Clinical Anatomy_ Applied Anatomy for Students and Junior Doct.pdf

Grant’s Dissector.pdf

ANESTHESIOLOGY
Barash Clinical Anesthesia 5th ed.pdf
Miller’s Anesthesia.pdf

BIOCHEMISTRY
Harper’s illustrated biochemistry 26ed.pdf
Harper’s illustrated biochemistry 27th edition.chm
Color Atlas of Biochemistry 2nd Ed J.Koolman K-H. Roehm Thieme 2005.pdf

CARDIOLOGY
ABC of Interventional Cardiology.pdf
Advanced Interventional Cardiology.pdf
Gulizia – Emerging Pathologies in Cardiology.pdf
Cannon – Critical Pathways in Cardiology 2001.pdb
Cardiology cd.exe
Wagner – Marriott’s Practical Electrocardiography 10th ed.pdb

CLINICAL EPIDEMIOLOGY
Basic Epidemiology – Beaglehole , Bonita.pdf
Clinical_Epidemiology__Robert_Fletcher.pdf
Pinciples of Epidemiology, An Introduction to Applied

evidence_base_of_clinical_diagnosis.pdf

Evidence-Based Imaging – Optimizing Imaging in Patient Care.pdf

Evidence-based Medicine Workbook.pdf

Evidence Based Practice in Primary Care [ILLUSTRATED].pdf

DERMATOLOGY
Atlas of Dermatology Schering Co USAss.pdf
Fitzpatrick – Dermatology 5th ed 2005.CHM
Fitzpatrick’s Dermatology In General Medicine 6th ed.pdb
Hall – Sauer’s Manual of Skin Diseases 8th ed.pdb

Handbook of Skin Diseases.pdf

EMERGENCY MEDICINE & ICU
Wolfson – The Clinical Practice of Emergency Medicine 3rd ed.pdb
Pediatric Emergency Medicine. (a comperhensive study guide). 2nd eition,2007.CHM
An Introduction to Clinical Emergency Medicine.pdf
Cline – Emergency Medicine – A Comprehensive Study
Intensive and Critical Care Medicine.pdf
Irwin and Rippe’s Intensive Care Medicine 5th ed.pdb
Noble – Textbook of Primary Care Medicine 3rd ed
Field Guide to Bedside Diagnosis, 2e 2006.CHM.part
Rosen’s Emergency Medicine.chm

ENDOCRINOLOGY
Williams Textbook of Endocrinology 10ed.pdf
Handbook of Diagnostic Endocrinology.pdf

FAMILY MEDICINE & GERIATRICS
CURRENT Diagnosis & Treatment in Family Medicine.chm
Evans – Oxford Textbook of Geriatric Medicine.pdb
Geriatric Medicine An Evidence-based Approach.pdf

HEMATOLOGY & IMMUNOLOGY
Modern Hematology Biology and Clinical Management 2nd ed.pdf
Oxford Handbook of Hematology.pdf
Color Atlas of Hematology.pdf
Wintrobe’s Clinical Hematology 11th.pdb
Adelman – Manual of Allergy and Immunology Diagnosis.pdb
World of Microbiology and Immunology.pdf
HISTOLOGY
Histology Image Review.CHM
Junqueira Carneiro – Basic Histology Text and Atlas 11ed.chm
Kuehnel – color atlas of cytology, histology and microscopic anatomy.pdf

INTERNAL MEDICINE

Harrison’s principles of internal medicine 17ed.chm
Harrison’s principles of internal medicine 16ed.pdf
Harrison_s_Manual_of_Medicine_16th_Edition.pdf
Cecil – Textbook of Medicine.pdf
Kelly’s Textbook of Medicine.pdb
Mayo Clinic Internal Medicine Concise Textbook.pdf
Lippincott.Wilkins.&.Williams.Yamada’s.Textbook.of.Gastroenterology.pdf
Schrier – Manual of Nephrology Diagnosis and Therapy 5th ed.pdb
Bates guide to physical examination+MCQs.pdf

Clinical Interviewing.pdf

Clinical Medicine – 6th edition.pdf

LR – Pocket Medicine 3rd Edition.pdf

Problem Solving in Clinical Medicine.pdf

MICROBIOLOGY
Jawetz, Melnick, & Adelberg’s Medical Microbiology, 24th Ed 2007 McGraw Hill.chm
Laboratory Exercises In Microbiology.pdf
Clinical Microbiology made simple.pdf
The Desk Encyclopedia Microbiology.pdf
Lippincott Illustrated Reviews_Microbiology
Essential Microbiology.pdf
Glazer Microbial Biotechnology – Fundamentals of Applied Microbiology 2nd ed.pdf

World of Microbiology and Immunology.pdf

NEUROANATOMY & NEUROLOGY
Snell’s clinical neuroanatomy
Neuroanatomy An Atlas of Structures, Sections, and Systems – Duane E. Haines.pdf
Adams and Victor’s Principles of Neurology 8th.pdf
Atlas of functional neuroanatomy 2nd ed.pdf

Cranial Nerves Functional Anatomy (2005).pdf

Differential Diagnosis in Neurology and Neurosurgery.pdf

Goetz textbook of neurology.pdb
The Clinical Science of Neurologic Rehabilitation (Contemporary Neurology Series, 66) (2003).pdf
Neuroanatomy – Atlas of Structures Sections Systems 6ed.pdf
Neuroscience – D.Purves, et al.pdf
Merritt – Merritt’s Neurology 10th Ed.pdb
Handbook of Neurology.CHM

Nervous System and Sensory Organs – Color Atlas and Textbook of Human Anatomy – Volume 3.pdf

OBSTETRICS-GYNECOLOGY
Benson Pernolls Handbook of Obstetrics-Gynecology.pdf
Williams Obstetrics 22nd Edition.pdf
Berek & Novak’s Gynecology 14th ed.pdf
Novak’s Gynecology 13ed.pdb
Obstetrics And Gynecology At A Glance.pdf
Stenchever – Comprehensive Gynecology 4th ed – Big Images.pdb
Havens – Manual of Outpatient Gynecology 4ed.pdb
The Johns Hopkins Manual of Gynecology and Obstetrics 2nd ed.pdb

Obstetrics and Gynecology An Illustrated Colour Text.pdf

ONCOLOGY

Weinstein Pediatric Oncology – Pediatric_Lymphomas.pdf

Manual of Pediatric Hematology and Oncology.pdf

Berek Practical Gynecologic Oncology 3ed.pdb

Rosenberg – Cancer – Principles and Practice of Oncology 6th.pdb

Pizzo – Principles and Practice of Pediatric Oncology 4th Ed.pdb

ORTHOPEDICS & RHEUMATOLOGY
MILLER’S_REVIEW_OF_ORTHOPEDICS.pdf
Manual of Rheumatology and Outpatient Orthopedic Disorders Diagnosis and Therapy 4th ed.pdb
Kelley’s Textbook of Rheumatology 6th Edition, 2-Volume Set – ISBN.pdb
DeLee and Drez’s – Orthopaedic Sports Medicine. Editor DeLee (2nd Ed. 2003).pdb
Current Diagnosis & Treatment in Orthopedics 3rd ed.pdb

Pediatric Orthopedics for Primary Care Physicians.pdf

Pediatric Orthopedics in Practice.pdf

PARASITOLOGY
Gillespie & Pearson – Principles and Practice of Clinical Parasitology 2001
Clinical Parasitology.pdf
Dictionary of Parasitology.pdf

PATHOLOGY
Robbins Pathologic Basis of Disease 7th ed 2005.pdf
stedmans Pathology&Lab medicine
Scott_Tietz’s Applied Laboratory Medicine 2nd ed.pdf
Ravel – Clinical Laboratory Medicine – Clinical Applications.pdb

PATHOPHYSIOLOGY OF DISEASE.pdf

PEDIATRICS
Nelson Textbook of Pediatrics 17th ed.pdf
Nelson Essentials of PEDIATRICS.CHM
Current Strategies in Pediatrics 2004.pdf

Pediatric.Musculoskeletal.Disease.pdf

Pediatric.Radiography.3HAXAP.pdf

Treatment.of.Pediatric.Neurologic.Disorders.3HAXAP.pdf

PHARMACOLOGY
Katzung basic clinical pharmacology 10ed.pdf
Katzung basic clinical pharmacology 9ed.pdf
Basic Clinical Pharmacology – 10th Ed.chm
Color Atlas of Pharmacology 3rdEd.pdf

Color Atlas of Pharmacology.pdf
Color Atlas Of Pharmacology,2Nd Ed (By H Lullmann Et Al ,Thieme 2000,Isbn 0865778434).pdf
Lippincott Illustrated Reviews_Pharmacology 2nd ed 2000
Edwards – Principles and Practice of Pharmaceutical Medicine 2nd ed.pdf
Goodman Gilman’s – The Pharmacological Basis of Therapeutics 11th Edition

PHYSIOLOGY
Review of Medical Physiology 21 Edition -William F. Ganong.chm
Physiology – Berne and Levy – 5th Edition.chm
physiology – Guyton.pdf

PSYCHIATRY
Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (2 Volume Set) 7th Ed (Lippincott Williams & Wilkins).pdf
Lewis – Child and Adolescent Psychiatry A Comprehensive Textbook 4th Edition

RADIOLOGY
Dahnert – radiology review manual 4th ed.pdf
Getting Started in Clinical Radiology – from Image to Diagnosis.pdf
Emergency Radiology.pdf
WHO manuals of diagnostic imaging – Radiographic Anatomy and Interpretation of the Musculoskeletal System.pdf
Churchill Livingstone – 2001 – Grainger & Allison’s Diagnostic Radiology. A Textbook of Medical I.pdb

SURGERY
Schwartz Manual of Surgery 8ed.pdf
Oxford Textbook of Surgery (2ed).pdf
Clinical Surgery in General R.M.Kirk 4th Ed 2004.pdf
Wilmore – ACS Surgery – Principles and Practice 2nd ed.zip
Morris – Oxford Textbook of Surgery 2nd ed.pdb
Sabiston Textbook of Surgery, 16th Edition.pdf

Current Surgical Diagnosis and Treatment 11ed With images.pdb
MANUALS, DICTIONARIES, ATLAS
Current Clinical Strategies. Physicians’ Drug Manual. Side Effects, Drug Interactions, and Newly Approved Drugs. 2003 Ed.pdf
Dale – Infectious Diseases The Clinician’s Guide to Diagnosis, Treatment, and Prevention – Big Images.pdb
Bennett and Brachman’s Hospital Infections (Lippincott, 2007).chm
LR – Pocket Medicine 3rd Edition.pdf
Lippincott Williams Wilkins 2003 Medical Terminology An Illustrated Guide 4th Ed.pdf
Merck Manual 17th.Ed.pdb
Pocket Atlas of Radiographic Anatomy 2nd ed, 2000.pdf
Pocket Guide to Diagnostic Tests-0838581358.pdf
Pocket.Guide.to.Musculoskeletal.Diagnosis.3HAXAP.pdf
Oxford Textbook Of Rheumatology, 2nd ed (1998).pdb
Oxford_textbook_of_public_health_4th_ed.pdb
Manual of Clinical Problems In Pediatrics 5th Edition (2000).pdb
Manual of Family Practice 2nd ed.pdb
Ferri’s Clinical Advisor 2004 – Instant Diagnosis and Treatment. 6th edition.pdb
Pocket Atlas of Echocardiography.pdf
Pocket Atlas Of Radiographic Anatomy 2d ed – Torsten B. Moller, Emil Reif.pdf
Pocket_Atlas_of_Human_Anatomy__H._Feneis__W._Dauber._4th_Ed._2000_.pdf
Pocket guide to diagnostic tests.chm
Stedman’s Electronic Medical Dictionary 6th Edition.pdf
Colour Atlas of Anatomical Pathology.pdf
Glossary of Biotechnology Terms, Third Edition.pdf
Clinical Neuropathology Text and Color Atlas.pdf
An Atlas Of Back Pain.pdf
An Atlas of Headache.maxiwarez.pdf
Atlas of Clinical Diagnosis 2nd Ed (2003).pdf
Henry Clinical Diagnosis and Management by Laboratory Methods 21st ed.chm

FLASH CARDS
- ANATOMY (NETTER)
- ANATOMY (ROHEN’S)
- PATHOLOGY
- PHARMACOLOGY

ABC SERIES

ABC of AIDS.pdf
ABC of Antenatal Care.pdf
ABC of Antithrombotic Therapy.pdf
ABC of Arterial and Venous Disease.pdf
ABC of Burns.pdf
ABC of Clinical Electrocardiography.pdf
ABC of Clinical Genetics.pdf
ABC of Clinical Haematology.pdf
ABC of Colorectal Cancer.pdf
ABC of Conflict and Disaster.pdf
ABC of Dermatology.pdf
ABC of Diabetes.pdf
ABC of Eyes.pdf
ABC of First Year.pdf
ABC of Heart failure.pdf
ABC of Intensive Care.pdf
ABC of Interventiona Cardiology 2004.pdf
ABC of Learning Teaching Medicine.pdf
ABC of Nutrition, 4th Edition.pdf
ABC of Occupational and Environmental Medicine.pdf
ABC of Preterm Birth.pdf
ABC of Psychological Medicine.pdf
ABC of Resuscitation.pdf
ABC of Sexually Transmitted Infections.pdf
ABC of Spinal Cord Injury 4th Ed.pdf
ABC of Subfertility.pdf
ABC of the Liver Pancreas and Gall Bladder.pdf
ABC of the Upper Gastrointestinal.pdf

—————————————————————
US MLE REVIEW SERIES

anatomy.pdf
basic epidemiology -beaglehole,bonita.pdf
behavioral sciences.pdf
beyond basic resp.pdf
biochemistry.pdf
clinical anatomy 11ed.pdf
clinical epidimiology -robert fletcher.pdf
kaplan lecture notes.pdf
lecture on visuals.pdf
microbiology,immunology.pdf
pathology.pdf
pharmacology.pdf
physiology.pdf
principles of epidemiology.pdf
Qbook.pdf
upper extremities cadaver pics.pdf
kaplan medical timeline.pdf

OTHERS:

1. Journal Medical Passwords 2003.pdf
——————————————————
1. Anatomy.tv – Anatomy Study Guides.chm
2. Cranial_Nerves_Functional_Anatomy.pdf
3. Outline of Biology – Fried, George H..pdf
——————————————————
1. Gray’s Anatomy for Students.chm
2. Chest Radiology The Essentials, 2nd Edition.CHM
3. Clinical Anatomy by Regions – 8th Ed.CHM
4. Grant’s Dissector.pdf
5. Clinical Radiology Made Ridiculously Simple (MedMaster Series 2003 Ed
6. Clinical Anatomy_ Applied Anatomy for Students and Junior Doct.pdf
7. The Medical Student’s Guide to the Plain Chest Film.pdf
——————————————————
1. Clinical Interviewing 3rd edition.pdf
2. What They Didnt Teach You at Medical School.pdf
3. Medical English.pdf
4. Medical Law and Moral Rights (Springer, 2005).pdf
5. Neuroethics.pdf
——————————————————
1. Ferri’s Clinical Advisor 2008_ Instant Diagnosis and Treatment.CHM
2. Current Medical Diagnosis & Treatment 2007, 46th Ed.chm
3. Handbook of Neurology.CHM
4. Professional Guide to Signs and Symptoms – 5th Ed.chm
5. Colour Atlas of Anatomical Pathology.pdf
6. Glossary of Biotechnology Terms, Third Edition.pdf
7. Clinical Neuropathology Text and Color Atlas.pdf
8. An Atlas Of Back Pain.pdf
9. An Atlas of Headache.maxiwarez.pdf
10. Atlas of Clinical Diagnosis 2nd Ed (2003).pdf
11. Atlas of functional neuroanatomy 2nd ed.pdf
12. Kahle, Color Atlas of Human Anatomy, vol 3 (2003).pdf
13. Neuroanatomy An Atlas of Structures, Sections, and Systems – Duane E. Haines.pdf
14. Pocket Atlas of Echocardiography.pdf
15. Pocket Atlas Of Radiographic Anatomy 2d ed – Torsten B. Moller, Emil Reif.pdf
16. Pocket_Atlas_of_Human_Anatomy__H._Feneis__W._Dauber._4th_Ed._2000_.pdf
17. Stedman’s Electronic Medical Dictionary 6th Edition.pdf
——————————————————
1. Skill 01[1].Temperature..pdf
2. Skill 02[1]..Pulse.pdf
3. Skill 03[1]..Respiration.pdf
4. Skill 04[1]..Blood Pressure.pdf
5. Skill 05[1]..Pulse Oximetry.pdf
6. Skill 06[1]..Capillary Blood Draw.pdf
7. Skill 07[1]..Venipuncture.pdf
8. Skill 08[1]..Blood Draw from a Central Venous Catheter.pdf
9. Skill 09[1]..Nasopharyngeal Swab.pdf
10. Skill 10[1]..Throat Culture.pdf
11. Skill 11[1]..Collection of Stool Specimen.pdf
12. Skill 12[1]..Collection of Urine Specimen.pdf
13. Skill 13[1]..Collection of a Midstream.pdf
14. Skill 14[1]..Assisting with Child during Bone Marrow.pdf
15. Skill 15[1]..Assisting with Child during Lumbar Puncture.pdf
16. Skill 16[1]..Assisting with Collection of Cerebrospinal.pdf
17. Skill 17[1]..Sponge Bath.pdf
18. Skill 18[1]..Insertion of a Peripheral IV Line.pdf
19. Skill 19[1]..Dressing Change Central Venous Line.pdf
20. Skill 20[1]..Insertion of a Nasogastric Tube.pdf
21. Skill 21[1]..Management of Gastrointestinal Suction.pdf
22. Skill 22[1]..Nasogastric Tube Irrigation.pdf
23. Skill 23[1]..Nasogastric Tube Lavage.pdf
24. Skill 24[1]..Administration of a Bolus Feeding.pdf
25. Skill 25[1]..Administration of NG, NJ, Gastrostomy and.pdf
26. Skill 26[1]..Changing a Fecal Ostomy Appliance.pdf
27. Skill 27[1]..Emptying an Ostomy Pouch.pdf
28. Skill 28[1]..Administration of Enemas.pdf
29. Skill 29[1]..Urinary Catheterization.pdf
30. Skill 30[1]..Petaling a Cast.pdf
31. Skill 31[1]..Pin Site Care.pdf
32. Skill 32[1]..Care of the Child in an External Fixation.pdf
33. Skill 33[1]..Pin Care, External Fixation Device.pdf
34. Skill 34[1]..EVD Maintaining System at Correct Level and Functioning.pdf
35. Skill 35[1]..EVD Client Assessment.pdf
36. Skill 36[1]..EVD Monitoring Cerebrospinal Fluid (CSF).pdf
37. Skill 37[1]..EVD Changing the Drainage Bag.pdf
38. Skill 38[1]..EVD General Nursing Care and Safety.pdf
39. Skill 39[1]..Assisting with Chest Tube Insertion.pdf
40. Skill 40[1]..Preparing the Chest Tube Drainage System.pdf
41. Skill 41[1]..Care of the Child with a Chest Tube.pdf
42. Skill 42[1]..Assisting with Removal of Chest Tube.pdf
43. Skill 43[1]..Oxygen Administration.pdf
44. Skill 44[1]..Bulb Suctioning.pdf
45. Skill 45[1]..Nasotracheal Suctioning.pdf
46. Skill 46[1]..Tracheostomy Monitoring.pdf
47. Skill 47[1]..Tracheostomy Tube Change.pdf
48. Skill 48[1]..Tracheostomy Tube.pdf
49. Skill 49[1]..Tracheostomy Suctioning.pdf
50. Skill 50[1]..Endotracheal Tube Monitoring (ETT).pdf
——————————————————

Churchill Livingstone – 2001 – Grainger & Allison’s Diagnostic Radiology. A Textbook of Medical I.pdb
Classifications and Scores of the Shoulder – Habermeyer.pdf
Clinical Examination of Musculoskeletal System – Assessing Rheumatic Conditions.pdf
Clinical Interviewing.pdf
Clinical Orthopaedic Examination, Fifth Edition (2004).pdf
Clinical Tests for the Musculoskeletal System.pdf
Clinical.Anatomy.11ed.1405138041.Oct.2006.pdf
Clinical.Knowledge.Management.Opportunities.and.Challenges.pdf
clinical_evidence_vol_10.pdb
clinical_evidence_vol_9.pdb
clinical_laboratory_medicine_-_clinical_applications.pdb
Clinician’s Pocket Reference_0838515525.pdf
Color Atlas of Pharmacology.pdf
Color Atlas of Physiology.pdf
Common Symptom Answer Guide.pdf
Complementary Therapies in Neurology.pdf
Comprehensive Management of Chronic Obstructive Pulmonary Disease (2002) – COPD.iso
Core Topics in Pain.pdf
Cranial Nerves Functional Anatomy (2005).pdf
Current Diagnosis & Treatment in Orthopedics 3rd ed.pdb
Current Medical Diagnosis & Treatment, 2005 full pic.pdb
DeLee and Drez’s – Orthopaedic Sports Medicine. Editor DeLee (2nd Ed. 2003).pdb
Differential Diagnosis in Neurology and Neurosurgery.pdf
Drawing the Line. Art Therapy with the Difficult Client.pdf
Dynamics_of_Human_Gait.pdf
Electrodiagnosis in Diseases of Nerve and Muscle – Principles and Practice.chm
Elsevier’s Medical Terminology for the Practicing Nurse (1998).pdf
Encyclopedia of Infectious Diseases.pdf
Essentials of Complementary and Alternative Medicine.pdf
Essentials_of_Physical_Medicine_and_Rehabilitation.pdb
Evaluation of the Low Back Pain Practice Guideline Implementation in the Army.pdf
Evidence Based Practice in Primary Care [ILLUSTRATED].pdf
Evidence-Based Imaging – Optimizing Imaging in Patient Care.pdf
Evidence-based Medicine Workbook.pdf
evidence_base_of_clinical_diagnosis.pdf
Exercise Leadership in Cardiac Rehabilitation – An Evidence-based Approach – 0470019719.pdf
Ferri’s Clinical Advisor 2004 – Instant Diagnosis and Treatment. 6th edition.pdb
Foundations of Sport-Related Brain Injuries.pdf
Fractures_Classification_in_Clinical_Practice__2006_.pdf
Fractures_in_children_5ed.pdb
Functional Neuroanatomy of Pain.pdf
General Practice, 3rd Edition (J. Murtagh).pdb
Geriatric Medicine An Evidence-based Approach.pdf
Hand Bone Age.pdf
Handbook of couples therapy.pdf
Healing or Stealing. Medical Charlatans in the New Age.pdf
Healing_Back_Pain_The_Mind.pdf
How to Present at Meetings 2001.pdf
How to Read a Paper.pdf
Human Biology_0071218068.pdf
Human Body Dynamics – classical mechanics and human movement – A.Tozeren.pdf
Image-guided spine interventions.pdf
Information Technologies in Medicine – Volume I.pdf
Instant Pain Control – Using the Body’s Trigger Points.djvu
Interpretation of Diagnostic Tests 7th ed.pdb
Interviewing And Diagnostic Exercises For Clinical And Counseling Skills Building – ISBN 08058464.pdf
Kelley’s Textbook of Rheumatology 6th Edition, 2-Volume Set – ISBN.pdb
Lab Notes Guide to Lab and Diagnostic Tests (2005).pdf
Learning_Medicine_An_Informal_Guide_to_a_Career_in_Medicine.pdf
Living well with Parkinson’s.pdf
Lovell_and_winter_s_pediatric_orthopaedics_3rd_ed.pdb
Managing the symptoms of multiple sclerosis.pdf
Managing Your Multiple Sclerosis.pdf
Manual of Clinical Problems In Pediatrics 5th Edition (2000).pdb
Manual of Family Practice 2nd ed.pdb
Manual of Rheumatology and Outpatient Orthopedic Disorders Diagnosis and Therapy 4th ed.pdb
Marketing health services.pdf
Massage For Dummies.pdf
MCQ.Companion.to.Applied.Radiological.Anatomy.3HAXAP.pdf
Means Ends and Medical Care.pdf
Medical and Psychosocial Aspects of Chronic Illness and Disability, Third Edition (2005).pdf
Medical Malpractice – A Physician’s Sourcebook.pdf
Medical_Physiol_2nd_Ed.pdf
Merritt – Merritt’s Neurology 10th Ed.pdb
MILLER’S_REVIEW_OF_ORTHOPEDICS.pdf
Modern Neuromuscular Techniques (Modern Neuromuscular Techniques (WCD)) (2003).ISO
MP Van De Graaff Human Anatomy.pdf
Musculoskeletal.Diseases.DIAGNOSTIC IMAGING AND INTERVENTIONAL TECHNIQUES.pdf
Nelson.Textbook.of.Pediatrics.17th.ed – Behrman.pdb
Nervous System and Sensory Organs – Color Atlas and Textbook of Human Anatomy – Volume 3.pdf
Neuroanatomy – Atlas of Structures Sections Systems 6ed.pdf
Neuroscience – D.Purves, et al.pdf
Neurotransmitters, Drugs and Brain Function Wiley (2001).pdf
Nurses manual of laboratory and diagnostic tests 4th Ed 2003.pdf
Nursing practice in multiple sclerosis – a core curriculum.pdf
Occupational Health Practice – Arnold.Publishers.Fourth.EditionISBN0750627204.pdf
Opportunities in Physician Careers_0071438483.pdf
Outpatient and Primary Care Medicine, 2005 Edition (2004).pdf
Oxford Textbook Of Rheumatology, 2nd ed (1998).pdb
Oxford_Dictionary_of_Medical_Quotations.pdf
Oxford_textbook_of_public_health_4th_ed.pdb
Pediatric Musculoskeletal Diseases.pdf
Pediatric Radiography.pdf
Pain and Depression – An Interdisciplinary Patient-centered Approach.pdf
Pain.Medicine.and.Management.Just.the.Facts.pdf
Pain.Psychological.Perspectives.eBook-DDU.pdf
PATHOPHYSIOLOGY OF DISEASE.pdf
Pediatric Orthopedics for Primary Care Physicians.pdf
Pediatric Orthopedics in Practice.pdf
Physical Medicine and Rehabilitation Board Review.pdf
Pocket Atlas of Radiographic Anatomy 2nd ed, 2000.pdf
Pocket Guide to Diagnostic Tests-0838581358.pdf
Pocket.Guide.to.Musculoskeletal.Diagnosis.3HAXAP.pdf
Primary_care_medicine_office_evaluation_and_managem.pdb
Principles.and.Practice.of.Burn.Surgery.3HAXAP.pdf
Quick reference dictionary for massage therapy and bodywork.pdf
Robbins Pathologic Basis of Disease (with pictures).pdb
Rosen’s Emergency Medicine.chm
Scientific Writing Easy When You Know How (2002).pdf
Screening Notes Rehabilitation Specialists Pocket Guide (Davis Notes S) ISBN0803615736.pdf
Soft Tissue Rheumatology.CHM
Sports Injuries – Mechanisms, Prevention, Treatment. 2nd edition.pdb
SPORTS MEDICINE Just the Facts.pdf
strength training anatomy.pdf
Stretching – anderson bob.pdf
Super Joints Russian Longevity Secrets for Pain-Free Movement, Maximum Mobility & Flexible Strength (2001).pdf
Symptoms of Unknown Origin.pdf
T’Ai Chi for Seniors. How to Gain Flexibility, Strength, and Inner Peace .pdf
Textbook of Clinical Trials Wiley (2004).pdf
Textbook of Medical Physiology.pdf
Textbook Of Physical Diagnosis History – Examination Swartz.djvu
The Aging Spine.pdf
The A-Z Medical Writing.pdf
The Circuitry of the Human Spinal Cord_Its Role in Motor Control and Movement Disorders_0521825814.pdf
The Clinical Drug Therapy Rationales for Nursing Practice (Field Guide Series) (2006).pdf
The Clinical Science of Neurologic Rehabilitation (Contemporary Neurology Series, 66) (2003).pdf
The Coiled Spring.pdf
The Handbook of Brain Theory and Neural Networks – ISBN 0262511029.pdf
The healthcare quality book- vision, strategy, and tools.pdf
The Massage connection – ANATOMY AND PHYSIOLOGY.pdf
The Trigger Point Therapy Workbook – Your Self-Treatment Guide for Pain Relief – Clair Davies.pdf
The.Ultimate.New.York.Body.Plan.eBook-TLFeBOOK.pdf
TMJ Disorders and Orofacial.doc
Toward.Replacement.Parts.for.the.Brain.Implantable.Biomimetic.Electronics.PDF.eBook-YYePG.pdf
Trauma.E.Moore, et al – 5th edition.pdb
Treating Pediatric Bed-wetting With Acupuncture & Chinese Medicine.pdf
Treatment of Osteoarthritic Change in the Hip – Joint Preservation or Joint Replacement.pdf
Treatment.of.Pediatric.Neurologic.Disorders.3HAXAP.pdf
Tyranny of Health Doctors and the Regulation of Lifestyle.pdf
Understanding Human Anatomy and Physiology 5th edition.pdf
Using Alternative Therapies – A Qualitative Analysis.pdf
Visions of the Future. Chemistry and Life Science.pdf
Weight Training Basics.pdf
What They Didn’t Teach You at Medical School.pdf
What’s Wrong With Me – The Frustrated Patients’ Guide to Getting an Accurate Diagnosis.pdf
When.Walking.Fails.eBook-DDU.pdf
WHO manuals of diagnostic imaging – Radiographic Anatomy and Interpretation of the Musculoskeletal System.pdf
Who s who in orthopedics.pdf
World of Microbiology and Immunology.pdf
Writing Skills in Practice (Health Professionals).pdf

Supported  by
CLINICAL PEDIATRIC ONLINE 

Yudhasmara Foundation 

email : judarwanto@gmail.com, 

http://clinicalpediatric.wordpress.com/

Copyright © 2009, Clinical Pediatric Online Information Education Network. All rights reserved.

Supported  by
CLINICAL PEDIATRIC ONLINE

Yudhasmara Foundation

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646

email : judarwanto@gmail.com,

http://clinicalpediatric.wordpress.com/

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

Copyright © 2009, Clinical Pediatric Online Information Education Network. All rights reserved.

• Extract
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Supported  by
CLINICAL PEDIATRIC ONLINE

Yudhasmara Foundation

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646

email : judarwanto@gmail.com,

http://clinicalpediatric.wordpress.com/

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

Copyright © 2009, Clinical Pediatric Online Information Education Network. All rights reserved.

Supported  by
CLINICAL PEDIATRIC ONLINE 

Yudhasmara Foundation 

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646 

email : judarwanto@gmail.com,

http://clinicalpediatric.wordpress.com/

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO 

Copyright © 2009, Clinical Pediatric Online Information Education Network. All rights

• Acute Poststreptococcal Glomerulonephritis
• Acute Tubular Necrosis
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• Hematuria
• Hemolytic-Uremic Syndrome
• Hemorrhagic Fever With Renal Failure Syndrome
• Henoch-Schonlein Purpura
• Hypercalciuria
• IgA Nephropathy
• Medullary Cystic Disease
• Medullary Sponge Kidney
• Multicystic Renal Dysplasia
• Myoglobinuria
• Nephritis
• Nephrotic Syndrome
• Oligomeganephronia
• Oliguria
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• Potter Syndrome
• Proteinuria
• Renal Cortical Necrosis
• Renal Glucosuria
• Uric Acid Stones
• Urolithiasis
• Xanthinuria

Supported  by
CLINICAL PEDIATRIC ONLINE 

Yudhasmara Foundation 

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646

email : judarwanto@gmail.com,

http://clinicalpediatric.wordpress.com/

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

Copyright © 2009, Clinical Pediatric Online Information Education Network. All rights reserved.

The results of these tests are important in assessing the excretory function of the kidneys. For example, grading of chronic renal insufficiency and dosage of drugs that are primarily excreted via urine are based on GFR (or creatinine clearance).

It is commonly believed to be the amount of liquid filtered out of the blood that gets processed by the kidneys. Physiologically, these quantities (volumetric blood flow and mass removal) are only related loosely.

Indirect markers

Most doctors use the plasma concentrations of the waste substances of creatinine and urea, as well as electrolytes to determine renal function. These measures are adequate to determine whether a patient is suffering from kidney disease.

Unfortunately, blood urea nitrogen (BUN) and creatinine will not be raised above the normal range until 60% of total kidney function is lost. Hence, the more accurate Glomerular filtration rate or its approximation of the creatinine clearance are measured whenever renal disease is suspected or careful dosing of nephrotoxic drugs is required.

Another prognostic marker for kidney disease is Microalbuminuria; the measurement of small amounts of albumin in the urine that cannot be detected by urine dipstick methods.

[edit] Glomerular filtration rate

Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time.^[1]

Glomerular filtration rate (GFR) can be calculated by measuring any chemical that has a steady level in the blood, and is freely filtered but neither reabsorbed nor secreted by the kidneys. The rate therefore measured is the quantity of the substance in the urine that originated from a calculable volume of blood. The GFR is typically recorded in units of volume per time, e.g. milliliters per minute ml/min. Compare to filtration fraction.

There are several different techniques used to calculate or estimate the glomerular filtration rate (GFR or eGFR).

[edit] Measurement using inulin

The GFR can be determined by injecting inulin (not insulin) into the plasma. Since inulin is neither reabsorbed nor secreted by the kidney after glomerular filtration, its rate of excretion is directly proportional to the rate of filtration of water and solutes across the glomerular filter.

[edit] Creatinine clearance approximation of GFR

In clinical practice, however, creatinine clearance is used to measure GFR. Creatinine is produced naturally by the body (creatinine is a break-down product of creatine phosphate, which is found in muscle). It is freely filtered by the glomerulus, but also actively secreted by the renal tubules in very small amounts such that creatinine clearance overestimates actual GFR by 10-20%. This margin of error is acceptable considering the ease with which creatinine clearance is measured. Unlike precise GFR measurements involving constant infusions of inulin, creatinine is already at a steady-state concentration in the blood and so measuring creatinine clearance is much less cumbersome.

[edit] Calculation of C_Cr

Creatinine clearance (C_Cr) can be calculated if values for creatinine’s urine concentration (U_Cr), urine flow rate (V), and creatinine’s plasma concentration (P_Cr) are known. Since the product of urine concentration and urine flow rate yields creatinine’s excretion rate, creatinine clearance is also said to be its excretion rate (U_Cr×V) divided by its plasma concentration. This is commonly represented mathematically as

Example: A person has a plasma creatinine concentration of 0.01 mg/ml and in 1 hour produces 60ml of urine with a creatinine concentration of 1.25 mg/mL.

Commonly a 24 hour urine collection is undertaken, from empty-bladder one morning to the contents of the bladder the following morning, with a comparative blood test then taken. The urinary flow rate is still calculated per minute, hence:

To allow comparison of results between people of different sizes, the C_Cr is often corrected for the body surface area (BSA) and expressed compared to the average sized man as mL/min/1.73 m². While most adults have a BSA that approaches 1.7 (1.6-1.9), extremely obese or slim patients should have their C_Cr corrected for their actual BSA.

BSA can be calculated on the basis of weight and height.

[edit] Estimated values

A number of formulae have been devised to estimate GFR or C_cr values on the basis of serum creatinine levels.

[edit] Estimated creatinine clearance rate (eC_cr) using Cockcroft-Gault formula

A commonly used surrogate marker for actual creatinine clearance is the Cockcroft-Gault formula, which may be used to calculate an Estimated Creatinine Clearance, which in turn estimates GFR:^[2] It is named after the scientists who first published the formula, and it employs creatinine measurements and a patient’s weight to predict the Creatinine clearance.^[3][4] The formula, as originally published, is:

This formula expects weight to be measured in kilograms and creatinine to be measured in mg/dL, as is standard in the USA. The resulting value is multiplied by a constant of 0.85 if the patient is female. This formula is useful because the calculations are relatively simple and can often be performed without the aid of a calculator.

For creatinine in µmol/L:

Where Constant is 1.23 for men and 1.04 for women.

[edit] Estimated GFR (eGFR) using Modification of Diet in Renal Disease (MDRD) formula

The most recently advocated formula for calculating the GFR is the one that was developed by the Modification of Diet in Renal Disease Study Group.^[5] Most laboratories in Australia,^[6] and The United Kingdom now calculate and report the MDRD estimated GFR along with creatinine measurements and this forms the basis of Chronic kidney disease#Staging.^[7] The adoption of the automatic reporting of MDRD-eGFR has been widely criticised.^[8][9][10]

The most commonly used formula is the “4-variable MDRD” which estimates GFR using four variables: serum creatinine, age, race, and gender.^[11] The original MDRD used six variables with the additional variables being the blood urea nitrogen and albumin levels.^[5] The equations have been validated in patients with chronic kidney disease; however both versions underestimate the GFR in healthy patients with GFRs over 60 mL/min.^[12][13] The equations have not been validated in acute renal failure.

For creatinine in mg/dL:

For creatinine in µmol/L:

Creatinine levels in µmol/L can be converted to mg/dL by dividing them by 88.4. The 32788 number above is equal to 186×88.4^1.154.

A more elaborate version of the MDRD equation also includes serum albumin and blood urea nitrogen (BUN) levels:

Where the creatinine and blood urea nitrogen concentrations are both in mg/dL. The albumin concentration is in g/dL.

[edit] Estimated GFR (eGFR) using the CKD-EPI formula

The CKD-EPI(Chronic Kidney Disease Epidemiology Collaboration)formula was published in May 2009. It was developed in an effort to create a formula more precise than the MDRD formula, especially when actual GFR is >60 mL/min per 1.73 m2.

Researchers pooled data from multiple studies to develop and validate this new equation. They randomly divided 10 studies which included 8254 participants, into separate data sets for development and internal validation. 16 additional studies, which included 3896 participants, were used for external validation.

The CKD-EPI equation performed better than the MDRD (Modification of Diet in Renal Disease Study) equation, especially at higher GFR, with less bias and greater accuracy. When looking at NHANES (National Health and Nutrition Examination Survey) data, the median estimated GFR was 94.5 mL/min per 1.73 m2 vs. 85.0 mL/min per 1.73 m2, and the prevalence of chronic kidney disease was 11.5% versus 13.1%.

The CKD-EPI equation, expressed as a single equation, is:

GFR = 141 X min(Scr/κ,1)α X max(Scr/κ, 1)-1.209 X 0.993Age X 1.018 [if female] X 1.159 [if black]

where Scr is serum creatinine (mg/dL), κ is 0.7 for females and 0.9 for males, α is -0.329 for females and -0.411 for males, min indicates the minimum of Scr/κ or 1, and max indicates the maximum of Scr/κ or 1.

This formula was developed by Levey et al. ^[14]

[edit] Estimated GFR (eGFR) using the Mayo Quadratic formula

Another estimation tool to calculate GFR is the Mayo Quadratic formula. This formula was developed by Rule et al. ^[12] in an attempt to better estimate GFR in patients with preserved kidney function. It is well recognized that the MDRD formula tends to underestimate GFR in patients with preserved kidney function.

[edit] Estimated GFR for Children using Schwartz formula

In children, the Schwartz formula is used.^[15][16] This employs the serum creatinine (mg/dL), the child’s height (cm) and a constant to estimate the glomerular filtration rate:

Where k is a constant that depends on muscle mass, which itself varies with a child’s age:

In first year of life, for pre-term babies K=0.33^[17] and for full-term infants K=0.45^[16]

For infants between ages of 1 and 12 years, K=0.55^[15].

The method of selection of the K-constant value has been questioned as being dependent upon the gold-standard of renal function used (i.e. creatinine clearance, inulin clearance etc) and also may be dependent upon the urinary flow rate at the time of measurement.^[18]

[edit] Calculation using Starling equation

It is also theoretically possible to calculate GFR using the Starling equation.^[19]

J_v = K_f([P_c − P_i] − σ[π_c − π_i])

The equation is used both in a general sense for all capillary flow, and in a specific sense for the glomerulus:

Note that ([P_c − P_i] − σ[π_c − π_i]) is the net driving force, and therefore the net filtration is proportional to the net driving force.

In practice, it is not possible to identify the needed values for this equation, but the equation is still useful for understanding the factors that affect GFR, and providing a theoretical underpinning for the above calculations.

[edit] Normal ranges

For most patients, a GFR over 60 mL/min is adequate. But, if the GFR has significantly declined from a previous test result, this can be an early indicator of kidney disease requiring medical intervention. The sooner kidney dysfunction is diagnosed and treated, the greater odds of preserving remaining nephrons, and preventing the need for dialysis.

The normal ranges of GFR, adjusted for body surface area, are:^[20]

• Males: 70 ± 14 mL/min/m²
• Females: 60 ± 10 mL/min/m²

Normal reference ranges for creatinine clearance are:

Risk factors for kidney disease include diabetes, high blood pressure, family history, older age, ethnic group.

GFR can increase due to hypoproteinemia because of the reduction in plasma oncotic pressure. GFR can also increase due to constriction of the efferent arteriole but decreases due to constriction of the afferent arteriole. Non-steroidal anti-inflammatory drugs (NSAIDs) prevent the production of prostaglandins, molecules which dilate the afferent arteriole. NSAIDs could therefore worsen kidney function by decreasing afferent blood flow to the Bowman’s capsule.

Currently the group has five members:

Professor Andy Rees (Regius Professor of Medicine & honorary Consultant Physician)

Dr Renate Kain (Senior Lecturer & honorary Consultant Pathologist)

Dr Lars-Peter Erwig (Wellcome Trust Clinician Scientist & honorary Consultant Physician)

Dr Heather Wilson (Senior research Fellow)

Dr Keith Stewart (Scientific Officer)

Intranet

Institute of Medical Sciences · University of Aberdeen · Foresterhill · Aberdeen · AB25 2ZD
Tel: 01224 555700 · Fax: 01224 555844
Director: Professor Ian Booth · Email: ims@abdn.ac.uk

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http://clinicalpediatric.wordpress.com/

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

Copyright © 2009, Clinical Pediatric Online Information Education Network. All rights reserved.