**Sohail Abdul Salim**

Chapter 1

Diseases

1. Introduction

Edward T. Zawada

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2. Renal disease diagnosis

Introductory Chapter: Renal

Renal diseases are notoriously silent. Renal diseases are notoriously expensive once they have led to end-stage renal failure requiring dialysis or transplantation. Most acute and chronic renal diseases present with rising serum creatinine and blood urea nitrogen, electrolyte abnormalities, frequent proteinuria, occasional red blood cells in the urine, occasional white blood cells in the urine, or renal cells in the urine often mistaken for white blood cells. It is not easy to make a specific diagnosis

I will now present the rationale for renal biopsy to establish renal diagnoses [1]. The classification which follows is the opinion of the author and editor based on over 45 years of experience and exposure to the pioneers in use of renal biopsy for diagnosis [2–4]. My goal is to simplify this argument for performing this invasive procedure to clarify the confusing array of renal diseases with indistinct or asymp-

Acute renal diseases are described as prerenal, renal, and postrenal, but most patients totally recover normal or near-normal renal function. It is the chronic, often symptomless chronic diseases which lead surreptitiously to end-stage renal disease. Chronic diseases include vascular, glomerular, tubular, and interstitial diseases. The main structures of the kidney are arteries and veins, glomeruli, tubules, and interstitium. Renal biopsy is often required to determine the site of injury. As described below, even when the site of injury is known, such as in glomerular diseases, the renal biopsy is needed to distinguish between the many similar dis-

I have been teaching about renal diseases since for 40 years since 1979. I have been struck by three main perspectives. First, diseases can occur in very small areas of the structures of the kidney while the rest of the kidney tissues work well and try to compensate. Second, glomerular diseases are confusing to understand because one needs a framework to separate the multiple very similar diseases into separate clinically relevant entities allowing individual management. Finally, the tubular diseases are the most silent of renal diseases, needing more effort to teach, understand, identify, and manage. Renal biopsy results will be briefly described as the tool to make a definitive diagnosis necessary for proper patient management.

eases in order to develop possible remission-inducing therapy strategies.

Affiliate Faculty, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi
