After a decade or longer, approximately one-third of individuals with either type 1 or type 2 diabetes commence a downhill course in which decreasing renal function and failing vision define a Renal-Retinal Syndrome, dominating all aspects of life and presaging early death. Only a generation ago, survival after onset of end-stage renal disease (ESRD) in diabetes was limited because rehabilitation was preempted by blindness, limb amputation, stroke, and heart disease. By 1998, however, team management has improved the outlook, with preserved sight and return to work and home responsibilities, usually for a decade or longer, following kidney transplantation and laser photocoagulation. Recognition of the critical requirement for blood pressure regulation and metabolic control are central themes in management. In this unique book, the accomplishments of ophthalmologists, nephrologists, diabetologists, transplant surgeons, and basic scientists are blended into a strategic approach that may be readily applied by all those caring for diabetic patients. Each of twenty-one presentations suitable for primary care physicians, as well as for subspecialists concerned with macrovascular and microvascular complications of diabetes, is placed in perspective by an introductory editorial analysis. Promising near-term innovative therapies, including insertion of genetically engineered beta cells or polymer-coated islets of Langerhans, interdiction of kinins that promote retinal angiogenesis, and prevention of synthesis of advanced glycosylated endproducts (AGEs), are presented in detail. While comprehensive care of diabetic patients reflects multiple incremental advances that in sum afford major benefit, this text envisions further remarkable changes likely to suppress and possibly entirely prevent the Diabetic Renal-Retinal Syndrome.

In all varieties of organ transplants, early results have dramatically improved over the past two decades and failures due to acute rejection are becoming rarer. Efficient immunosuppressive regimens have been developed with the objective of very good results at 1, 3 and 5 years. Successful transplants, however, are significantly less frequent at 10 and 20 years, and many patients require retransplantation. Many factors are involved in late graft loss and it is now well recognized that, in addition to chronic rejection, a number of non-immunologic factors play a prominent role. In the case of renal transplantation, a reduced mass loss (transplantation of a single kidney, sometimes from an aged donor, ischemic injury and alteration of some nephrons in the case of early acute rejection) will result in slowly progressing chronic renal failure, even in the absence of any supplementary attack of an immunological nature. The new treatments must be analyzed in the light of their capacity to reduce these late failures. Several preventive measures can also limit both immunologic and non-immunologic factors of late transplant deterioration.

We are pleased to present to our readers the proceedings of th~ Third Bari Seminars in Nephrology. The tDpic ~f these proceedi~gs deals with effects of drugs and o:.yst el'll C ct i se;'Isc;- an the Id dney. Tho B?rj S~~jnar5 in Nephr~logy are bi-annual meetings ~tt~~~Dd k) D large international audience comprised of clinicians-scientist~ in the various displines of ~~phrnlDgy nnrl rQlated fi~ld$. The ne~t Bari S~mjnar5 of Nephrology will take place i" npril 19qn ~nd thp theme of the gathering will be Interstitial Nephritidies and Obstructive Uropathy. We are indc-bted for the goner-ells financial support of the Centro N::I~innalC' tiGBP:'llGBP'", Pichp.rche, Italy. Alberto Amerio Pasquale Coratelli Vito M. Campese Shaul G. Massry vii CONTENTS Lupus Nephritis: Pathogenesis, Course and Management .*..*...3 James E. Balow Prognostic Determinants in Lupus Nephritis ...*...* 17 P. Coratelli, R. Rizzi, G. Pannarale, A. Ramunni M. Giannattasio, and G. Passavanti Thrombotic Microangiopathy in Lupus Nephritis . * * . . 35 . M.T. Porri, M.I. Quarenghi, F. Ferrario G. Colasanti, R. Rossi, E. Schiaffino, G. Toia, and G. D'Amico Vasculitis and the Kidney . * ...* ...* * * 41 .

We are pleased to present to our readers the proeeedings of the Seeond Bari Seminars in Nephrology. The topie of theses proeeedings deals with elinieal and experimental aspeets of aeute renal failure. The Bari Seminars in Nephrology were initiated in 1984 and will be held every two years. It is attended by a large number of international elinieal seientists in the diseiplines of nephrology and related fields. The next Bari Seminars in Nephrology will take plaee dur i n g Ap r i 1 2 0 - 2 4 i n 1 988 'a n d t he t he m e 0 f t he ga t her i n g w i 1 1 be Drugs, Systemie Diseases and the Kidney. \\e are indebted for the generous finaneial support of the Centro Nazionale delle Rieherehe, Italy. Alberto Amerio Pasquale Coratelli Vito M. Campese Shaul G. Massry vii CONTENTS I. PATHOPHYSIOLOGY AND STRUCTURAL CHANGES OF ACUTE RENAL FAlLURE Pathogenesis of Acute Renal Failure 3 M. Burnier and R. W. Schrier Structural-Functional Correlates in Acute Renal Failure . . . . . . 15 G. Eknoyan, D. C. Dobyan, and R. E. Bulger Long Term Clinical and Morphological Evaluation of Acute Renal Failure . . . . . . 27 V. Bonomini, A. Vangelista, G. Frasca, S. Stefoni, M. P. Scolari, and G. Feliciangeli The Role of Renal Biopsy in Acute Renal Failure . . . . . . . . . . 35 G. D'Amico, G. Colasanti Catabolism in Acute Renal Failure: Importance of Glucocorticoids and Lysosomal Enzymes . . . . . 41 A. Heidland, R. M. Schaefer, J. Weipert, E."

We are pleased to present to our readers the Proceedings of the Third International Workshop on Phosphate and Other Minerals which was held in Madrid, during July 15-18, 1977. It was hosted by Dr. Aurelio Rapado, Head of the Metabolic Unit at the Fundacion Jimenez Diaz. The Third International Workshop was organized in the tradition of the previous two Workshops. Scientists from 15 countries attended the meeting which provided a forum for formal presentations and informal discussions of topics of current interest in the field of phosphate metabolism, and that of the homeostasis of other minerals. One day of the Workshop was devoted to the subject of Phosphate Depletion. The latest information on the various aspects of the metabolic consequences of phosphate depletion were brought into focus. In the preface of the Proceedings of the Second International Workshop on Phosphate, we indicated that the enthusiasm with which these Workshops were received generated the idea for the creation of a Journal which will publish research endeavors related to mineral and electrolyte metabolism. These efforts were brought into fruition, and the first issue of the new Journal, M). . neJLai. . and E-te. c. ;tJr. o-ty-te. Me. -taboWm has already appeared in November, 1977. It is published by Karger of Basel, Switzerland under the Editorship of Dr. Shaul G. Massry of Los Angeles, with Dr. Louis V. Avioli of St. Louis and Dr. Eberhard Ritz of Heidelberg, serving as Associate Editors.

We are pleased to present to our readers the Proceedings of the Sixth International Workshop on Phosphate and Other Minerals which was held in Verona, Italy, during June 24-26, 1983. It was hosted by Professor Giuseppe Maschio, Professor of Medicine and Chief, Department of Nephrology at the University of Verona. The Sixth Workshop maintained the tradition of the previous ones. It provided a unique and outstanding opportunity for close interaction between scientist involved in the research of the overall field of Mineral Metabolism. The current Workshop was attended by 250 scientists from 15 countries including Austria, Canada, Denmark, England, France, Germany, Holland, Israel, Italy, Japan, Spain, Sweden, Switzerland, and the United States of America. The topics discussed included the renal handling of phosphate, transport of other minerals, intestinal absorption of calcium and phosphate and phosphate homeostasis in health and disease. Two symposia dealing with the recent developments of the interactions between minerals, parathyroid hormone, and blood pressure and between minerals and myopathies were included. In addition to the 15 State-of-the-Art Lectures, there were 43 oral and 63 poster presentations selected from over 200 abstracts sub mitted to the Program Committee. The Seventh International Workshop on Phosphate and Other Minerals will be held during September, 1985, in Marseille, France. It will be hosted by Professor Michel almer, Chief of the Department of Nephrology at the University of Marseille. The theme of this coming Workshop will focus on the pathophysiology of phosphate homeostasis and the metabolism of other minerals."

Im Juni 1979 hatte in Dusseldorf ein Symposion uber Diuretika stattgefunden. Behandelt wurden experimentelle und klinische Ergebnisse mit Diuretika, unter anderem mit Diucomb. Ziel des Symposions war, Untersuchungsergebnisse zu referieren und diskutieren. Teilnehmer waren Wissenschaft ler aus der Schweiz, Osterreich, Grossbritannien, USA und der Bundesrepublik Deutschland. Das Material dieses Symposions wurde uberarbeitet, Diskussionen durch einen Redaktionsstab gestrafft. Wir danken Frau J. BOROS fur wertvolle technische Assistenz. Der Springer-Verlag hat uns wiederum sach kundig beraten und ist in grosszugiger Weise unseren Wunschen entgegengekommen Die Herausgeber Inhaltsverzeichnis Einleitung. F. KRUCK . . . . . . . . . . . . . 1 1. Wirkungsmechanismen. Moderation: K. GREEFF . 3 Plasma Concentrations and Comparative Bioavailability of Bemetizide and Triamterene in Combination. L. F. CHASSEAUD . . . . . . . . 5 Pharmakokinetik von Diuretika bei eingeschrankter Nierenfunktion. H. KNAUF und E. MUTSCHLER 14 Diskussion 24 Neue Daten zur Toxizitat von Diuretika. F. LEUSCHNER 26 Diskussion 29 2. Renale Wirkungen. Moderation: O. KRAuPP. . . . . . . . . . . . 33 Die Wirkungsweise diuretischer Substanzen in Abhangigkeit von ihrer re- len Behandlung. P. DEETJEN . . . . . . . . . . . . . . . . . . . 35 Effects of Diuretics on Renal Potassium and Hydrogen Ion Transport. G. GIEBISCH and M. HROPOT . . . . . . . . . . . . . . . . . . . 42 Wirkungen von Diuretika auf den transzellularen Elektrolyttransport der Niere. M. WIEDERHOLT und L. L. HANsEN 53 Diskussion 60 Interaktion zwischen Diuretika und renalem Prostaglandinsystem. H. J. KRAMER, B. STINNESBECK, W. PRIOR und R. DUSING 64 71 Diskussion Untersuchungen zum Wirkungsmechanismus von Acetazolamid und SITS auf den Bikarbonattransport im proximalen Tubulus der Rattenniere."

Anti-native DNA antibodies and DNA are present in cryopreClpItates from patients with systemic lupus erythematosus and some other cryoglob ulinemic states. The data suggest that these antibodies may be bound in immune complexes. The demonstration of native DNA in these precipitates raises the likelihood that they represent specific antigen in these complexes. Whether or not these complexes play a pathogenetic role in nonlupus inflammatory diseases remains to be demonstrated. References Aarden, L. A., de Groot, E. R., and Feltkamp, T. E. W., 1975, Immunology of DNA. III. Crithidia luciliae, a simple substrate for the determination of anti-dsDNA with the immu nofluorescence technique, Ann. N.Y. A cad. Sci. 254:505. Agnello, V., Winchester, R. J. and Kunkel, H. G., 1970, Precipitin reactions of the Clq component of complement with aggregated 'Y-globulin and immune complexes in gel diffusion, Immunology 19:909. Anker, P., Stroun, M., and Maurice, P. A., 1975, Spontaneous release of DNA by human blood lymphocytes as shown in an in vitro system, Cancer Res. 35:2375. Bankhurst, A. D., and Williams, R. C., 1975, Identification of DNA-binding lymphocytes in patients with systemic lupus erythematosus, ]. Clin. Invest. 56:1378. Bluestone, R., Goldberg, L. S., Cracchiolo, A., and Barrett, E. V., 1970, Detection and characterization of DNA in mixed (IgG-IgM) cryoglobulins, Int. Arch. Allergy Appl. Immunol. 39:16."

The first edition of this book was well received by updated. The two of us have made further collab orative efforts to present a better understanding of medical students, graduate students, and clinicians interested in furthering their understanding of basic the function of the kidney in conjunction with the principles of renal physiology. Most of the reviews most recent anatomical findings. of the first edition and comments from the various The second edition consists of 13 Chapters and 3 instructors who used the book were very positive Appendices. As in the first edition, the anatomical and complimentary with regard to the presentation description of the kidney is incorporated into the of the physiological information and the use of the various chapters dealing with kidney functions. Most system analysis approach to describe renal function. of the anatomical information was written by Wil These positive and encouraging comments over the helm Kriz. The physiological information was writ past nine years, since the publication of the first ten by Esmail Koushanpour, except for Chapter 12 edition, gave us the impetus to consider the prepa which was jointly written. Chapters 1 through 3 were ration of a second edition."

Infectious and non-infectious tubulointerstitial nephropathies are old subjects but there is enough confusion and disagreement on terminology and etiopathogenesis to warrant a new look at these problems. We were fortunate in having at the Pediatric Nephrology Seminar 6 and as contributors to this volume, the representative- or shall I say "originators"? - of each of the three most identifi- able positions: Dr. Renee Habib - congenital anomalies, Dr. John Hodson - reflux, and Dr. Robert Heptinstall - infection. Although some tend to hold onto one position and exclude others, in this case there was overlapping of perception. Dr. Habib accepts a role for infection in reflux and for infection in the presence of obstruc- tion; Dr. Hodson accepts infection and congenital anomalies as modi- fiers; and Dr. Heptinstall takes an overall position whicm encompas- ses the three. Thus the first part of the book emphasizes the complexity of something as seemingly simple as UTI and demonstrates awareness of disagreement even among the pros about meanings, interpretations, and treatment. Drs. Gustavo Gordillo, Jorge de la Cruz and their associates emphasize the importance of predisposing factors for UTI; Dr. Materson focuses on the workup of the patient, Dr. Zillerueloon bacteriological aspects, and Dr. Gorman on treatment approaches. Dr. Vaamonde reviews nephrotoxic agents. Finally, Drs. Andres and Noble review the immunological aspects of various tubulointer- stitial nephritides.

We are pleased to present to our readers the Proceedings of the Fifth International Workshop on Phosphate and Other Minerals which was held in New York City, New York, U.S.A during September 23-27,1981. It was hosted by Joseph M. Letteri, M.D., Professor of Medicine at the State University of New York at Stonybrook School of Medicine, and Chief, Division of Nephrology, Nassau County Medical Center. As in the previous Workshops, this meeting provided an oppor tunity for interested scientists from interrelated fields, including nephrology, endocrinology, physiology, biochemistry and nutrition, to get together and discuss the recent advances in the field of phosphate and mineral metabolism. There were 29 invited presenta tions by leading scientists and 40 oral and 90 poster presentations selected from over 250 abstracts submitted to the Organizing Committee. The Workshop was attended by 250 scientists from 14 countries including Austria, Australia, Canada, Denmark, England, France, Germany, Holland, Israel, Italy, Japan, Sweden, and the United States of America. The Sixth International Workshop on Phosphate and Other Minerals will be held during June 24-26, 1983 in Verona, Italy. It will be hosted by Professor Giuseppe Maschio, Director, Division of Nephrology, Istituti Ospitalieri, Verona, Italy. The theme of this coming Workshop will continue to focus on the pathophysiology of phosphate homeostasis and the metabolism of other minerals."

We are pleased to present to our readers the Proceedings of the Fourth International Workshop on Phosphate and Other Minerals which was held in Strasbourg during June 22-24, 1979. It was hosted by Professor Henri Jahn, Professor of Medicine and Chief, Department of Nephrology at the University of Strasbourg. These Workshops have become a tradition in the scientific scene of mineral metabolism. The meetings have been providing a unique framework for close interaction between scientists from various disciplines, such as nephrologists, endocrinologists, bio chemists, nutritionists, and those dealing with bone metabolism. The Workshops also created a forum for the delivery of original information, as well as state-of-the-art presentations on exciting topics of current interest in this evergrowing field of phosphate and mineral homeostasis. The Fourth International Workshop was attended by three hundred scientists from 15 countries including Austria, Canada, Denmark, England, France, Germany, Holland, Israel, Italy, Japan, Sweden, Switzerland and the United States of America. The topics discussed included those dealing with the renal handling of phos phate, calcium and magnesium, intermediary phosphate metabolism and phosphate homeostasis in health and disease. Two symposia were also presented: one dealt with nephrolithiasis and its rela tion to phosphate and the other with bone metabolism. In addition to 22 presentations by invited speakers, the Workshop provided 46 oral and 93 poster presentations selected from over 250 abstracts submitted to the Organizing Committee."

In one golden age of medicine epitomized by William Osler, the physician also aspired to mastery of gross and microscopic pathologic anatomy. Now another such age has dawned in which ultrastructure and immunopathology provide insights into mysterious diseases of the kidney, connective tissues, joints, and muscles, among other sites. Dr. Anil K. MandaI has a background in clinical nephrology, experimental pathology, and diagnostic pathology of renal diseases that suits him well for his chosen task. This is to explain clearly the clinicopathologic entities seen by nephrologists, using the full range of available morphologic techniques. His ap- proach is brisk and incisive. To read his monograph as a pathologist is to make oneself a better clinician, and as a physician is to improve one's grasp of pa- thology. Such correlative knowledge seems at present the means most likely to lead to the ultimate control of some crippling chronic renal diseases. Sheldon C. Sommers, M.D.

We are pleased to present to our readers the proceedings of the Fourth Bari Seminars in Nephrology. The Topic of these proceedings deals with tubulo- interstitial nephropathies. The Bari Seminars in nephrology are bi-annual meetings attended by a large international audience comprised of clinician-scientists in the various disci- plines of nephrology and related fields. We trust that our readers will find the content of these proceedings reward- ing and interesting. We are indebted for the generous financial support of the Centro Nationale delle Richerche, Italy. Alberto Amerio Pasquale Coratelli Shaul G. Massry TUBULO-INTERSTITIAL NEPHROPATHIES 1 STRUCTURAL, ASPECTS OF THE RENAL INTERSTITIUM W.KRIZ AND K.V. LEMLEY Institute of Anatomy and Cell Biology, University of Heidelberg, D-6900 Heidelberg 1, F.R.G. Childrens Hospital of Los Angeles, Division of Nephrology, Los Angeles, U.S.A. The interstitium of the kidney includes the extravascular inter- tubular spaces of" the renal parenchyma, with their attendant cellular elements and extracellular substances. It is bounded on all sides by tubular and vascular basement membranes. The lymphatics are considered as part of the interstitium.

Over the last few years, transplantation knowledge and techniques, as well as insights into pharmacology, have improved, thus enabling greater access to transplantation for patients. The pool of organs for transplantation is stable, and therefore insufficient to cope with the growing demand. To adjust demand and resources in the most equitable way, organ procurement and allocation have been organized nationally and often across borders. The national and international organ exchange programs were studied and discussed during the Congress on Organ Allocation, from which this book is derived. This book describes the state of the art in the management of waiting lists and the allocation of organs in transplantation. It includes chapters on the possibilities of expanding the pool of available cadaver organs. It also analyzes the results of transplantation of cadaver organs from older donors and marginal, non-heart beating donors. Transplantation policies based on the offering of organs by living donors are also described, as is the impact of delayed graft function on organ allocation.

Many groups of biologically important compounds experience cycles of furious research activity and near oblivion. The purines however seem not to be falling into such a pattern. Interest seems to be continuing almost exponentially with no sign of diminution. The result is a frighteningly extensive literature and an increas ing demand for international conferences and symposia. Unfortunately meetings such as these also spawn increasingly voluminous proceedings and it becomes more and more difficult for a newcomer to the area, or a non specialist, to obtain the general introductory survey he needs. This volume therefore is not intended to be comprehensive - far from it. We have tried to be selective in the material presented and the references quoted. They should provide a quick guide and access to key works in the literature which can be expanded by library or computerised searching. We hope that our efforts will widen the appreciation of purines as biologically important substances and will herald the day when more purine related drugs than the handful currently available are used for the selective treatment of disease. We are grateful to the many authors and publishers who have given permission to reproduce figures or quote unpublished results, and to Anne Stone for her patient typing of the manuscript."

Although it has been appreciated for many years that immune processes underlie most types of glomerulonephritis, it is the recent explosion in knowl edge of cellular and molecular immunology that has prompted another book on the subject. The understanding of the mechanisms involved in renal injury requires the integration of information from in vitro cell-culture systems, experimental models of disease, and clinical studies. This volume draws on all of these sources in an attempt to explain current concepts of nephritis. Increased emphasis is placed on autoimmune processes, as opposed to the deposition of circulating immune complexes, although it will be apparent that these may overlap in the area of "in situ" immune complex formation. Of central importance in autoimmunity is the relationship between antigen pre senting cells (including B cells) expressing MHC class II molecules, autoan tigenic peptides, T helper lymphocytes, and various effector cells. The mechanisms by which the immune system may lead to tissue injury are also becoming better understood, and consideration is given to the role of inflam matory cells, the complement proteins, and soluble factors such as cytokines and eicosanoids."

The contents of this book represent papers which were presented at the Third International Meeting on "Side-Effects of Anti-Inflammatory and Analgesic Drugs" which was held under the auspices of the University of Verona, Institute of Pharmacology in Verona on 8-11 May 1991. This meeting was held in conjunction with the 13th European Workshop on Inflammation and although publications from this part of the meeting are not published here (they appear in Agents and Actions), we were fortunate in having a group of people interested in inflammation from varying backgrounds. The success of the third meeting followed previous meetings held in Cambridge and Verona respectively and continue a tradition which has now become well established. The meeting brought together physicians, scientists and those concerned with the production and use of anti-inflammatory drugs to a very stimulating conference to discuss basic issues affecting all aspects of side-effects of anti-inflammatory and analgesic drugs as well as their detection and treatment. The meeting was held in the Auditorium of Glaxo Italy and we are very grateful to that company for use of their facilities as well as to the University of Verona, Institute of Pharmacology, for valuable secretarial and administrative help. The success of the conference would not have been possible without valuable financial assistance of the companies listed separately (under Acknowledgements) as well as to the organizers of the 13th European Workshop on Inflammation who collaborated with us.

Cardiac disease is the major cause of death in dialysis patients, accounting for over one third of deaths. This book focuses on myocardial function and dysfunction in chronic uremia. It is aimed at practicing and training nephrologists, cardiologists, and internists, and at research workers in the field. We have tried to produce an up-to-date, in-depth review of the subject by inviting experts in clinical epidemiology, pathophysiology, and thera peutics to write the 18 chapters. The book is divided into three sections. The first section comprises five chapters that provide an overview of the burden of illness associated with cardiac disease in end-stage renal disease and a review of clinical epidemi ological aspects of various cardiac diseases that occur in renal patients. The second section discusses abnormalities of left ventricular contractility and mass, and the factors that predispose to both systolic and diastolic disorders. The importance of hypertension, anemia, hyperparathyroidism, hyper lipidemia, and diabetes mellitus in predisposing to these abnormalities is reviewed splendidly by researchers active in these areas. The final section concentrates on therapeutics. Data and opinion on management of congestive heart failure, cardiomyopathy, coronary artery disease, hypertension, and arrhythmias are provided. In editing this book, we have reviewed an extensive literature, but un fortunately we have become more aware that substantial gaps in our knowl edge exist. Insufficient high-quality clinical research has been undertaken xiii xiv Preface regarding the various cardiac diseases that occur in end-stage renal disease."

These proceedings of the 5th Prouts Neck Meeting on Prostate Cancer, held in October, 1989, highlight the many advances in the understanding of prostatic growth and function at the cellular and molecular levels which have been registered since the first Prouts Neck Meeting in 1985, a meeting which also focused on the then current concepts and basic approaches to understanding prostate cancer. Inter vening Prouts Neck Meetings in 1986, 1987 and 1988 were devoted to treatment, image cytometry and clinical markers. As before, the Prouts Neck tradition of bringing together an international, multidiscipli nary group of experts for 3 days to exchange ideas and new data, in the relaxed atmosphere of an old iun on the scenic Maine coast, proved to be an ideal combination for a highly successful conference. Accordingly, the Organ System Program of the National Cancer Institute plans to use the Prouts Neck model for future conferences on other solid tumors (bladder in 1990 and kidney in 1991) and will return to the prostate in 1992. A new dimension was added to the current program through the inclusion of a poster session to recognize the research of pre-and postdoctoral investigators. The posters were judged by Drs. Collette Freeman, Frank French, Shutsung Liao, Robert Matusik and Henry Sun. The three winners, in alphabeti cal order, were John Fabian, Robert Getzenberg and Ming Fong-Lin."

This book contains 55 chapters that summarize referred to the special issue of Drug Development lectures given during the Fifth International Research (Volume 31, Number 4, April 1994). Symposium on Adenosine and Adenine Measured by the number and quality of presenta- Nucleotides held in Philadelphia, Pennsylvania, tions, and by the record number of participants, U. S. A. , May 9-13, 1994. The symposium and the Fifth International Symposium on Adenosine its proceedings follow four previous symposia and Adenine Nucleotides was clearly an intel- and their published proceedings. Previous sym- lectually stimulating meeting. It is safe to posia were held in Banfff, Canada (1978), conclude that the purine research field is vibrant Charlottesville, Virginia (1982), Munich, and still growing. Adenosine has rapidly become Germany (1986), and Lake Yamanaka, Japan the drug of choice for the acute management (1990). of supraventricular tachyarrhythmias and was The program included a wide range of sub- recently approved for use in combination with jects from molecular and cellular biology to cardiac imaging for detection of ischemic heart clinical applications. Great emphasis was placed disease. Additional clinical applications of on cutting edge information derived from studies adenosine and adenosine-related drugs and ATP using molecular and cellular biology techniques seem closer than ever before. The editors would like to express their grati- applied to the field of adenosine and adenine nucleotide research. Likewise, the program tude to the distinguished contributors for their included a number of presentations on poten- excellent chapters and to all participants.

The last twenty years has seen the biggest revolution in the treatment of renal tract stone that has ever been experienced in the history of urolithiasis. The treatment of upper tract renal stone has progressed from the days of a very traumatic and morbid procedure to the relatively innocuous, walk in/walk out therapy of extracorporeal lithotripsy. This progression of events has resulted in a complete reappraisal of management of all types of urinary calculi. From an initial reluctance to treat many stones because of the trauma involved, we have now passed to a situation where smaller and asympto matic stones may be pre-emptively treated before the treatment of serious clinical problems. It is true to say that in Westemized societies the problem of urolithiasis has almost completely been solved by the advent of advanced technology. In this volume, attention is drawn to the fact that there are still persistent difficulties in treating urolithiasis in the less developed and less affluent societies. The differences in epidemiology of urolithiasis in various areas of the world are highlighted, noting a rapid decrease in the incidence of bladder calculi in impover ished areas where affluence increases. Coupled with this progression of affluence however is the well documented increase in the incidence of upper tract renal stones of oxalate nature. This scenario has been almost universal across all coun tries in the last few decades.

The master tool of logic is the syllogism. If A> Band B> C, then it must follow as the night the day that A > C. If the major and minor premises are true or scientifically correct by current knowledge, the conclusion is true or at least scientifically correct by current knowledge. The demographer of today beams a clear message, which if not true is at least scientifically correct by current knowledge. In the first 80 years of the Twentieth Century, the 'over-65' population of Americans increased eight fold. By century's end it will have increased 12-fold and shortly thereafter will include one in five Americans. While initially a fact of the developed world, the pace of similar graying is accelerating even more rapidly in the Second and Third Worlds. This gray delta constitutes about 35 million living Americans, who may use one-half or more of the health care resources. A would have to be a lot more foolish than B if they failed to recognize that in the coming decade the causation, case-mix, and area of the gray delta demands a change from early, mid-or even later-century medicine. If Homer Smith was right in saying, "We are what we are because we have the kind of kidneys we have" and "The kidneys make the stuff of philosophy", then the who, what, where, when, and why the gray delta will be cared for must focus on the stuff of geriatric nephrology.

This book, the proceedings of the 32nd International Conference on Transplantation and Clinical Immunology, held in Lyon, France, on May 25-26, 2000, addresses novel issues in terms of changing indications for transplantation in the management of organ failure, whether humans will remain the only source for organ procurement, prospects for engineering in organ replacement, and whether transplantation will remain the most appropriate approach to organ failure. Some promising treatments are approached, such as enzymic and biochemical replacement, gene therapy, tolerance induction, stem cell transplantation, and xenotransplantation. In addition to the constant improvement in conservative management of organ failure in general, ongoing research in selected fields is reported in the proceedings, such as liver transplantation vs artificial liver, novel dialysis strategies vs evolving immunosuppression in kidney transplantation, islets transplantation and external implantable insulin pumps vs pancreas transplantation in diabetic patients, circulatory assistance and intramyocardial myoblast injection vs heart transplantation. Pivotal experience in selected emerging transplantations is included, that is, small bowel, limb, skin and neuronal transplantation. Such fascinating perspectives raise medical, economical, and ethical problems which are discussed in this book.

Drug dosage in renal insufficiency has become an toxication. In 1975, his Poison Index was pub important facet of nephrology, a subspeciality of lished, first in German, and two years later in internal medicine which is only 30 years young but English, with supplements in 1979 and 1983. This constantly growing in scope and importance. Two volume has become an obligatory reference in more thirds of all drugs are partially, mainly, or exclu than 2500 dialysis units. sively excreted by the kidneys. In the presence of Based on GOnter Seyffart's experience and renal insufficiency, dose adjustments are therefore knowledge in this field, the plans for this book obligatory. In patients on dialysis, drug elimination matured in 1984, a logical step in view of his by this route must also be considered. untiring effort and diligence. In order to deal with As the reader of this book will discover, 20 more than 1200 different drugs and almost 4000 percent of currently used drugs are contraindicated references, 21 contributors were sollicited, while it where there is any degree of renal insufficiency, took six years to complete the work. The major and for at least another 60 percent a dose reduc share of the effort was thus left to the main author tion is required. It is obvious, therefore, that the and editor and he has produced a concise work of detailed knowledge required can never be com impressive clarity.