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

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

Bladder Cancer is designed for researchers and clinicians involved in urologic practice, including urologists, medical oncologists, pathologists and radiologists. It provides comprehensive guidance for treating and understanding bladder cancer and serves as an up-to-date reference reflecting evidence-based research. The biological behavior of this disease entity shows a heterogeneous pattern with diverse morbidity and mortality depending on a variety of factors, such as tumor characteristics (tumor stage, grade, size, number, shape, and histologic subtypes) and applied treatment modalities (surgery or non-surgical management). This book presents the substantial academic developments in the field of bladder cancer in one convenient reference.

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

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

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

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

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

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

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

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

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

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

On behalf of the organizing committee of this symposium, I would like to wel come you to Cologne and thank you very much for coming. We appreciate that some of the leading scientists in the field of hypertension have accepted our invi tation to participate actively at this conference. Our first symposium on renin-angiotensin, aldosterone, and hypertension took place at Titisee in the Black Forest in 1967. The second one, on the renin-angio tensin-aldosterone system under the influence of therapeutic procedures, was held at the same place in 1970. Five years later in 1975 at a third symposium in Cologne, we discussed the problems of central nervous control of sodium balance in relation to the renin-angiotensin system. The symposium about to begin is devoted to the significance of mineralocorti coids in developing and sustaining arterial hypertension. 1) In order to provide a physiologic background for the understanding of the mechanisms involved in this complicated process, new concepts on the regulation of mineralocorticoid secretion must be discussed in detail. As the most important mineralocorticoid, aldosterone is regulated by changes in sodium and potassium homeostasis and is also influenced by adrenocorticotropic hormone (ACTH)."

A few years ago, as the editor of Kidney International, I was ap proached by Drs. Cohen, Kassirer, and Harrington who suggested that a new feature should be included in each monthly issue of the journal. They suggested that it should employ a case discussion format such as that used frequently at specialty rounds in teaching hospitals, and that the discussion should place a special emphasis on the relationship between basic science and important problems in clinical nephrology. The summary of an actual patient history would first be presented to exemplify a particular clinical problem, a seasoned person of proven expertise would be invited to deliver a well-documented analysis of the relevant issues, and perhaps most ambitiously of all, a critical audience would be assembled to challenge the principal discussant in an open ended, question-and-answer period. The entire affair would be recorded at the time of the live conference and transcribed subse quently in preparation for publication as a "Nephrology Forum. " I must confess that I was somewhat hesitant at first to endorse their proposal because, at the time, Kidney International had just begun to establish a solid reputation for the publication of high quality, peer reviewed manuscripts dealing with the clinical and laboratory research interests of the international nephrological community."

Kidney stones is a common and ancient disease. Yet, many questions concerning their etiology, treatment, and prevention are still open. The Harnstein-Symposien Bonn-Wien is an organization designed to bring together scientists from the various fields relevant to urolithiasis: medicine, urology, biochemistry, etc. In the framework of this organiza tion an International Workshop was held in Tel Aviv on December 10 and 11 1980 to discuss the various aspects of uric acid lithiasis. Uric acid stones have been known to mankind for thousands of years. Urate-contain ing stones were found in Egyptian mummies and in a three-thousand-year old mummy from Arizona. Evidently, with the constant increase in standard of living, associated with increased amount of purine intake, which we are facing in this century, the fre quency of uric acid lithiasis is on the increase. In the second half of this century, signi ficant progress has been made in the knowledge of the mechanisms of uric acid over production, as well as in the understanding of the etiology, prevention, and tretament of uric acid stones. As a result, uric acid lithiasis can be prevented and when present it can be treated well. Moreover most uric acid stones can be dissolved in vivo. This workshop included reviews from some of the leading authorities on the various aspects of uric acid metabolism in man: biochemistry, pathology, renal handling, nutri tion, etc., and these reviews and results of new studies are presented here."

Nebenwirkungen der medikamentosen Therapie werden bei eingeschrankter Nierenfunktion ungleich haufi- ger als beim Nierengesunden beobachtet. Grund hier- fUr ist vor allem die nicht ausreichende Kenntnis der bei Niereninsuffizienz veranderten Pharmako- kinetik, die eine verlangerte renale Ausscheidung, aber auch Xnderungen von Resorption, Biotrans- formation und VerteilungsvO.lwnen zahlreicher Substanzen umfaBt. 1m Stadium der Uramie kann schlieBlich auch die Wirkstoffrezeptorbeziehung, d.h. die Pharmakodynamik, alteriert sein, woraus eine verstarkte oder abgeschwachte Medikamenten- wirkung resultiert. Renale Funktionsstorungen als Ursache einer ver- anderten Pharmakokinetik treten nicht nur bei ent- zUndlichen Nierenerkrankungen auf, weitaus haufiger manifestieren sie sich im Gefolge eines langjahri- gen Hypertonus, im hoheren Lebensalter oder aber auch durch operativen oder traumatischen StreB und bei vie len anderen Storungen im Wasser- und Elektro- lythaushalt. Hinzu kommt die wachsende Zahl von Kranken mit irreversiblem Nierenversagen, die ihr Leben allein der regelmaBigen Dialysebehandlung ver- danken. Der 5. Dialysearzte-Workshop, der am 13. und 14. Oktober 1978 in Bad Kissingen stattfand, widmete sich vorwiegend den pharmakotherapeutischen Problemen bei eingeschrankter Nierenfunktion, erorterte aber auch arzneimittelbedingte Schaden der Nieren und die Dia- lysefahigkeit von Pharmaka, ein Problem, das bei einer Reihe von Intoxikationen aktuell ist. Die Referate dieses Symposions mit auslandischen Gasten sind hier in Buchform zusammengestellt. Sie sollen damit einem groBen Kreis von Xrzten nahezu aller Fachdisziplinen zuganglich gemacht werden.

BELDING H. SCRIBNER The year was 1942 and Will em Kolff was hard at 60's, we encountered exactly the same kind of work perfecting the device that would not only resistance to the concept of chronic dialysis. But revolutionize the treatment of renal failure, but as has happened over and over again in all of more importantly point the way to the develop science, the heresy of one decade becomes the ment of the entire field of extracorporeal devices practice of the next - a phenomenon that the in general and cardiac bypass devices in particular. young heretics among the third generation readers The enormity of the impact that Kolffs con of this volume should not forget. tribution was to have on medicine was revealed And so, today Drukker, Parsons and Maher retrospectively to me when I recalled that in that have successfully undertaken the very difficult same year, 1942, I was a second year medical task of bringing together in one volume all the student at Stanford University, taking among diverse elements of dialysis therapy. The size of other things, P. J. Hanzlik's required course in the volume reflects not only the magnitude ofthe pharmacology. I have two memories of that interdisciplinary effort that brought about the course. One was the requirement that we students technical and clinical advances, but also the learn to recognize 64 old time drugs by appear many clinical and other ramifications of dialysis ance, smell and taste. For better or worse, almost therapy."

The rapidly proliferating research on the human immunodeficiency virus (HIV), now well in its second decade, continues to generate new information at a rate heretofore unparalleled in medicine. As a direct result, the increasing variety of methods for the prevention, diagnosis, and treatment of HIV and AIDS has made it difficult for physicians to keep abreast of the optimal management approaches in the field. The HIV Manual is an immensely practical, accessible, and up-to-date summary of the wide range of clinically relevant information on HIV-infected adults. It deals with the key issues and frequently encountered problems in HIV clinical care, and includes a special section on the symptom-based approach to diagnosis. In addition, this concise reference contains several chapters discussing topics rarely covered in similar books on the subject, such as HIV testing, initial evaluation, future anti-HIV therapies, alternative therapies, and nutrition.
The format is specifically designed for the busy practitioner's convenience. Subheadings clearly outline the principal elements of each chapter and treatment regimens are encapsulated in boxes so that needed material can be located with ease. The diagnostic and treatment guidelines are easy to follow and even where a concensus on treatment is lacking, the authors have made recommendations based on the existing data. This manual is intended to serve the information needs of health professionals involved in the care and treatment of HIV-infected patients in the clinical setting. It will also provide an easy-to-read guide for the general reader interested in finding out more about the diagnosis and prevention of HIV and AIDS.

At the end of 1976 there were 34,215 people with end-stage renal disease alive on dialysis and transplantation within the registry centers of the European Dialysis and Transplant Association (14:4, 1977). From July, 1973, when the American Government began to fund dialysis, the estimated number of dialysis patients in the United States has risen from 5,000 plus to over 35,000. Jfwe add other regions, such as Canada, Australasia and Latin America, it is safe to say that as this is written, over 100,000 people are living on dialysis. The u.s. Social Security System, Veterans Administration, Medicaid and State Agencies are now paying out over one billion dollars annually to support patients on dialysis in the U. S.A. Cobe, Redy, Travenol, Dow Cordis, Drake Willock, Gambro, Asahi, Erica and a host of other company names have become household words in many households throughout the world. I cite these factors not out of a pretense at precision or a passion for phenomenology, but simply to indicate that dialysis has become lore than this century's therapeutic miracle. (Perhaps the first treatable fatal chronic, terminal, medical disease I). It has also become big business! As such, it has perhaps become too important to be left solely in the hands of medical specialists, such as nephrologists.

Despite the rising popularity of the minimally invasive laparoscopic option, open nephron-sparing surgery is still seen by many experts as the 'gold standard' for open surgery for kidney tumors and should remain the first choice for many patients. This challenges the idea that less-invasive therapies are always more desirable than open surgery. While laparoscopic nephron-sparing surgery may be a more attractive option for treating small, easily accessible kidney tumors, for large tumors this is not always the case. Nephron-sparing surgery is a outstanding text that analyses all forms of surgery, open or laparoscopic, as well as providing a backdrop on renal cell carcinoma in general, and the complications and outcomes following surgery that both surgeon and patient will face. Featuring 100 colour photos, the text includes chapters on: Imaging renal masses: current status Open nephron-sparing surgery for renal cell carcinoma Minimally invasive approaches for renal cell carcinoma: an overview Laparoscopic partial nephrectomy Controversies in nephron-sparing surgery Renal cell carcinoma: long-term outcome following nephron-sparing surgery Dr Sasidharan and Professor Soloway have created a superb text covering all aspects of nephron-sparing surgery that should provide excellent guidance for all those who are just beginning to perform nephron-sparing surgery or act as an aide-memoire for those familiar with nephron-sparing surgery.

With detailed contributions and research from experts in the physiology of normal acid-base homeostasis and the management of acid-base disorders, this reference supplies an abundance of information on acid-base physiology, disorders of acid-base equilibrium, and the management and treatment of these disorders in clinical practice. A unique and timely source, this guide provides a large number of tables, references, and figures to illustrate the relationship between the underlying physiology and diagnosis of acid-base disorders.

The present volume contains the edited proceedings of the Vth Symposium of the "Gesellschaft fiir Nephrologie" held in Lausanne, Switzerland, from September 21 to September 23, 1967. The manuscripts were arranged according to their contents rather than to their titles. An attempt was made to divide the allotted space between different contributors according to the apparent importance or originality of the contributions. Most of the papers submitted were written in either German or a rather inarticulate English, and subsequently, have been translated into English by the editors and their collaborators. The editors are indebted to Mr. R. Darling, student of medicine of the Faculte de Medicine de l'Universite de Lausanne, for reviewing the English translation. Editing was limited to requirements based on form rather than on content. In a few instances, manuscripts which were inadequate in form were accepted because their contents appeared interesting or important. A very few manuscripts were either not submitted or could not be included in the present proceedings, because they did not satisfy the editorial standards. Some papers are published in the present proceedings in abstract form because they have been submitted elsewhere for full publication. The editors' responsibility does not extend to the factual content of the manuscripts. The editors wish to apologize for the long delay in publishing these proceedings, a delay which may be attributed to difficulties in communication and cooperation with various authors.