Increasingly, medicine in general and nephrology specifically is based on clinical trials and verifiable presumption. Still, however, much of everyday clinical practice is the consensus of pundits and experts unable to validate their suggestions beyond personal bias.

In this unique volume, several core beliefs in renal medicine are examined and challenged. Starting as assignments for nephrology fellows, this book grew out of surprising revelations' indicating that the emperor has no clothes'.

The book is suitable as a stimulus for provocative discussions for nephrologists, internists, house staff, and medical students.

Der Dialyseshunt als moderne Form des permanenten Gefazugangs ist grundlegender Bestandteil der Betreuung des chronisch niereninsuffizienten Patienten.

In diesem Band wird das komplette Spektrum der Fragestellungen rund um Dialyseshunts fachkundig und umfassend abgehandelt: von der interdisziplinaren Vorbereitung der Gefauntersuchung durch Nephrologen und Gefachirurgen, uber die Diskussion unterschiedlicher chirurgischer Moglichkeiten der direkten Gefazugange bis hin zur Shuntpflege und Shuntpunktion. Daruber hinaus werden Diagnostik und Therapie bei Komplikationen sowie alternative Dialysezugange detailliert dargestellt.

Mit der 1. Auflage dieses Buches wurde vor 10 Jahren erstmals eine interdisziplinare, gefachirurgisch und nephrologisch angelegte Darstellung des groen Gebietes der Dialyseshunts in deutscher Sprache vorgelegt. Diese 2. Auflage belegt die weitere rasche Entwicklung dieses immens wichtigen Gebietes.

Immunosuppression in solid organ transplantation is experiencing a worldwide revival since new drugs are now available in the late-1990s and others are under development. In order to contribute to the design of future strategies, a critical approach of surrogate endpoints is given and long-term side effects are analyzed, together with the impact of non-compliance, quality-of-life and economical parameters. In this book, international specialists have set up the scientific rationale and provided new bases for further immunosuppressive strategies.

Seeing a patient die under his hands because there is no adequate treatment causes an emotion and a frustration in a doctor, which sometimes stimulates him to try to develop a new type of treatment. Seeing so many wounded young soldiers die due to renal failure in World War I incited the German doctor Georg Haas to try to develop an artificial kidney. He had to give up in despair in 1928. Ten years later doctor Willem Kolff saw a young man die in his ward in the University Hospital of Groningen due to renal failure. By that time two essential factors for an artificial kidney had become available: a drug to keep the blood from clotting outside of the body and an efficient dialysing membrane through which waste substances can pass from the blood into the dialysing fluid. Kolff succeeded in creating the rotating artificial kidney which he started using in the town hospital of Kampen in 1943. The rotation of this artificial kidney started a revolution that made it possible for thousands of kidney patients all over the world to keep on living - and sometimes to forget their disease for the time being. In addition it gave rise to the development of other artificial organs such as the heart-lung machine, the artificial heart and the artificial eye. Doctor Jacob van Noordwijk, the author of this book, was Kolff's first assistant in the treatment of the first 15 patients. How Kolff succeeded in spite of all the limitations imposed by the German occupation of the Netherlands and in spite of the absence of antibiotics and other medical tools which are common nowadays makes a story which may sound incredible. Yet it did happen and visitors to the town of Kampen can still see the hospital building where it all took place.

Explores the latest findings for both selective and efficient separation devices in the field of kidney research. It is divided into three major sections. Part one deals with the biochemistry'' part of the problem, including how to identify ligands of interest, how to link them to synthetic membranes, and some kinetic limitations of frontal elution chromatography. The second part comprehensively discusses the various substrata used in affinity separations and the formation processes of semi-permeable membranes. The final section explores the filtration processes using membranes and the kinetics of separations based on affinity membranes.

Having kidney failure is not a unique experience. Neither is receiving a kidney transplant or undergoing dialysis. Adopting to irreversible uremia - a devastating illness- by assisting others to cope with their own life trial represents the best of human traits. Bonded by marriage for 42 years, I was privileged to love and live with a marvelous and unique individual whose approach to life with this horrific disease taught me to regard every moment of our existence as precious. Preparation of this volume had two main objectives: 1) To honor the author for all of efforts in behalf of kidney patients. 2) To disseminate her insights and wisdom to those who may derive comfort and benefit from her words. Mildred (Barry) Friedman was a medical writer and patient advocate devoted to the American Association of Kidney Patients, who died at University Hospital of Brooklyn on September 21 st 1997 at the age of 61 of complications of type 1 diabetes. Barry, the second child of Leontine and Hardinge Barrett-Lennard, was born on October 17,1935 in Manhattan and attended Brooklyn College as a New York State Scholarship Awardee earning a Bachelor of Arts degree in 1953. She subsequently began teaching in the New York City elementary schools gaining a Master's degree in education. Following the birth of her third child, Barry developed both diabetes and Addison's disease forcing her retirement from teaching.

A practical primer for physicians wanting to learn about simple and complex urodynamic testing. The clear, concise workbook structure allows for quick reference to multichannel urodynamic tracings and their interpretation. Brief but thorough discussion of the underlying theory and concepts behind urodynamic testing enable readers to gain a firm grasp of the implications of test results in individual patients. It provides an understanding of all the techniques used for the evaluation and treatment of the incontinent or lower urinary tract dysfunctional female patient, and also includes a quick reference guide to outpatient treatment. In contrast to other didactic texts, this book allows readers to initiate testing programs and will thus be of practical benefit to all those interested in improving patient care.

'A powerful and moving book - it's quite a battle he has faced' Nick Robinson, BBC Radio 4 Today Programme 'It really is an interesting read' Dan Walker, BBC Breakfast *INCLUDES A FOREWORD BY SIR ALEX FERGUSON* __________ 'I'm not sure whether life prepared me for football, or football prepared me for life.' Misconceptions have stalked Andy Cole like a hatchet-man defender determined to cut him down to size. Now, in his candid and inspirational autobiography, Cole finally puts his side of the story. In the world of modern-day football, Andy Cole's reserved demeanour, combined with belief in his own ability, was often interpreted as an attitude problem that overshadowed his natural aptitude for goalscoring. Throughout his glittering career, he scored 187 Premier League goals, won 5 Premier League titles and 1 Champions League trophy. Now, two decades on from United's historic Treble, he not only gives the inside track on Eric Cantona, Roy Keane, Dwight Yorke and other members of that illustrious side, but also opens up about his fractious relationship with Teddy Sheringham and reveals the prejudices and preconceptions he had to contend with in his twenty years in the game. Compelling in its honesty and frankness, Fast Forward is the thought-provoking story of one man's determination to succeed and survive against all the odds.

This classification is based primarily on the microscopic charac- teristics of tumours and, therefore, is concerned with morpho- logically identifiable cell types and histological patterns, as seen with conventional light microscopy. The term tumours is used synonymously with neoplasm. The phrase tumour-like is applied to lesions which resemble neo- plasms, clinically or morphologically, but do not behave biologi- cally in a neoplastic manner. They are included in this classifica- tion because they give rise to problems in differential diagnosis and because of the unclear borderline between neoplasms and certain non-neoplastic lesions. Synonyms are listed only if they have been used widely, or if they are considered to be helpful to the understanding of the lesion. In such cases, the preferred term is given first, followed by the synonym. Although the emphasis of this classification is on histological typing, in the examination of kidney tumours, consideration should be given to the degree of cellular anaplasia, the extent of local spread, vascular and lymphatic invasion, and the occur- rence of metastasis. The scheme of histological grading suggested here is as fol- lows: Grade I applies to the tumours that have the least degree of cellular anaplasia compatible with a diagnosis of malignancy; . grade II! applies to tumours with the most severe degrees of cel- lular anaplasia; and grade I! applies to those tumours in be- tween. This scheme is applicable to the carcinomas of the renal parenchyma and pelvis.

This volume focuses on the investigatory methods applied to autosomal dominant polycystic kidney disease (ADPKD), one of the most common human genetic diseases. ADPKD is caused by mutations in PKD1 and TRPP2, two integral membrane proteins that function as receptor/ion channels in primary cilia of tubular epithelial cells. Thus, ADPKD belongs to ciliopathies, a group of disorders caused by abnormal cilia formation or function. This proposed book will cover the state-of-the-art methods ranging from molecular biology, biochemistry, electrophysiology, to tools in model animal studies. Key Features Explores the role of cilia in polycystic kidney disease Focuses on myriad state-of-the-art methods and techniques Reviews specific mutations integral to this autosomal genetic disease Includes discussions of model systems

International illicit trade in human organs is on the increase, fueled by growing demand and unscrupulous traffickers. In order to truly understand the problem of organ trafficking, an analysis should take into account the various perspectives that come into play in this multifaceted issue. With contributions from international scholars and experts, The International Trafficking of Human Organs: A Multidisciplinary Perspective provides a broad-based exploration of this controversial phenomenon. Divided into four parts, the book examines the issue of human organ trafficking from the perspectives of criminal justice, business, medicine, ethics, philosophy, and theology. The book begins by presenting case studies of the trafficking of body parts occurring in the U.S. and Mexico. It examines the increase in organ harvesting from Chinese prisoners and describes widespread instances of trafficking in Europe. Diverse perspectives Next, it examines the economic ramifications of possible legislation of the sale of body parts and discusses other proposals for increasing the supply of kidneys and other organs. It explores ethical issues surrounding the kidney shortage and incentives to promote donation. It also offers arguments for and against compensation for transplant organs from Kantian, Dworkinian, and other perspectives. Lastly, theologians discuss opposing Catholic and Protestant perspectives on the sale of human organs. Learning tools Each chapter provides discussion questions to provoke vigorous debate and references to facilitate further study. The wide-ranging analysis provided by this volume is certain to enhance further inquiry into a disturbing and increasingly prevalent issue.

This invaluable guide, endorsed by the UKMi and reflecting the extensive experience of the UK Renal Pharmacy Group, features drug monographs guiding physicians in how to prescribe, prepare, and administer drugs to patients with different levels of kidney function and when undergoing renal replacement therapy. It has been fully updated for this fifth edition to include up to 100 additional drugs, while maintaining the clear structure and format that is easy to use and simple to follow in the busy clinical setting. It continues to offer support and guidance to health care professionals enabling them to prescribe medications to their renal patients appropriately and safely.

Medical Semiology Guide of the Renal System provides a comprehensive understanding of medical semiology in the renal system. Highly illustrated with many original images from the author's daily medical practice, the book highlights all signs of diseases and important semiological maneuvers in the field. Each chapter incorporates a specific questionnaire with important questions that should be asked to patients in different situations to obtain valuable information that helps identify rare and unusual diseases. This unique feature of the book aims to facilitate the learning process among medical students, while also acting as a quick reference guide for clinicians in practice.

In about 5% of all organ (kidney, liver) transplant recipients, malignancies occur as a late complication of the massive immunosuppression. The malignancies are mainly skin cancers, lymphomas and renal carcinomas. The present book discusses the possible mechanisms of this type of tumorigenesis and inquires into possibilities of prevention. In particular, the described malignancies might be of viral origin. The book informs about a completely new type of carcinogenesis. Apart from the scientific aspects, it is of great practical value.

Advanced renal cell carcinoma is refractory to nearly forms of systemic therapy. For this reason the last decade has seen numerous research groups working on immunotherapeutic s trategies against it. Immunotherapy of Renal Cell Carcinoma reports the contributions of most of the world's leading re- search groups to two international conferences on the immu- nobiology of this illness. Sixteen chapters divided in expe- rimental and clinical studies provide an overview of immuno- therapy in renal cell carcinoma and a discussion of new la- boratory approaches to this topic.

This is the first book to summarize experimental results from the new, rapidly expanding field of research into the calcium channel in cell membrane. Calcium is an ubiquitous messenger of various cellular functions. Its fundamental role in the regulation of cardiac contractions has long been recognized. Drugs counteracting some actions of calcium ions, namely calcium antagonists, have since become essential to research. In the last decade it has been established that calcium ions reach their target intracellular system by passing through specialized calcium channels in the membrane. Recently improved experimental techniques combined with the discovery of highly specific Ca channel ligands have dramatically enlarged our knowledge of the molecular structure and function of such channels. The contributions by leading world specialists shed new light on both basic science and possible clinical implications for cardiovascular pharmacology, endocrinology and neuropharmacology.

The association of diabetes mellitus and hypertension has been well known for a long time. However, the important impact of hypertension on the development of chronic complications of diabetes and on the prognosis of the diabetic patient has only recently been realized. The increasing number of patients with endstage diabetic nephropathy who need regular dialysis or renal transplantation reflects only one important aspect of this problem. As new targets for the treatment of hypertension were considered, it became evident, that drug treatment of hypertension in diabetics must take side effects into account which may be negligible in the nondiabetic patient. Basic research has granted much new insight into the mechanisms which function to link diabetes, kidney function, hypertension, and vascular disease. As a result of the high specialisation in research, such new information diffuses only slowly out of the circles of experts into clinical practice. Therefore, it was a most rewarding initiative of the Bayer Company to sponsor a conference which aimed at a mutual exchange of ideas between clinicians and researchers who are experts in either hypertension or diabetes.

Peritoneal dialysis (PD) is in widespread use for the treatment of acute and chronic renal failure. A considerable amount of knowledge about the various procedures and problems associated with this form of treatment has accumulated over recent years, particularly since the introduction of continuous ambulatory peritoneal dialysis (CAPD). However to date the information regarding the more technical or practical aspects of PD has been largely scattered in various books and journals. There appears to be no straightforward text concerned with these points suitable for recommending to junior doctors or nurses dealing with patients receiving this therapy. Though in-house-training is of considerable value it takes time and I have noticed that on a number of occasions in our own unit, technical problems with PD have not been dealt with quickly because of lack of knowledge in the staff on duty. There thus appeared to me to be a need for a short book giving firm advice on how to perform the various procedures and how to deal with problems as they arose. This manual is an attempt to fulfil that aim. Initially it was tried and tested on the renal unit in the Cardiff Royal Infirmary for 3 years. Prior to publishing it has been extensively revised and updated.

Membrane Transport Processes in Organized Systems is a softcover book containing portions of Physiology of Membrane Disorders (Second Edition). The parent volume contains six major sections. This text encompasses the fourth and fifth sections: Transport Events in Single Cells and Transport in Epithelia: Vectorial Transport through Parallel Arrays. We hope that this smaller volume, which deals with transport processes in single cells and in organized epithelia, will be helpful to individuals interested in general physiology, transport in single cells and epithelia, and the methods for studying those transport processes. THOMAS E. ANDREOLI JOSEPH F. HOFFMAN DARRELL D. FANESTIL STANLEY G. SCHULTZ Vll Preface to the Second Edition The second edition of Physiology of Membrane Disorders represents an extensive revision and a considerable expansion ofthe first edition . Yet the purpose of the second edition is identical to that of its predecessor, namely, to provide a rational analysis of membrane transport processes in individual membranes, cells, tissues, and organs, which in tum serves as a frame of reference for rationalizing disorders in which derangements of membrane transport processes play a cardinal role in the clinical expression of disease. As in the first edition, this book is divided into a number of individual, but closely related, sections. Part V represents a new section where the problem of transport across epithelia is treated in some detail. Finally, Part VI, which analyzes clinical derangements, has been enlarged appreciably.

In many ways this book is a team effort. Many people have helped me in writing it. Firstly, I thank my wife who read the manuscript twice correcting grammatical errors and spelling and clarifying many sentences. Secondly, I thank friends and colleagues at St. Mary's Hospital, including Mrs Jean Emerson, Renal Unit Social Worker and Mrs June Morgan, Senior Dietician, both of whom contributed technical information; Sisters Christine Holmes and Malinie Polpitiye who read and criticized some chapters; Miss Mary Williams, Mr Robert Minor and Mr Richard Viner who as patients read some sections and made useful suggestions. My thanks are due to Miss Veronica Adams who typed most of the manuscript and also to Mrs June Marshall and Miss Joyce Meadows who helped with typing and much photocopying. I must thank Travenol Laboratories Limited whose generous financial support enabled this book to be published. The editorial staff of MTP Press have been very helpful, rapid and efficient in publishing the text. If any reader wants to know more about renal disease, there 7 PREFACE are several good introductory books on renal medicine available. I am sure that the local public library will be pleased to help. Any parts of this book that are wrong or misleading are my responsibility. If anyone has the energy to point out errors to me I will try to correct them in any subsequent edition.

Clinical Disorders of Membrane Transport Processes is a softcover book containing a portion of Physiology of Membrane Disorders (Second Edition). The parent volume contains six major sections that deal with general aspects of the physiology of transport processes and specific aspects of transport processes in cells and in organized cellular systems, namely epithelia. This text contains the last section, which deals with the application of the physiology of transport processes to the understanding of clinical disorders. We hope that this smaller volume will be helpful to individuals particularly interested in clinical derangements of membrane transport processes. THOMAS E. ANDREOLI JOSEPH F. HOFFMAN DARRELL D. FANESTIL STANLEY G. SCHULTZ Vll Preface to the Second Edition The second edition of Physiology of Membrane Disorders represents an extensive revision and a considerable expansion of the fIrst edition. Yet the purpose of the second edition is identical to that of its predecessor, namely, to provide a rational analysis of membrane transport processes in individual membranes, cells, tissues, and organs, which in tum serves as a frame of reference for rationalizing disorders in which derangements of membrane transport processes playa cardinal role in the clinical expression of disease. As in the fIrst edition, this book is divided into a number of individual, but closely related, sections. Part V represents a new section where the problem of transport across epithelia is treated in some detail. Finally, Part VI, which analyzes clinical derangements, has been enlarged appreciably.

Discovery and Relative Importance of Continuous Arteriovenous HemofIltration Lee W. Henderson Continuous arteriovenous hemofiltration (CAVH) has seen a brisk upswing in popularity in Europe since its introduction by Dr. Kramer and colleagues from Gottingen, West Germany in 1977 [1]. In the United States, the technique re- ceived approval as a clinical tool from the Food and Drug Administration in April 1982. This approval flowed, in no small measure, from the extensive expe- rience reported from Europe and in particular West Germany [e. g. , 2, 3]. Reports of its clinical utility now have begun to appear in the United States [4]. Removal of excess total body water using synthetic membranes in an extracor- poreal circuit dates back to the work of Alwall and the artificial kidney that he designed which permitted utilization of a hydrostatic pressure gradient to moti- vate water flow across the membrane [5]. Kolffs original rotating drum with its unencased membrane required an osmotic driving force [6]. Hemofiltration, the use of the filtration process to remove uremic solutes with the artificial kidney, in analogy with the glomerulus, was reported in 1967 [7]. This was made possible by the availability of synthetic membranes with far higher hydraulic permeability (approximately 10 times higher) than conventionally used cellulosic hemodialysis membrane. Specific applications of these "high flux" membranes to the removal primarily of excess total body water followed shortly thereafter [8].

Recent experimental and clinical research performed by outstanding authorities has enabled us to characterize fundamental processes that govern the regulation of salt and water content of the body. Their results have provided not only an important gain of insight into mechanisms at the cellular level but also the possibility to integrate single cell activities into a complex organ function. Moreover, this knowledge enables scientists to develop broader concepts concerning the regulation of organ function and thus contributes to a better understanding of the overall status in health and disease. In the present volume some of these physiologists and clinicians discuss principal questions of humoral and non-humoral influences involved in the control of electro lyte and fluid content of the organism. It contains three essential topics: Data concerning basic principles of cell behaviour and transport processes are followed by the description of natriuretic substances and their influence on volume regulation. Finally, attempts are undertaken to elucidate the meaning of these basic principles for the explanation of the development of patholocigal states. This symposion was held in honor to Professor H. P. Wolff, one of the internatio nally wellknown pioneers in this field of clinical research. The editors. wish to express their graditude to the Melusin-Schwarz-Monheim GmbH for the generous support of the symposion."

More than 50 years after Haas' first human dialysis, and second edition by incorporating chapters on its history 40 years after Kolfrs pioneering work, a book on the and on the practical aspects. present state of the art cannot be written by one person: The size of the book has almost doubled, partly by obviously it had to be a multi-authored volume. There using more illustrations. The inclusion of a number of fore some overlap between chapters and even a few con colour reproductions has been made possible by a sup troversies between authors became unavoidable. porting grant * of the National Kidney Foundation of we deliberately avoided editorial streamlin the Netherlands, which the editors gratefully acknow However ing of manuscripts, leaving the authors' personal style ledge. We considered asking several authors to shorten their and personal opinions unaltered as much as possible. We resisted this as it would have delayed the This may make the book more vivid to read and may chapters. sometimes stimulate readers to study a subject in greater publishing date and would possibly have removed much detail from the literature. Additionally, both British and material besides being a painful task for our collea American spellings have been kept because of the inter gues."

The Sixth International Symposium of Paediatric Nephrology took place between 29 August and 2 September 1983 in Hannover, Federal Republic of Germany. It was organized on behalf of the International Paediatric Nephrology Association (IPNA), and sponsored by the regional societies of paediatric nephrology, i. e. the American Society of Pediatric Nephrology (ASPN), the European Society ofPaedi- atric Nephrology (ESPN), the Japanese Society of Pediatric Nephrology (JSPN) and the Latin American Society of Pediatric Nephrology (ALANEPE). The five in- ternational meetings preceding the Hannover symposium were held in Guadalajara 1968 (G. Gordillo-Paniagua), Paris 1971 (P. Royer, R. Habib, H. Mathieu), Washing- ton 1974 (P. L. Calcagno, C. E. Hollerman), Helsinki 1977 (N. Hallman, O. Koski- mies) and Philadelphia 1980 (A. B. Gruskin, M. E. Norman). The scientific programme of the Hannover meeting was a reflection of the many suggestions brought before the Programme Content Committee. It consisted of plenary sessions, symposia, workshops, short communications and posters. The lec- turers at the plenary sessions were invited by the President according to the topics selected by the Programme Content Committee. The symposia dealing with special aspects of paediatric nephrology were organized in a combined effort by chairper- sons selected as experts in the topic concerned and by the President. This volume contains all the papers from the four plenary sessions and 95% of the symposia presentations.