane attack complex
MACE major adverse cardiovascular events
MAHA microangiopathic haemolytic anaemia
MAOI monoamine oxidase inhibitor
MAP mean arterial pressure
MARS molecular absorbent recirculating system
Mb myoglobin
MBD mineral and bone disorder
MCD minimal change disease
SYMBOLS AND ABBREVIATIONS
xxi
MCGN mesangiocapillary glomerulonephritis
MCN minimal change nephropathy
M,C+S microscopy, culture, and sensitivity
MCUG micturating cystourethrography
MDRD Modifi cation of Diet in Renal Disease
MEN multiple endocrine neoplasia
meq milliequivalent
MFI median fl uorescence intensity
mg milligram
Mg

2+
magnesium ion
MGUS monoclonal gammopathy of uncertain signifi cance
MHC major histocompatibility complex
MHRA Medicines and Healthcare products Regulatory Agency
MI myocardial infarction
MIDD monoclonal immunoglobulin deposition disease
min minute
mIU milli international unit
mm millimetre
MMF mycophenolate mofetil
mmHg millimetre of mercury
mmol millimole
MMR mumps, measles, and rubella
MN membranous nephropathy
mOsmol milliosmole
MPA mycophenolic acid; microscopic polyangiitis
MPO myeloperoxidase
MPS myocardial perfusion scan; mycophenolate sodium
MR magnetic resonance; modifi ed release; mineralocorticoid
receptor
MRA magnetic resonance angiography
MRI magnetic resonance imaging
MRSA meticillin-resistant Staphylococcus aureus
MRSI magnetic resonance spectroscopy imaging
MS multiple sclerosis
MSCT multislice computed tomography
MSU midstream urine
mTOR mammalian target of rapamycin
mU milliunit

MVR mitral valve replacement
MW molecular weight
SYMBOLS AND ABBREVIATIONS
xxii
Na
+
sodium ion
NAC N-acetylcysteine
NaCl sodium chloride
NADR noradrenaline
NAG N-acetyl- B -D-glucosaminidase
NaHCO
3
sodium bicarbonate
NB take note ( nota bene )
NBM nil by mouth
NFAT nuclear factor of activated T cells
ng nanogram
NG nasogastric
NGAL neutrophil gelatinase-associated lipocalin
NH
4

+
ammonium ion
NHHD nocturnal home haemodialysis
NHL non-Hodgkin’s lymphoma
NHS National Health Service
NICE National Institute for Health and Care Excellence
NIH National Institutes of Health

NIPD night-time intermittent peritoneal dialysis
NK natural killer
NKF- National Kidney Foundation Kidney Dialysis
KDOQI Outcomes Quality Initiative
nm nanometre
NMSC non-melanoma skin cancer
NO nitric oxide
NODAT new-onset diabetes after transplantation
nPCR normalized protein catabolic rate
NR normal range
NSAID non-steroidal anti-infl ammatory drug
NSF nephrogenic systemic fi brosis
NSTEMI non-ST elevation myocardial infarction
N+V nausea and vomiting
NYHA New York Heart Association
O
2
oxygen
od once daily
OSA obstructive sleep apnoea
OSP oral sodium phosphate
p probability
PAC pulmonary artery catheter
PAK pancreas after kidney
SYMBOLS AND ABBREVIATIONS
xxiii
PAN polyarteritis nodosa
PaOP pulmonary artery occlusion pressure
PAS periodic acid–Schiff
PC pelvicalyceal

PCA patient-controlled analgesia
PCP pneumocystis pneumonia
PCR protein/creatinine ratio; polymerase chain reaction
PCT proximal convoluted tubule
PD peritoneal dialysis
PDGF platelet-derived growth factor
PEEP positive end expiratory pressure
PEG percutaneous endoscopic gastrotomy; polyethylene glycol
PET peritoneal equilibration test; positron emission tomography
PEX plasma exchange
PFT pulmonary function test
pg picogram
PIGN post-infectious glomerulonephritis
PIH pregnancy-induced hypertension
PIN prostatic intraepithelial neoplasia
PlGF placental growth factor

plt platelet
pmol picomole
pmp per million of population
PNCL percutaneous nephrolithotomy
PNH paroxysmal nocturnal haemoglobinuria
PO orally
PO
4
phosphate ion
POF premature ovarian failure
POTS postural tachycardia syndrome
PP pulse pressure
PPI proton pump inhibitor

PR3 proteinase 3
PRA panel reactive antibody
PRCA pure red cell aplasia
PRES posterior reversible encephalopathy syndrome
prn as required
PSA prostate-specifi c antigen
PT prothrombin time
PTA pancreas transplant alone
PTC proximal tubular cell; peritubular capillary