This book does not pretend to be a comprehensive textbook of nephrology, nor is it a guide to the management of renal disease, as space does not allow the description or discus sion of investigation and treatment. Its intention is to illustrate the diverse diseases which present to nephrologists. Since the key to understanding the effects and progression of a disease are to know and com prehend its pathology, I have approached the subject not by discussing presenting symptoms of single diseases in different sections, which would lead to much repetition, but by describing the disorders according to the mechanisms which cause them. To illustrate the text I have chosen the most immediate clue which usually appears in a given dis ease, which may therefore be a clinical sign, a radiograph or the histological appearance of a renal biopsy. D. Gwyn Williams Guy's Hospital, London 1. Trauma Trauma is a common cause of acute renal failure. This may arise directly from injuries to the kidneys themselves despite their protected position (Figure 1). Trauma can also cause acute renal failure by damaging the renal arteries, which may be actually avulsed from the kidneys, or stretched at the time of impact, with tearing of the arterial wall and secondary thrombosis. Figure 2 shows the renal arteriogram of a young man who presented with anuric acute renal failure after a motorbike accident. Only the upper pole of the right kidney is Figure 1.

This book provides a comprehensive look at renal cell carcinoma, exploring its biology as well as current and future molecular targets for renal cancer carcinoma.

A year or so after Dr. Robert Popovieh arrived in Seattle in 1965 to begin working on his doctoral thesis under Dr. A.L. Babb, we had just begun work to try to prove the prediction that the peritoneum had a higher permeability to 'middle molecules' than hemodialysis membranes [I]. Several years later, when Dr. Popovieh accepted a position at the University of Texas in Austin, he decided to concentrate his research efforts in the area of peritoneal dialysis and everyone knows how successful that effort has become [2]. Indeed, because of continuous ambulatory peritoneal dialysis (CAPD), long-term per itoneal dialysis after a two-decade incubation period is finally becoming an equal option to hemodialysis and transplantation in the management of chronic renal failure. For me this development represents final vindication of a twenty-year effort to help promote peritoneal dialysis, often in the face of enormaus opposition. I particularly remember a policy meeting at the NIH a few years back in which it was decided by my colleagues on the committee that long term peritoneal dialysis had no future and therefore no funds for projects in this area would be forthcoming. Based on the excellent results that Boen and later Tenckhoff had been getting in our Seattle program, I knew the committee was wrong and tried to convince them otherwise. Naturally, being the only favorable vote, I failed. I often wonder how many years this decision and others like it set back peritoneal dialysis.

This second edition of the Manual of Clinical Dialysis is a concise and well-illustrated guide to all aspects of dialysis. All chapters have been revised and present a complete overview of the techniques, processes and equipment involved in clinical dialysis as well as an overview of the complications of dialysis. The manual also provides an overview of common clinical problems related to renal failure such as hypertension, anemia and renal osteodystrophy.

Hyponatremia is a common electrolyte disorder found in a variety of settings. Manifestations range from subtle abnormalities to convulsions and death. New treatment options, such as Antidiuretic Hormone (ADH) antagonists, have created the need for a resource presenting the latest evidence and clinical approaches. Hyponatremia: Evaluation and Treatment is a comprehensive review of hyponatremia, with an emphasis on managing this disorder from diagnosis to treatment. The incidence and occurrence of acute and chronic hyponatremia in general terms are covered, as well as disorders of the central nervous system, heart and liver with their relation to hyponatremia. Common clinical scenarios are presented along with both traditional and new methods of treatment. Authored by experts on this disorder from around the world, experienced members of the medical community and trainees alike will find Hyponatremia as an indispensible guide to diagnosis, managing and treating patients with hyponatremia.

In 1986, the Committee of Experts on Blood Transfusion and Immunohae- tology of the Council of Europe chose for their Programme of Co-ordinated Research "An investigation of the procurement and sharing of transplantable organs for potential recipients who are highly sensitized to HLA-antigens." This topic was of common concern to all centres practising renal transplan- tion. The terms of reference of the study were: To estimate the number of patients who are virtually "untransplantable" because of high sensitization in each European country. To study the nature of immunization in terms of the type and specificity of antibodies present in the blood and techniques used for their detection. To investigate possible practical solutions - both current and future, invo- ing cross-matching procedures, the circulation of reference material from patients, and the willingness of the national organizations to share resources. 4. To explore other methods of resolving this problem. Although the study did not offer the prospect of a brilliant new insight into the problem of high sensitization, it was unique in several ways: for the first time we saw all European organizations collaborating in a common project to provide information on their activities, their problems and the methods to resolve them; it introduced, for this subject, relatively novel statistical methods to investigate susceptibility to sensitization and factors affecting transplant outcome; it enabled a large database of transplanted highly sensitized patients and matched controls to be assembled, that would have been unavailable as a research resource at any single centre.

Rejection and Tolerance is the latest subject in the Continuing Education series, organized by Fondation Marcel Merieux and Universite Claude Bernard in Lyon. The annual subject is chosen to reflect the status of the topical issues of the year, as taught by leading international experts. The contribution of transplantation and clinical immunology to advanced medicine is considerable and promising. The annual volumes in this series keep the reader abreast of these developments. "

This book provides a concise, patient-directed approach to stone prevention. It defines who to evaluate and when to treat, and provides empiric guidelines for all stone formers. Specific treatment guidelines are also included, based on the kidney stone composition and the underlying metabolic abnormalities demonstrated by 24-hour urine stone risk profile. Written by experts in the field, Pocket Guide to Kidney Stone Prevention: Dietary and Medical Therapy serves as a valuable resource for a broad base of clinicians in primary and specialty care.

While patients with metastatic renal cell carcinoma (mRCC) are now living longer with improved quality of life, the success of novel therapies for mRCC has created challenges for practicing oncologists. Many patients who initially respond to targeted therapies ultimately develop progressive disease due to acquired resistance to these agents. Additionally, some patients do not respond at all to any of the currently approved targeted agents, underscoring the need for continued and concerted efforts to identify other relevant targets and pursue alternative therapeutic strategies. Part of the Oxford American Oncology Library, Renal Cell Carcinoma is a concise handbook that addresses the complex management of patients with mRCC. The book begins with a review of the epidemiology, pathology, and biology of renal cell carcinoma followed by chapters on specific targeted therapies and managing complications. The final chapters discuss supportive and integrative care and emerging therapies.

We present to our readers the proceedings of the Second International Workshop on Phosphate. A short account of the history of the effort led to the Phosphate Workshops is appro priate and can be of interest to the reader. The idea for Phosphate Workshops was born in the early days of November, 1974. One of us (S. G. M. ) suggested the thought to a group of scientists gathered for a luncheon in one of the attrac tive small restaurants in Weisbaden, Germany. The purpose of the workshop was to bring together interested scientists to discuss the newer developments and the recent advances in the field of phosphate metabolism and the other related minerals. An Organizing Committee made of Shaul G. Massry (USA), Louis V. Avioli (USA), Philippe Bordier (France), Herbert Fleisch (Switzerland), and Eduardo Slatopolsky (USA) was formed. The First Workshop was held in Paris during June 5-6, 1975 and was hosted by Dr. Philippe Bordier. Its proceeding was already published. The Second Workshop took place in Heidelberg during June 28-30, 1976 and was hosted by Dr. Eberhard Ritz. Both of these workshops were extremely successful scientific endeavors, and the need for them was demonstrated by the great interest they generated among the scientific community. The Or ganizing Committee, therefore, decided to continue with the tradi tion to hold additional Workshops annually or every other year."

This is the first textbook entirely dedicated to the endovascular treatment of complications related to arteriovenous accesses for hemodialysis (native fistulas and prosthetic grafts). The book addresses the anatomy of upper limb arteries and veins as well as the clinical presentation of patients and the way to perform and read a fistulogram. Many details and illustrations are provided, clarifying the subtleties in catheterization and the dilation of stenoses. From a strategic point of view, it is explained for the first time that many stenoses must either be ignored or deliberately underdilated. A wealth of images helps to understand the different stages of access recovery from thrombosis. As the number of incident dialysis patients is increasing by 5% every year, this is a field of growing interest. In testament to this there are several annual or bi-annual meetings held by numerous national and international societies (vascularaccesssociety.com, sfav.org, vasamd.org, dialysiscontroversies.org, asdin.org).

Biologics have revolutionised the treatment of many severe conditions, delivering exceptional clinical results but also producing exceptionally high prices. As patents expire, copies and price competition are expected throughout the world. However, due to the intrinsic heterogeneity and molecular complexity of biologic medicinal products, their copies cannot simply be authorized under the "generic rule" valid for small chemical entities. In response, a dedicated regulation was issued in the European Union. It is based on the concept of "biological medicinal products similar to a biological reference product", or "biosimilars". This book analyses the context of biotechnological production and addresses the European legal framework for biosimilar market approval. It highlights post-market authorisation issues, such as Risk Management Plans and substitution of products, and outlines some other issues, such as cost management and international nomenclature. This book is primarily intended for hospital-based physicians and pharmacists. It will also be a valuable resource for all actors from all countries who want to better understand the emergence of these new medicinal products within the European context.

WEGENER'S GRANULOMATOSIS & ANCA-ASSOCIATED DISEASES: THE STORY CONTINUES The disease now designated as Wegener's granulomatosis (WG) was first described in 1931 by Heinz Klinger, who considered it to be a special form of polyarteritis nodosa. Klinger's friend, Friedrich Wegener, expanded on the first observations and interpreted the pathological and clinical fmdings to represent a distinct disease entity (Wegener, 1939). He described this entity as a "peculiar rhinogenous granulomatosis with a unique participation of the arterial system and the kidneys". Later, Godman and Churg (1954) established the classical diagnostic criteria (the "WG triad"): granuloma, vasculitis, and glomerulonephritis. In 1958 Walton pointed out the poor prognosis of WG based on a small number of published cases (mean survival time: 5 months). In 1966 Carrington and Liebow reported "limited forms" of WG with a defmitely more favorable prognosis. Since then positive results have been reported with cyclophosphamide therapy. In addition, a retrospective study of combined low-dose cyclophosphamide and prednisolone in 85 WG patients over a period of 21 years found a similarly encouraging outcome. The*latter experience led to the current "standard" treatment protocol (FAUCI et al. , 1973 and 1983). More recently, strong evidence has emerged that some of the morbidity and mortality ofWG - and other types of systemic vasculitis - may be a consequence of this treatment (Hoffman et al. , 1992).

This volume was designed as a text for medical students, house officers, and even clinicians. It deals with the most common problems in nephrology, providing new insight into how to improve clinical skills. A comprehensive overview of renal physiology and electrolyte disorders lays the groundwork for a clear presentation of the pathophysiological principles that underlie these disorders and a step-by-step presentation of the mechanisms behind the signs and symptoms of kidney failure. The origins of this book can be traced to the teaching of a Renal Pathophysiology course at the Washington University School of Medicine, beginning in the mid-1960s. When changes in the medical school curriculum took place in the early 1970s, an effort was made to synthesize the minimum core curriculum for sophomore medical students, and the distillation of "essential material" to be covered in the area of renal pathophysiology led to the development of the first edition of a renal syllabus. This syllabus has been used in our department since 1974, and, following some of the recommendations and critiques of students and faculty, it has been entirely reworked many times to improve its effectiveness and value. This book is a direct extension of that syllabus, integrated with contri butions from faculty members in our Renal Division, and expanded to include a section on therapy in most chapters. It is our hope that this format will serve the needs of not only sophomore and senior medical students, but also house officers, nephrology fellows, and clinicians."

Diabetic nephropathy is a tragic illness. Its often insidious onset in the insulin dependent (type I) diabetic, typically a young adult, heralds the last act in the course of a disease that will increasingly become the dominant preoccupation in the patient's shortened life. For most type II diabetics, the beginning of clinical renal insufficiency is but a phase in a continuous deterioration that affects the integrity ofjob, marriage, and family. The nephropathic diabetic is hypertensive, has worsening retinopathy, and more often than not, is also plagued by peripheral vascular insufficiency, heart disease, gastrointestinal malfunction, and deepening depression. Until the 1980's, few type I diabetics who became uremic (because ofdiabetic nephropathy) lived for more than two years. Hardly any attained true rehabilitation. This dismal prognosis is changing substantially for the better. Research in diabetes has resulted in striking advances at both ends of the type I diabetic's natural history. In one exciting clinical trial now underway in London, Ontario, halfofchildhood diabetics treated with cyclosporine within six weeks of onset evince"permanent" disappearanceofhyperglycemia and the need for insulin. At the otherendofthe natural historyofdiabetes for the nephropathic patientwith worsening eye disease (renal-retinal syndrome), who receives a kidney transplant, patient and graft survival, two years after cadaveric kidney transplantation in type I diabetics is now equal to that of the nondiabetic."

Proceedings of the FEMS Symposium on Genes and Proteins Underlying Microbial Urinary Tract Virulence: Basic Aspects and Applications, held September 16-19, 1999, in Pecs, Hungary. Urinary tract infections are among the most frequent diseases caused by microbial pathogens. In this volume, researchers, clinical microbiologists and clinicians exchange the latest ideas covering four major aspects of this important topic: * Genetic information, synthesis and assembly of virulence factors in urinary pathogens; * Regulation of genes involved in the phenotypic appearance of virulence; * Host-parasite interactions determining the process and outcome of the infection; * Possible applications of the above aspects in diagnosis, therapy and prevention.

Extracorporeal shock wave lithotripsy (ESWL)" arrived in the United States in February of 1984 with explosive impact in the field of urology. The first ESWL treatment in the United States with the Dornier H~ device occurred at the Methodist Hospital of Indiana, and by the end of 1984, In spite of the rapidly the United StatesESWL study group had accrued over2,5()() ESWL treatments. accumulated experience at the six institutions involved in the FDA trial of the Dornier HM] device, other urologists in this country and around the world had little opportunity to gain knowledge about the utilization of this revolutionary technique. For this reason, the Methodist Hospital of Indiana organized the first symposium on shock wave lithotripsy in February of1985. Interest in this meeting was intense, as approval of the Dornier device had occurred only a few weeks earlier in December of 1984. Because of the success of this initial meeting, subsequent meetings have been held annually in Indianapolis. Following the third annual symposium on extracorporeal shock wave lithotripsy in March of 1987, a number of participants and attendees requested that the information presented at the meeting be made available. Therefore, plans were made to publish the proceedings of the next meeting which occurred March 5 and 6, 1988. The Methodist Hospi tal ofIndiana' s 4th Symposium on Shock Wave Lithotripsy: State of the Art was the best attended meeting to date with over 650 registrants from 36 states and 24 countries.

Stjarne: The present review puts the emphasis on two important developments: the discovery that individual postganglionic sympathetic neurons may secrete multiple transmitter substances from different classes of vesicles and by different mechanisms, and the introduction of new techniques which may permit for the first time direct impulse by impulse analysis of transmitter secretion in individual sympathetic nerve varicosities. Illes: Exogenous and endogen opioid peptides elicit a number of effects in the organism, usually by modifying the function of transmitter and hormone systems, for example, activation of multiple opioid receptors. The effects of opioids on transmitter and hormone release have frequently been reviewed. This review gives a detailed overview on the involvement of multiple opioid receptors in these processes. Rothstein: This article gives an overview of the exchange in acidification and transepithelial salt and water transfer in nonepithelial cells. Delineating the exchanger's most important, common features, and concentrating particularly on its role in cell pH and volume regulation.

Chronic Kidney Disease (CKD) is a recognized risk factor for cardiovascular events and death. The coexistence of CKD and heart failure is increasing in prevalence worldwide and requires a unique and subtle approach to patient management. The Kidney in Heart Failure focuses on the changes that occur in kidney physiology as a function of a failing heart. This comprehensive resource covers epidemiology, pathophysiology, management of kidney disorders and advances in nephropathy management. In addition, the latest therapies, common heart failure dilemmas and kidney disease markers are included. Each chapter is co-authored by a Nephrologist and Cardiologist, offering a unified perspective to these chronic conditions. This indispensible volume provides the reader with the depth-of-knowledge needed for assessing and treating the cardio renal patient.

The sum of clinical problems caused by diabetic renal disease has been steadily increasing since the first edition of this book was published in 1988. The years since have seen tremendous progress in research activities. Importantly, this also includes improvement in the treatment programs to prevent end-stage renal failure. It has become clear that the diabetic kidney is extremely pressure-sensitive, responding to effective antihypertensive treatment by retarded progression of disease. Some agents may be more beneficial in this respect than others, although effective blood pressure reduction per se is crucial throughout the stages of diabetic renal disease. However, the prime cause of diabetic renal disease is related to poor metabolic control and it is now documented beyond doubt that good metabolic control is able to postpone or perhaps even prevent the development of renal disease. However, in many individuals we are not able to provide such a quality of control that will prevent complications, and therefore non-glycaemic intervention remains important.Maybe in the future non-glycaemic intervention will become the most important research area in diabetic nephropathy. Much information is now available on the exact mechanisms behind poor metabolic control and development of renal disease. It is likely that a combination of genetic predisposition and metabolic and haemodynamic abnormalities explain the progression to renal disease, seen in about 30% of diabetic individuals. Much of this development probably relates to modifiable genetic factors, such as blood pressure elevation or haemodynamic aberrations. However, mechanisms related to the response to hyperglycaemia are also of clear importance, as is the possibility that these metabolic or haemodynamic pathways may be inhibited. This volume reviews older data as well as the progress seen within the research on diabetic nephropathy over the last five years and describes the state of the art of the development.

We have witnessed a rapid development within the field of the kidney and hypertension in diabetes mellitus. A significant amount of work within the traditional areas has been published, and several new dimensions are now being developed, mostly in the experimental setting. These dimensions are discussed in several chapters of this new edition, The Kidney and Hypertension in Diabetes Mellitus, Fourth Edition. This volume endeavors to cover all aspects of renal involvement in diabetes. It is written by colleagues who are themselves active in the many fields of medical research covered in this volume: epidemiology, physiology and pathophysiology, laboratory methodology and renal pathology.

Renal sonography forms a basic part of routine diagnostic strategy. This textbook summarizes eighteen years of experience in diagnostic ultrasound. We want it to serve as a guide to both imagers and mere consumers of information. That is why we shall emphasize practical advice and diagnostic pitfalls; it is also why we shall often deal with the relations of sonography with other diagnostic procedures, which it may complement or replace, precede or follow, the purpose being to achieve efficiency at low cost. We shall limit our subject matter to the kidney itself and the neighboring retroperitoneal compartments, dealing only briefly with the lower urinary tract, which requires specialized procedures. We devoted considerable space to renal sonography in our book Clinical Atlas of Ultrasonic Radiography, published in 1973. Since then, nothing has changed and everything has changed. Nothing, because even then the differential diagnosis between a solid and a cystic mass, the etiologic diagnosis of a nonsecreting kidney, and the positive diagnosis of a traumatic juxtarenal hematoma were quite reliable, making possible drastic reductions in the indications for instrumental roentgenologic examinations. Everything, be cause improved resolution and grey scale imaging (already partially achieved in 1973, thanks to real time) have profoundly refined both anatomic and pathologic ultrasonic studies. And now high resolution real time imaging has revolutionized renal examination techniques, whereas Doppler is entering routine ultrasonic diagnosis."

There is a rapid increase in interest related to novel approaches in artificial kidneys, artificial liver, and detoxifi cation. Recent research has included the successful clinical appli cations of the principle of artificial cells for adsorbent hemo perfusion. Since it is 20 years ago at McGill that the first report on "Artificial Cells" was presented, I thought it might be useful to get together a small group of speakers and participants for a day before the ASAIO meeting to discuss some recent advances in the area of the clinical applications of artificial kidney, artificial liver and artificial cells with emphasis on adsorbent hemoperfusion. However, the enthusiastic supports of distinguished speakers, session chairmen and participants were such that the original pro jection of 100 participants had expanded to a preregistration total of 250, from Australia, Canada, England, France, Germany, Israel, Italy, Japan, The Netherlands, Scotland, Sweden and U. S. A. The program also expanded to include a review section on hemodialysis, dialysate regeneration, hemofiltration, resin hemoperfusion and oxystarch given by their respective originators. The remaining of the symposium emphasizes the status of the art on different encap sulated adsorbent hemoperfusion approaches. I would like to apolo gize to those who we could not accommodate beca se of space limita tions. It is hoped that this symposium volume may be useful for them and for others who are interested in this area. Special thanks are due to Ms Joanne Toms for her excellent secretarial assistance for the conference and Mrs."