Gabriel of Urantia asked the question, in the beginning of his struggle with dialysis, "God, why is this happening to me?" Throughout his 8-month dialysis experience, 3 days a week, 4 hours a day, being tied down to a chair while his blood flowed from his body through a machine and back, he realizes-from the people he meets also on dialysis and in the hospitals after post-kidney-transplant-that very bad things happen to very good people. He met young and old alike, tied down to the machines just like he was, and the young people were the hardest for him to resolve in his mind with God and also to try to give them hope. As a minister, he felt obligated to do so. Being a Pastor of a church (Global Community Communications Alliance-a very social, environmental, and spiritual activist church), he knew that bad things happened to good people who try to change the world. But this disease is personal, between him and God you might say. So he had to discover for himself why God allowed this to happen to him and to the other very good people he met with various traumatic illnesses in the hospitals and dialysis centers. Gabriel of Urantia tries to explain how he felt along the path, from the beginning to the receiving of his new kidney from his 22-year-old daughter and gaining the hope and health to continue not only his spiritual work, but his work as a musician, guitar player, and singer (in which he was planning a tour around the country with his 11-piece Bright & Morning Star Band), while now taking immunosuppressant drugs to keep him alive. He had all the fears that a new transplant patient has. How long will the kidney last? What other affects do these drugs have on my body? He writes about his experience with the medical world, the services he experienced from both very qualified people and those not so qualified (experienced and inexperienced care givers), as well as the bureaucracy of the medical field and insurance companies (both private and governmental). He realized that often in the medical field, the right hand didn't know what the left hand was doing and the patient suffered the results. Beyond that, Gabriel of Urantia tries to give hope to people with life-threatening illnesses by sharing his faith in the Creator to all who may read his book. A must-read for anyone on dialysis or with any life-threatening illness, from a writer who went through this and can identify with what they are going through and give them hope through this trauma in their lives.

Heme oxygenases (HOs) are the enzymes responsible for the breakdown of heme and the generation of biliverdin/bilirubin and carbon monoxide (CO). The kidney is a complex organ consisting of many different cell types all working together for the single purpose of filtering the blood to eliminate waste products and conserving ions, minerals, and water necessary for life. HO enzymes and their products play a critical role in the normal function of the kidney as well as protecting the kidney from various insults including ischemia and exposure to nephrotoxins. For example, the HO metabolite, bilirubin, is a potent antioxidant which can limit damage to renal tubular epithelial cells following exposure to nephrotoxins associated with chemotherapy or traumatic injury. Another HO metabolite, CO, is an important vasodilator of renal blood vessels and helps protect against severe decreases in renal blood flow in conditions as diverse as exposure to radiocontrast agents and in hypertension-induced kidney disease. HO and its metabolites also play an important role in the survival of kidney cells after acute and chronic injuries by regulating important cell growth and programmed cell death pathways. The intent of this volume is to highlight the important role that HO enzymes and their related metabolites, bilirubin and CO, play in the regulation of renal function and in the response of the kidney to both acute and chronic pathologies. Table of Contents: Introduction to the HO System / HO and Renal Vascular Function / HO and Renal Tubule Function / HO and Acute Kidney Injury / HO and Chronic Kidney Injury / Future of Renal HO Research / References

The effect of calcium antagonists on heart muscle and blood circulation is the reason that they have found widespread clinical application for a number of years. Less well known, in contrast, is the effect this group of substances has on the kidneys, both on kidney cells and the blood flow through the kidneys. This effect was the subject of a workshop we organized in Tiibingen in June 1986. Different groups studied the effects of these substances, especially in animals, on the processing of calcium by the kidney cells and on blood flow. A possible explanation is that the calcium antagonists block the influx of calcium through special cell canals, especially the cells of the distal tubule. It is necessary to test whether there is a blockade or only a reduction in the passage of calcium. Our understanding of the effect of calcium antagonists is in large part based on the results of morphologic, physiologic, and pharmacologic studies of calcium in the kidneys. The particular processes involved in nephrocalcinosis are special objects of study with regard to calcium antagonists. This book presents the results of experimental studies of the effect of calcium antagonists on nephrocalcinosis and acute renal failure after ischemia. In this context, the clinician is particularly interested in the use of calcium antagonists to protect against the kidney in urolithiasis, in acute renal failure and during kidney transplantation. The book is thus of interest to urologists and nephrologists as well as pharmacologists. biochemists, physiologists, and others in research.

For more than a generation haemodialysis has been the principal method of treating patients with both acute and chronic renal failure. Initially, developments and improvements in the system were highly technical and relevant to only a relatively small number of specialists in nephrology. More recently, as advances in therapy have dem onstrated the value of haemofiltration in the intensive therapy unit and haemoperfusion for certain types of poisoning, the basic principles of haemodialysis have been perceived as important in many areas of clinical practice. In this volume, the potential advantages of bicarbonate haemo dialysis are objectively assessed, the technical and clinical aspects of both haemofiltration and haemoperfusion discussed and the con tinuing problems associated with such extra corporeal circuits analysed. All the chapters have been written by recognized experts in their field. The increasing availability of highly technical facilities for appropriately selected patients should ensure that the information contained in the book is relevant not only to nephrologists but to all practising clinicians. ABOUT THE EDITOR Dr Graeme R. D. Catto is Professor in Medicine and Therapeutics at the University of Aberdeen and Honorary Consultant Phy sician/Nephrologist to the Grampian Health Board. His current inter est in transplant immunology was stimulated as a Harkness Fellow at Harvard Medical School and the Peter Bent Brighton Hospital, Boston, USA. He is a member of many medical societies including the Association of Physicians of Great Britain and Ireland, the Renal Association and the Transplantation Society."

Chronic renal disease has received increasing attention and concern since the passage in 1972 of PL 92-603, which provided coverage for end-stage renal disease (ESRD) treatment by the federal government. The human and economic costs of the ESRD program serve to emphasize the need to prevent or to arrest those diseases resulting in chronic renal failure, since none of the available treatments is without complications and/or side effects. The ESRD program, the only federal one that provides coverage for a catastrophic illness for almost the entire population (those qualifying under Social Security), cost almost $2 billion in 1983. The escalating costs of the ESRD program are attributed to the increasing number of patients requiring treatment and have focused concerns of the United States Government, both Congress and the administration, on ESRD. The National Institutes of Health (NIH), especially the Kidney, Urology, and Hematology Division of the National Institutes of Arthritis, Diabetes, and Digestive and Kidney Diseases (NIADDK), supports a sizable research program that bears on chronic renal disease and in association with this has sponsored many conferences and workshops on research on and causes and complications of chronic renal failure. This book is an outgrowth of the issues addressed by participants at a number of NIH conferences held in the 1980s.

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).

Professor David Kerr Royal Victoria Infirmary) Newcastle upon Tyne Do we need another book on renal disease? There are few small books, particularly from this side of the Atlantic, which provide a really sound foundation of renal physiology, biochemistry and immunology. For two decades "The Kidney" by Hugh de Wardener has given a splendid background in renal physiology but I doubt if any author has brought to this subject as wide an experience and knowledge of basic science as Dr Wardle possesses. His researches have ranged over haematology, the role of in travascular coagulation in acute renal failure, the biochemistry of uremic metabolites, the immunology of glomerulonephritis, to hyperlipidemia in the genesis of arterial disease. In all these topics he has mastered the laboratory techniques as well as studying the patients personally. He therefore has a unique opportunity to show how renal disease can be illuminated by an understanding of the pathogenetic mechanism and to point the way to future treatment more logical than the crude and empirical methods we use today. This approach should appeal particularly to the young graduate whose memory of biocht: mistry and physiology is still reasonably fresh."

It must be considered that there is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. Machiavelli: The Prince (1513) These are the Proceedings of a Conference on Temperature and Environmental Factors and the Testis which took place at New York University School of Medicine, December 8th and 9th, 1989. There is good reason to believe that this was the first of its kind to address, exclusively, the implications of temperature for this highly thermosensitive organ and its precious genetic cargo. The organizers of the Conference hoped to stimulate interest in this area which, paradoxically, has a considerable literature but which has received scant attention and sometimes outright opposition from clinicians expert in male infertility. There have been studies of the relationship of temperature to reproduction starting in the mid-18th Century with observations of the relationship of water temperature to spawning of fish. There is also a vast literature on the deleterious effects of externally applied heat upon spermatogenesis but little study of the possibility that intrinsic heat may be an important etiologic factor in subfertile semen. Today, fertility research has largely ignored this in favor of research in areas which have not produced successes, in terms of live births, comparable to what can be obtained by varicocelectomy (when appropriate) or scrotal hypothermia: viz. 1. Concentration upon the endocrine aspects of testicular function and its relation to spermatogenesis.

This book is intended for use by nephrologists, internists, hospitals, trainees in these specialties and indeed anyone interested in renal medicine. It contains top-class authoritative and up-to-date reviews by internationally renowned experts coming from some of the best nephrology centres in the world. It covers the diagnosis, causes and management of acute kidney injury. It also includes a discussion of the diagnosis of chronic kidney disease, including the use of simple clinical and laboratory data, imaging, proteinomics and renal biopsy. It reviews the general management of chronic kidney disease, including an in-depth analysis of kidney transplant immunology. This book is therefore a comprehensive, authoritative text with clear explanation of even the most complex topics.

The cause of end-stage renal failure in one-third of patients treated by regular haemodialysis or kidney transplantation is some variety of glomerular disease. Less serious glomerular dis orders are more common and often cause inappropriate conster nation to the patients and, sometimes, to their doctors. Similar clinical features can be produced by pathological lesions ranging from the trivial to the life-threatening, and renal biopsy is often necessary to establish the diagnosis. However, its widespread use during the past 20 years has enabled clinicopathological correlations to be made and the natural history of many 'glomerulopathies' to be established, though large areas of uncer tainty remain. In contrast to symptomatic measures, such as the management of uraemia or the nephrottc syndrome, the use of treatment in arresting the progress of the glomerular lesion itself is controver sial and is based on anecdotal evidence rather than controlled trials. Knowledge of the renal pathology will, at least, enable conditions in which immunosuppressive therapy is appropriate to be distinguished from those which are benign or self-limiting. In this book symptomatic management of the clinical syn dromes is detailed, but classification is firmly based on renal histological appearances. The relevance of immunofluorescent microscopy, ultrathin section examination and electron micros copy to our understanding of pathogenesis is described, as well as the uses of these techniques for morphological discrimination."

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.

Currently, individuals interested in seeking an in-depth discussion of transplantation immunology must seek individual articles published in several journals, or extrapolate information from various non-transplant immunology textbooks. The purpose of this text is to provide the reader with a single source of information for the basic science of immunobiology of organ transplantation. It is unique that it focuses on immunobiology from the basic research side, with an emphasis on the cellular and molecular levels. The readers will be physicians, scientists, and graduate students interested and engaged in the study of immunology as it relates to allo- and xenotransplantation. This book is designed to be the reference standard for the immunobiology of transplantation.

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.

The Department of Continuing Education of Harvard Medical School and members of the faculty of Harvard Medical School held a multidisciplinary course on the management of patients with urologic cancer in the fall of 1982. This course high lighted the multidisciplinary approach to the care of these patients, and outlined the clinical and pathophysiological basis for diagnosis and treatment. The term multidisciplinary was essential to the course in which the disciplines of uro logic surgery, medical oncology, and radiation therapy were each appropriately emphasized. Widespread interest in the contents of this course, and the timely and useful nature of much of the information presented there, has encouraged us to publish, in as rapid a manner as possible, new information and highlights of that course. A camera-ready format was used to allow rapid production, and a variety of disparate styles were maintained from chapter to chapter--some in prose, others in outline. Again, our intent was to disseminate information rapidly and accurately, and to that end, we felt that consistency of style was irrelevant."

When Shaul Massry and Herbert Fleisch asked me to write a foreword for this book, I was honored and eagerly looked forward to reading the many chapters. As they came and I skimmed through them, my mind wandered back to the earliest classic contributions in this field in the late 1920s and early 1930s by Albright and his associates, Greenwald and Gross and Adolph, on the homeostatic regulation of inorganic phosphate and the central role of parathyroid hormone (PTH) in this regulation. They clearly showed the exquisite sensitivity of the renal handling of phosphate to varying dietary and parenteral loads and to changes in the level ofPTH. That two outstanding investigators in the field of divalent ion me tabolism should choose to edit a book solely about the renal handling of inorganic phosphate shows how far we have progressed from these early classics to the recent almost exponential increase in the research and publications related to this subject. Despite this increase, I asked myself, is such a large new monograph, consisting of 13 chapters and 30 distin guished authors, warranted? My reading of these chapters and my learning so much from them convinced me that it is, and my pride was heightened in being asked to write the foreword for this book."

Recent developments in recombinant DNA technology have led to the large-scale production of human erythropoietin and to the demonstration that it is effective in the treatment of renal and possibly some other anaemias. This has lent a new impetus to studies of the pathophysiology and pharmacology of the hormone which is reflected in this report of the proceedings of a meeting held in Liibeck in June 1988. In 15 papers, all from European centres, the broad topics covered are erythropoietin's physiology and chemistry, the patho- physiology of erythropoiesis and the use of erythropoietin in the treatment of anaemia. Several of the papers include up-to-date reviews of the literature. The field is now expanding rapidly, and this volume, though not comprehensive, usefully points up many areas of recent understanding as well as others of continuing un- certainty. Overall, it contains material likely to be of interest to biochemists and experimental haematologists as well as to phar- macologists, clinical haematologists and nephrologists.

The Fourth International Congress of Peritoneal Dialysis was held in Venice, Italy, June 29 to July 2, 1987. By this time peritoneal dialysis had emerged as a treatment for a substantial fraction of patients with end-stage renal disease and countless numbers of patients with acute renal failure. This treatment is now practiced worldwide and is the life-sustaining treatment for about 40,000 patients with chronic renal failure, representing 15 to 20% of dialysis therapy in about 1000 centers. It is not surprising, therefore, that the number of health professionals engaged in the investigation and the application of the treatment has also grown exponen tially. The First International Symposium on Peritoneal Dialysis, organized by Dr. A. Treviiio-Be cerra in Chapala, Mexico, in 1978, brought together a group of pioneers when continuous ambulatory peritoneal dialysis was in its infancy. In 1981, Dr. G. M. Gahl chaired the Second Symposium, in West Berlin, when the technique and professional interest were growing con siderably. By 1984, when Dr. 1. F. Winchester and I organized the Third Symposium, the pre sented papers exceeded 100 and there were about 1000 attendees. At that time, it was deemed appropriate to form a more organized group and the International Society for Peritoneal Dialy sis was founded. One of the first actions of the Society was to choose from among several applicants Dr."

Nitrates have been for many years the cornerstone of cardiovascular therapy for various indications. Not only have nitrates stood the test of time for treatment of chronic stable angina pectoris, but the indications for them have markedly ex panded. They now include all forms of angina pectoris and myocardial ischemia, congestive heart failure and hypertensive emergencies. The beneficial effects of nitrates in all these conditions result from their vasodilatory properties, but it is still unclear whether the central or peripheral effects predominate in the thera peutic mechanism. Recently nitrates have been shown to fulfill the most important requirement for each and every drug - to reduce mortality. A large scale study revealed that isosorbide dinitrate, combined with hydralazine, reduced long-term mortality by 28% in patients with congestive heart failure. This finding will certainly stimulate research on nitrates, and it might be expected that interest in these drugs will markedly increase. The primarily used nitrates in clinical practice are nitroglycerin and the com plex organic nitrates, mainly isosorbide dinitrate. The organic mononitrates are now under clinical investigation, and isosorbide-5-mononitrate (IS-5-MN) appears to be especially promising.

The kidney, similar to the heart, plays a three-fold role in essential hypertension. First, it participates in the patho genesis of arterial hypertension. Second, it suffers as a target organ of long-standing hypertension, and third, it experiences the effects of antihypertensive therapy. Perhaps most contested at the present time is the involvement of the kidney in the patho genesis of essential hypertension. More than a century ago, William Osler put forward three basic hypotheses about the "genuine contracted kidney. "l 1. "The hypertrophy can be regarded as an effect to overcome a sort of stop-cock action of the vessels when under the influence of an irritating ingredient in the blood greatly contracted and increased the peripheral resistance. " Clearly this hypothesis of an "irritating ingredient" is perhaps the most convincing nowadays, and numerous attempts have been made to identify a specific vasoconstrictive agent in the blood in essential hypertension. 2. "The obliteration of a large number of capillary territories in the kidney materially raised the arterial pressure. An additional factor of dimin ished excretion of water also heightened the pressure within the blood vessel. " Today we know that fluid volume overload in the presence of reduced renal mass seems to be the most likely mechanism accoun ting for renal parenchymal hypertension and, as shown by Guyton's group, for certain forms of experimental hypertension. 3.

This volume emphasizes the comparative approach to under standing vertebrate renal function. I am convinced that this approach is of particular value in understanding both the details of renal function at the cellular and subcellular levels and the renal role in regulating fluid volumes and solute concentrations. My exposure to this approach first occurred during a student research experience in the laboratory of Wilbur H. Sawyer, who also provided an introduction to the works of Homer W. Smith and August Krogh. The importance of this approach was reinforced by doctoral and postdoctoral research in the laboratory of Bodil Schmidt-Nielsen. It has been confirmed through years of personal experience since then. My research and my understanding of renal function have been aided through the years by collaboration and discussion with numerous students and associates. Of particular impor tance in developing my views on comparative renal function, and especially on the relationship of structure to function, has been my long association with my colleague and friend, Eldon J. Braun. Donald S. Farner, who suggested the writing of this volume, provided valuable editorial assistance. Much of my personal research in this area has been supported over the years by grants from the United States National Science Foundation and National Institutes of Health. The writing of this volume was completed while I was in Wiirzburg, Federal Republic of Germany, supported by a Senior U.S. Scientist Award from the Alexander von Humboldt Foundation."

The focus of this book is to provide a nephrology reference manual for the developing pediatrician and pediatric nephrologist. Its objective is not only to inform but also to teach -- one that inspires thinking in the reader. The contents and level of teaching in the manual are intended for trainees at four different levels: medical student, intern, resident and fellow. This handbook provides what other nephrology textbooks cannot -- a useful and practical guidebook that is written to teach at a level that is appropriate for various stages of learning. Each chapter focuses on a specific topic, followed by several patient cases, and with an answer and discussion of each case.

In this book, the authors present topical research in the study of the indications, procedures and complications of hemodialysis. Topics discussed in this compilation include cardiovascular involvement in chronic kidney disease; nutritional therapy during hemodialysis; vascular access and common complications in patients undergoing hemodialysis treatment; prevention of hemodialysis catheter-related infections; antiplatelet medication and the risk of bleeding in hemodialysis; and vascular calcifications in end stage renal disease.

The management of chronic renal failure by dialysis and transplantation has now become an established form of treatment in many parts of the world. However, these forms of treatment have brought with them problems in relation to the selection of patients, economics, clinical problems such as hypertension, encephalopathy, anaemia and renal bone disease, and psychological and social problems. The management of haemodialysis has changed over the years with developments in dialysers, vascular access and the duration of dialysis. Although the overall survival from renal trans plantation has changed little in the past four or five years, there are hopes of improvements in relation to tissue typing and enhancement. Perhaps the most important aspect in the management of chronic renal failure is the multi-disciplinary approach. Nursing and medical staff work closely with dialysis technicians, engineers, dietitians, local authority per sonnel, social workers and with the relatives of the patients. The symposium was planned to draw together representatives from all disciplines involved in the care of patients with chronic renal failure. One of the most relevant sessions was that in which two patients with chronic renal failure described their experience."

Vittorio E. Andreucci of keeping alive patients in terminal chronic Initially created with the purpose renal failure, dialysis has undergone improvements in methodology, and its final goal has become complete health rehabilitation and optimization of the quality of life of chronic dialysis patients. To achieve this, many investigators have attempted to increase dialysis efficiency and at the same time shorten dialysis time. Their main concern was, obviously, patient safety: the Latin proverb 'primum non nocere' is still valid all over the world. Thus, when clinical observations of the first patients on regular dialysis therapy suggested an inverse relationship between duration of dialysis sessions and severity of peripheral neuropathy, long and frequent dialysis sessions were considered the only way to prevent the catastrophic consequences of nerve damage and underdialysis syndrome. It was then, in 1971, when dialysis duration was 8- 12 hours per session, that Vincenzo Cambi started a 'short dialysis' trial, i. e. , 4 hours 3 times weekly or 3 hours every second day. For the first time, dialysis was shortened from 24-36 hours weekly to 10. 5-12 hours weekly [1, 2]. In 1971 I was still at the Parma University Hospital. We had both just returned from the United States, and Dr. Cambi was responsible for the dia lysis unit.

Gabriel of Urantia asked the question, in the beginning of his struggle with dialysis, "God, why is this happening to me?" Throughout his 8-month dialysis experience, 3 days a week, 4 hours a day, being tied down to a chair while his blood flowed from his body through a machine and back, he realizes-from the people he meets also on dialysis and in the hospitals after post-kidney-transplant-that very bad things happen to very good people. He met young and old alike, tied down to the machines just like he was, and the young people were the hardest for him to resolve in his mind with God and also to try to give them hope. As a minister, he felt obligated to do so. Being a Pastor of a church (Global Community Communications Alliance-a very social, environmental, and spiritual activist church), he knew that bad things happened to good people who try to change the world. But this disease is personal, between him and God you might say. So he had to discover for himself why God allowed this to happen to him and to the other very good people he met with various traumatic illnesses in the hospitals and dialysis centers. Gabriel of Urantia tries to explain how he felt along the path, from the beginning to the receiving of his new kidney from his 22-year-old daughter and gaining the hope and health to continue not only his spiritual work, but his work as a musician, guitar player, and singer (in which he was planning a tour around the country with his 11-piece Bright & Morning Star Band), while now taking immunosuppressant drugs to keep him alive. He had all the fears that a new transplant patient has. How long will the kidney last? What other affects do these drugs have on my body? He writes about his experience with the medical world, the services he experienced from both very qualified people and those not so qualified (experienced and inexperienced care givers), as well as the bureaucracy of the medical field and insurance companies (both private and governmental). He realized that often in the medical field, the right hand didn't know what the left hand was doing and the patient suffered the results. Beyond that, Gabriel of Urantia tries to give hope to people with life-threatening illnesses by sharing his faith in the Creator to all who may read his book. A must-read for anyone on dialysis or with any life-threatening illness, from a writer who went through this and can identify with what they are going through and give them hope through this trauma in their lives.