PNL is the gold standard for the management of large and/or otherwise complex renal stones. Since its introduction in the seventies PNL has undergone considerable evolution, mainly driven by the improvement in access techniques, endoscopic instrument technology, lithotripsy devices and drainage management. The conventional prone position for PNL has been challenged in the last two decades by a variety of modifications, including the supine and Galdakao-modified supine Valdivia positions, which make simultaneous retrograde working access to the collecting system possible and have proven anesthesiological advantages. The Galdakao-modified supine Valdivia position allowed the development of ECIRS (Endoscopic Combined IntraRenal Surgery), a technique exploiting a combined antegrade and retrograde approach to the upper urinary tract, using both rigid and flexible endoscopes with the related accessories. The synergistic teamwork of ECIRS provides a safe and efficient, minimally-invasive procedure for the treatment of all kinds of urolithiasis. The aim of this book is to share with the urologic community worldwide our experience, our standardization of all the steps, and tips and tricks for the procedure.

Acute renal failure induced by rhabdomyolysis after strenuous, prolonged exercise such as marathon running or mountain climbing is a well-known medical phenomenon, but exercise-induced acute renal failure after short-term anaerobic exercise - for instance, short-distance track races - has been recognized only recently. This monograph provides in-depth information on exercise-induced acute renal failure after short-term anaerobic exercise, which causes severe pain in the loin and patchy renal ischemia with no sign of rhabdomyolysis. Half of the patients suffering from this condition experience renal hypouricemia, for which approximately 20% are treated with dialysis. This complete clinical reference book includes characteristics of the disease, diagnosis, treatment and prognosis, and corresponding preventive measures. Important information on gene analysis and etiology is also included, creating a valuable resource for nephrologists as well as for emergency physicians and those in the field of sports medicine.

Fresh insights into the pathogenic mechanisms by which hyperglycemia induces tissue and organ injurt are the basis for rapidly evolving promising therapies in diabetes. Especially promising as targets for intervention are products of oxidative stress, including kinins and growth factors. Improving results of renal replacement regimes now incorporating pancreatic islet transplants are able to delay and prevent end-organ damage in diabetic individuals. The evolving story of the taming of diabetes is of direct concern to nephrologists, endocrinologists, ophthalmologists, primary care physicians and medical students.

More than half a million people worldwide are now sustained by renal replacement therapy, mainly hemodialysis at a cost exceeding USD 30 billion per year. Each case of ESRD that is delayed or prevented saves funds that may be applied to other aspects of health care. Edited by an internationally renowned nephrologist, Prognosis for Kidney Disorders provides a timely summary of exciting work in progress directed toward renoprotection and of ultimate interdiction of ESRD.
Suitable for researchers and clinicians, Dr. Morrell Michael Avram has collected and commented on promising initiatives likely to enter everyday practice in the immediate future. Suitable for renal trainees, experienced kidney doctors, nurses, nutritionists and cardiologists.

Acute Renal Failure in Practice, edited by practising renal physicians, is the essential guide to the clinical management of patients with acute renal failure and its complex, life-threatening metabolic sequelae. This book explains the workings of the normal kidney, illustrates the aetiology and pathophysiology of acute renal disease, and provides practical treatment guidelines relevant to the day-to-day needs of the practising clinician. There is a clear emphasis on the underlying pathogenic mechanisms naturally leading to a full understanding of the rationale behind the recommended treatments. Each chapter is illustrated throughout by coloured tables and diagrams, and incorporates unique easy-to-follow "practice points" algorithms which detail, step-by-step, the precise treatment protocols required to succeed in caring for these complex patients. An entire section is dedicated to dealing with patients who develop acute renal failure in specific hospital settings, such as the labour ward or intensive care unit. Doctors working in a wide range of acute medical specialities frequently encounter patients with acute renal failure and will therefore find this an invaluable clinical handbook.

Chronic kidney disease with a worldwide prevalence of 10% in the general population is emerging as a major public health priority. Renal dysfunction is associated with a high risk for cardiovascular complications. The relationship between renal insufficiency and cardiovascular disease, termed the cardiorenal syndrome exists whether impairment of renal function is a consequence of primary renal parenchymal disease or primary heart disease.

Several pathophysiologic mechanisms have been postulated to explain the relationship between renal dysfunction and cardiovascular disease. Recent studies indicate an integrated response of the vascular smooth muscles and glomerular mesangial cells to traditional and uremia related cardiovascular risk factors. Traditional risk factors can incite renal impairment and cardiac damage. As renal function deteriorates, uremia-related risk factors play an increasing role both in reduction in glomerular filtration rate and cardiovascular damage. Several uremia related factors such as uncontrolled hypertension, disturbed glucose insulin metabolism, microalbuminuria, phosphate retention, secondary hyperparathyroidism, myocardial and vascular calcification, hypertensive-uremic cardiomyopathy, inflammation, oxidant injury, and neurohormonal dysregulation have been implicated in the pathogenesis of the cardiorenal syndrome. Recent data suggest that management of the cardiorenal syndrome requires aggressive control of traditional risk factors as well novel approaches to prevent or reverse uremia related processes.

This book provides a comprehensive update analysis of our current understanding of the cardiorenal syndrome including epidemiology, pathophysiologic mechanisms, and therapeutic approaches.

Nocturia: Causes, Consequences and Clinical Approaches is the first volume exclusively on the topic of nocturia and is designed to be a comprehensive treatise on the subject. The volume is organized into 11 chapters first introducing and defining nocturia and its impact to patients and society, followed by chapters dealing with predictors and risk factors; relationship to sleep disorders; overactive bladder; and water homeostasis. Therapeutic areas addressing nocturia are covered in specific chapters and include pharmacotherapy affecting the bladder, prostate and kidneys as well as behavioral therapy and surgical intervention. Separate chapters are devoted to alternative therapies as well as the impact of nocturia in the elderly. The volume closes with a chapter presenting avenues for future investigation into the etiology and management of nocturia. Clinical case scenarios inclusive of figures and tables illuminate the evaluation and management of patients with nocturia. Nocturia: Causes, Consequences and Clinical Approaches will give physicians and related healthcare providers the background to understand the conditions causing nocturia, how nocturia affects society and the basis for its rational treatment. It will be used as a state of the art reference by urologists, urogynecologists, internists, nephrologists, pulmonologists, endocrinologists and sleep medicine specialists.

When the kidney fails its intended mission to manage the body's waste products, physicians must perform multi-level and simultaneous adjustments to replicate kidney function. The management of the body's absorption, reabsorption, utilization and excretion of calcium and phosphate requires constant fine tuning. Calcium and Phosphate Metabolism Management in Chronic Renal Diseases provides an overview of the state-of-the-art clinical and basic science aspects of abnormal calcium and phosphate metabolism and its management.

The papers in this volume arose out of the workshop Membrane Transport and Renal Physiology, which was conducted as part of the IMA 1998-1999 program year, Mathematics in Biology. The workshop brought together physiologists, biophysicists, and applied mathematicians who share a common interest in solute and water transport in biological systems, especially in the integrated function of the kidney. Solute and water transport through cells involves fluxes across two cell membranes, usually via specialized proteins that are integral membrane components. By means of mathematical representations, transport fluxes can be related to transmembrane solute concentrations and electrochemical driving forces. At the next level of functional integration, these representations can serve as key components for models of renal transcellular transport. Ultimately, simulations can be developed for transport-dependent aspects of overall renal function. Workshop topics included solute fluxes through ion channels, cotransporters, and metabolically-driven ion pumps; transport across fiber-matrix and capillary membranes; coordinated transport by renal epithelia; the urine concetrating mechanism; and intra-renal hemodynamic control. This volume will be of interest to biological and mathematical scientists who would like a view of recent mathematical efforts to represent membrane transport and its role in renal function.

As the number of people aged 65 years and above rises, physicians are increasingly confronted by elderly patients with impaired renal function, altered drug metabolism and multiple comorbidities. This book examines in detail the nature of renal injury in the elderly and its optimal management. A wide range of key topics are covered, including end-stage renal disease, diabetic nephropathy, acute kidney injury, drug metabolism and renal toxicity, dialysis and its complications and the use of renal transplantation. In addition, the assessment of glomerular filtration rate in the elderly and the role of novel renal biomarkers are carefully examined. Quality of life issues, the significance of other age-related medical problems and end of life care are also discussed. This book will be of value not only to nephrologists but also to general practitioners, medical students, intensivists, cardiologists, pharmacologists and those working in related specialties. "

Over the last decade the development of new molecular biology tools, advanced microscopy, live imaging and systems biology approaches have revolutionized our conception of how embryonic development proceeds. One fundamental aspect of development biology is the concept of morphogenesis: understanding how a group of multipotent cells organize and differentiate into a complex organ. In Kidney Development: Methods and Protocols, expert researchers in the field detail different approaches to tackle kidney development. These approaches include culture and live imaging aspects of kidney development, analyzing the 3-dimensional aspects of branching morphogenesis as well as nephrogenesis, manipulation of the gene/protein expression during kidney development as well as in the adult kidney, and how to assess kidney malformation and disease. Written in the highly successful Methods in Molecular Biology (TM) series format, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible laboratory protocols, and key tips on troubleshooting and avoiding known pitfalls. Authoritative and practical, Kidney Development: Methods and Protocols seeks to aid scientists in the further study of the process of morphogenesis which is fundamental important not only for studying developmental biology but also for regenerative medicine.

Kidney Development and Disease brings together established and young investigators who are leading authorities in nephrology to describe recent advances in three primary areas of research. The first section describes the use of animal models as powerful tools for the discovery of numerous molecular mechanisms regulating kidney development. The second section focuses on nephric cell renewal and differentiation, which lead to diverse cell fates within the developing kidney, and discusses diseases resulting from the aberrant regulation of the balance between cell fate decisions. The final section concentrates on morphogenesis of the developing kidney and its maintenance after formation as well as the diseases resulting from failures in these processes. Kidney form and function have been extensively studied for centuries, leading to discoveries related to their development and disease. Recent scientific advances in molecular and imaging techniques have broadened our understanding of nephron development and maintenance as well as the diseases related to these processes.

Conditions such as oxidative stress and hypoxia, which have a generalized impact on the oxygen metabolism, have been implicated in the genesis of kidney disease. This means that deepening our understanding of the pathobiology of oxygen metabolism in such diseases could be a fruitful path towards tangible clinical benefits. Studies in Renal Disorder collects reviews from leading researchers and clinical scientists working in exactly this field, providing an overview of the latest advances. The causal role of impaired oxygen metabolism in kidney disease has numerous clinical implications. It affects our understanding of the therapeutic benefits accruing from anti-hypertensive agents; the way we control hyperglycemia/hyperinsulinemia and hyperlipidemia; and our use of dietary approaches to the correction of obesity. The defensive mechanisms against oxidative stress, such as the Nrf2-Keap1 system, and hypoxia, such as the PHD-HIF system, have recently been explored in various cells, including kidney cells. These mechanisms include intracellular sensors for oxidative stress and hypoxia. This means that novel approaches targeting these sensors may offer clinical benefits in kidney disease in which oxidative stress and/or hypoxia is a final, common pathway.

A complete guide to caring for your kidneys and maximizing your health. Kidney disease occurs when your kidneys are damaged and no longer function as well as they should. In the past, it was fatal, but thanks to new treatments, including dialysis and transplantation, people can live long and healthy lives. This book provides everything you need to know to help you cope with your kidney disease and maximize your health. Walter A. Hunt, a medical researcher who had kidney disease and received a kidney transplant, walks you through what science says about how you can take care of your kidneys, including what foods to avoid and what treatment options may be best for you. Also included are recommendations to help you sleep and feel better along with overall health advice. In this latest edition, Hunt adds new sections on emerging subjects, including * coping skills for caregivers * kidney disease in children * environmental causes of chronic kidney failure * conservative care for those who wish to decline treatment * related conditions like gout, depression, and sleep disturbances * diet after transplantation * how best to work with your care team * insurance issues * potential new treatments A useful guide for the healthcare professionals who work with individuals with kidney problems.

Table 1 Comparison of MIDD and immunoglobulinic amyloidosis MIDD Amyloidosis Presentation Multivisceral or predominant involvement of an organ (kidney) Underlying disease Monoclonal immunoproliferative disorders, mostly myeloma. Monoclonal bone marrow plasma cell populations without overt malignancy. Possibility of 'non-secretory' forms. Deposits by EM (Granular) non-organized Fibrillar (13 pleated sheets) Spectrum LCDD : L chains, most K, either AL-amyloidosis : fragments (?)* of or apparently enlarged, normal-sized normal-sized or apparently enlarged or short. Frequent glycosylation L chains most A. Frequent and polymeration. glycosylation.Abnormal susceptibility to proteolysis. LHCDD : associated H chains Cases with associated short H chains (short by biosynthesis by biosynthesis experiments. experiments). HCDD: short H chains. AH-amyloidosis : short H chains. L chain isotypy V K IV predominance. VAVI C A3predominance. V region mutations Yes Yes *Found in necropsy material; whether they exist in vivo is doubtful. 3 After Preud'homme et al. AL-amyloidosis). Therefore, we believe' that the term MIDD should be restricted to this pathological entity, whatever the Ig content of the deposits, light 4 5 ) or both (LHCDD ). However, the chains (LCDD), heavy chains (HCDD New York group used the denomination MIDD for both Randall's disease and immunoglobulinic amyloidosis'S". The two processes have many features in common (Table I) and they can be associated in the same patients.

Is the nephrology community facilitating excess cardiovascular deaths in patients with kidney failure and anemia by treating to a subnormal hematocrit? Why have clinicians and nephrologists permitted health insurance companies and the government to decide when anemia therapy should begin in persons with progressive kidney failure? Is iron the only variable that can be manipulated to maximize response to recombinant erythropoietin? Are we using too much intravenous iron in kidney failure patients, and is oral iron supplementation worthless in sustaining iron stores during long-term erythropoietin treatment? When does left ventricular hypertrophy begin to emerge in patients with progressive renal disease and is there convincing evidence that anemia is a significant cause of LVH in this setting? Is darbepoetin alfa, a new novel, long-acting erythropoietin, really superior to recombinant erythropoietin? This book is a compilation of proceedings from a conference in Brooklyn convened to address these and other controversial and unresolved issues in renal anemia management.

This conference and monograph were the result of many collective efforts. The whole concept was formulated one early Wednesday morning at our weekly research meeting at Children's Hospital in our division of urology. We have been most fortunate to have a close collaboration with Bob Levin, Ed Macarak, and Pam Howard who have helped steer the course of our division's growing interest in basic science. At our weekly meetings our laboratory fellow will summarize their current work. Other ongoing areas of investigation in our labs and elsewhere are discussed. We have always made an effort to try and understand what other groups are doing who are working in the area of bladder smooth muscle research. It occurred to us that the best way to really know what everyone working in this field was doing would be to sponsor a 2-day meeting where we could all gather to discuss our ongoing work. A major limitation of the annual meeting of the American Urologic Association or the urology section of the American Academy of Pediatrics is that the scientfic sessions are limited as these are meant to be primarily clinical meetings (as they should be). For this reason the idea of a meeting devoted solely to research about the urinary bladder had great appeal. In addition to allowing for longer presentations than the standard 5 to 7 minutes, every effort would be made to encourage a dialogue amongst the presenters and the audience.

The prevalence of hypertension is almost three times as high as that of diabetes mellitus type 2, with both conditions being major risk factors for stroke, ischemic heart disease, cardiac arrhythmias, and heart failure. The exact prevalence of hypertension related to hormonal derangements (endocrine hypertension) is not known but estimated to affect less than 15% of hypertensive patients. Recent scientific discoveries have increased the understanding of the pathophysiologic mechanisms of hypertension. In Endocrine Hypertension, a renowned panel of experts provides a comprehensive, state-of-the-art overview of this disorder, discussing when to assign an endocrine cause in one of many conditions that may present with hypertension. The first part of Endocrine Hypertension is dedicated to adrenal causes. The second part of the volume concerns potential nonadrenal causes of hypertension, such as growth hormone excess or deficiency, primary hyperparathyroidism, vitamin D deficiency, testosterone deficiency, insulin resistance, obesity-associated hypertension, and the role of central mineralocorticoid receptors and cardiovascular disease. An important contribution to the literature, Endocrine Hypertension is an indispensable reference not only for endocrinologists, diabetologists, and adrenal investigators, but also for translational scientists and clinicians from cardiology, internal medicine, pediatrics, family medicine, geriatrics, urology, and reproductive medicine / gynecology.

Because of many advances in medicine and biotechnology, an increasing number of individuals are surviving into old age, and we are now challenged to apply sophisticated medical knowledge to the care of the elderly citizen. In nephrology, individuals older than 65 are the fastest-growing group of patients requiring dialysis. Similarly, in increasing numbers, elderly persons present themselves with renal complaints to their family doctor, the geriatrician or the nephrologist. In August 1998, with the financial support of the John A. Hartford Foundation, leaders in geriatrics, nephrology and urology met in Jasper, Alberta, for one week to discuss their areas of special knowledge and to learn from each other. Geriatricians learned from nephrologists, nephrologists learned from geriatricians, and both came to see that they had much in common. All participants discovered a common interest, challenge and commitment, namely, to provide the best renal care to a progressively aging population and to teach their fellows the principles of the other collaborating specialties. This book contains all the papers presented at this meeting and also the text of group discussions on Training and Education, Special Clinical Problems in Geriatric Patients, and Recommendations in Basic and Clinical Research. Nephrology and Geriatrics Integrated will prove useful to both nephrologists and geriatricians in their efforts to manage the renal complaints of the elderly, who come to them in increasing numbers.