Infectious complications renal disease

Abstract This book considers the aetiological factors that render renal patients at risk of infection and covers the infectious complications of the major modalities of renal replacement therapy. The book has been written by a combination of microbiologists, clinical scientists and clinicians active in the care of kidney patients at all stages in their treatment from chronic renal insufficiency through dialysis and on to transplantation. It brings together a large body of clinical and scientific material to help clinicians manage infectious complications of kidney disease. As far as is possible a clinical chapter is balanced by a chapter dealing with pathophysiology. The book is divided in to three sections: Basic Mechanisms, Infectious Complications of Common Renal Conditions, Renal Failure and Transplantation, and Prevention and Management. The uraemic condition as a state of immunosupression is discussed to set the scene for why renal patients are prone to so many diverse infections. Increasingly potent immunosuppressive drugs are being deployed in a variety of primary conditions and also to prevent renal allograft rejection. The mechanisms by which these drugs predispose to infection are discussed. A chapter deals specifically with peritoneal defence mechanisms of critical importance in the management of infection complicating continuous ambulatory peritoneal dialysis. The second section of the book deals specifically with infectious complications in defined situations. For example, diabetes mellitus is discussed in detail as this is now the major cause of endstage chronic renal failure. Infectious complications of glomerulonephritis and vasculitis are discussed, and this relates to the effects of the potent immunosuppressive agents now deployed. Specific chapters are devoted to infectious complications of peritoneal dialysis and haemodialysis including a chapter on mucormycosis. Hepatitis B and Hepatitis C have each been given a chapter and the impact of these hepatitis viruses on the renal patient from chronic renal failure through dialysis to transplantation is described. Infectious complications of transplantation follows and reviews the common infections as well as presenting some new data on viral induced tumours. In the final section of the book, prevention of infection is discussed with particular emphasis to vascular access and the care of the uraemic ischaemic/diabetic foot. The general principles relating to limiting the spread of infection within the Renal Unit are discussed in detail. Increasing patient mobility and travel requires that travel and vaccination in renal patients are discussed. The book ends with a practical chapter on prescribing advice for the use of common anti-microbial agents. This book will be of value to all those involved in the care of this vulnerable group, specifically nephrologists, renal transplant surgeons and physicians and diabetologists.