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.

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.

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].

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."

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.

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."

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)."

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.

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.

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."

This superbly written text gives students, residents, and practitioners the edge in understanding the mechanisms and clinical management of acid-base disorders. Presents the core information to understand renal and electrolyte physiology, and reviews the treatment rationale for all major acid-base and electrolyte disturbances. The entire text is exhaustively revised, and now includes questions and answers in each chapter.

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.

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 responsibilities of the Pediatric Nephrologist in the Nephrologist and other involved specialists is vital to critical care setting are multifaceted. Management of optimize the outcome for each individual child. acute renal failure with and without renal replacement In this first edition of the book, we have included therapy, fluid and electrolyte abnormalities and hyper- chapters focused on general topics in pediatric nephr- tensive emergencies are only some of the major clinical ogy that are most germane to the care of the critically circumstances where the renal specialist is involved in ill child. We have tried to look at the clinical situations the care of children admitted to the Pediatric Intensive from the aspect of both the Pediatric Intensivist and Care Unit. Due to the complex and specialized care renal specialist. We hope that this book will supply the required, critical care nephrology could even be consid- medical providers with a framework to approach the ered a separate entity compared to the clinical scenar- challenges faced in practicing Pediatric Intensive Care ios treated in the outpatient setting or on the inpatient Nephrology. pediatric ward.

The kidney plays a vital role in certain endocrine functions. Abnormalities caused by toxic chemicals or other interventions can have profound effects on these functions and consequently, on total functions. Toxicology of the Kidney, Third Edition is updated to reflect the latest research in this field and focuses on the correlation between anatomy, biochemistry, and physiology of the kidney. The text explains how these factors are related to concepts of clinical nephrotoxicity and renal failure in humans, and how animal models can be used to understand the mechanisms of human renal disease. In addition to updating many of the key elements of previous editions, such as in vitro models for studying renal function and toxicity and classic nephrotoxicants, it also incorporates cutting edge information on newly emerging areas of renal research. These include mechanisms of cell injury, signaling pathways, biomarkers of renal disease and the interface between basic renal science and clinical outcomes. This book includes current reviews of unpublished and recently published information which allows it to serve as a concise compendium of many key topics that will continue to play a central role in our understanding and treatment of nephrotoxicity for decades to come.

This book offers a comprehensive guide to peritoneal dialysis (PD). Home dialysis, and more specifically PD, is growing in popularity in the US. By conservative estimates, experts suggest that 45 percent of dialysis patients in the US can be on home dialysis. However, the current penetration rate is only 10 percent. This is changing with an expected major increase in the next 5 years. One of the reasons for the low uptake is that many nephrologists lack comfort and confidence in using PD as a dialysis modality. This book addresses those concerns by covering all aspects of PD. Chapters include its history, patient selection, implementation options, comorbidities, quality of life concerns, and developing approaches to treatment. This comprehensive resource fills the unmet need for a practical, hands-on book that is both detailed and can work as a quick reference. This is an ideal guide for academic nephrologists, private practice nephrologists, NPs, PAs, nurses, fellows, and residents.

Primary glomerulonephritis is one of the most frequent renal diseases, and a main cause of end-stage kidney disease. Glomerulonephritis has multiple subtypes, each with different physiopathologies, clinical presentations, and management requirements, which makes treatment difficult. As a complex set of diseases, the choice of symptomatic and specific treatment is critical to ameliorating the relentless course of glomerulonephritis. Focusing on all aspects of primary glomerulonephritis, from their epidemiologies and classification, to their pathogenesis and treatment, this third edition of Treatment of Primary Glomerulonephritis has been fully updated to include the latest research and evidence-based practice. With a strong emphasis on drugs used for both symptomatic and specific treatments, mechanisms of action, effectiveness, and potential toxicity are considered for therapeutic strategies in the different subtypes of primary glomerulonephritis. Each chapter follows a clear and logical format, allowing easy access to key information. Featuring over 20 full-colour histological images of different diseases to aid diagnosis, and with commentary from internationally recognised experts in the field, this new edition is an essential resource for all practising or academic clinical nephrologists.

Chronic kidney disease affects approximately 30 million adults in the United States. Demystifying Drug Dosing in Renal Dysfunction supports your clinical decision process with guidance on dosage adjustments and monitoring in renal dysfunction for medications, subpopulations, and renal replacement modalities. This time-saving resource provides helpful tips and support for a range of clinical situations, including: Antiepileptics Cardiovascular Disease Co-morbidities associated with chronic kidney disease Critical illness Infectious diseases Oncology Pain management Pediatrics Psychiatry Therapeutic plasma exchange Transplantation

Integrative Sexual Health explores beyond the standard topics in men's and women's health, drawing on a diverse research literature to provide an overview of sexual biology and sexual dysfunction, diverse lifespan, lifestyle and environmental impacts on sexual function, integrative medicine solutions to sexual problems, and traditional eastern and western treatment approaches to healing sexual difficulties. This comprehensive guide written by experts in the field provides clinical vignettes, detailed treatment strategies for mitigating the side effects of both medications and sexual dysfunction associated with medical illness and poor lifestyle habits, and extensive further reading resources. Integrative treatment modalities not typically consulted in mainstream medicine, such as traditional Chinese medicine, Ayurvedic medicine, aromatherapy, and botanical medicine, are presented with the best evidence, in a clinically relevant manner. Part of the Weil Integrative Medicine Library, this volume is a must read for the specialist and non-specialist alike who wish to address sexual problems using an integrative medicine approach, and acquire tools to maintain lifetime optimal health and vitality that supports healthy sexuality. Integrative medicine is defined as healing-oriented medicine that takes account of the whole person (body, mind, and spirit) as well as all aspects of lifestyle; it emphasizes the therapeutic relationship and makes use of appropriate therapies, both conventional and alternative. Series editor Andrew Weil, MD, is Professor and Director of the Arizona Center for Integrative Medicine at the University of Arizona. Dr. Weil's program was the first such academic program in the U.S., and its stated goal is "to combine the best ideas and practices of conventional and alternative medicine into cost effective treatments without embracing alternative practices uncritically."

Selected as a Doody's Core Title for 2022! Concise, readable, practical and well-illustrated, the sixth edition of the Handbook of Kidney Transplantation has been thoroughly updated and revised to reflect the most current knowledge and practice in the field. Ideal for physicians, surgeons, fellows, and nurses who manage kidney transplant patients, it covers everything from treatment options for end-stage renal disease to transplantation, post-operative management and transplant immunology, focusing on every key aspect of the clinical practice of kidney transplantation. Includes new chapters on the Allocation of Deceased Donor Organs and Kidney Transplantation in the Developing World, as well as expanded chapters on living donation and immunosuppressive drugs and protocols. Outlines the major concerns surrounding renal transplantation and the most successful approaches to problems arising in short-term and long-term patient care. Covers immunobiology and immunosuppression, as well as surgery, histocompatibility, and short and long-term follow-up. Your book purchase includes a complimentary download of the enhanced eBook for iOS, Android, PC & Mac. Take advantage of these practical features that will improve your eBook experience: The ability to download the eBook on multiple devices at one time — providing a seamless reading experience online or offline Powerful search tools and smart navigation cross-links that allow you to search within this book, or across your entire library of VitalSource eBooks Multiple viewing options that enable you to scale images and text to any size without losing page clarity as well as responsive design The ability to highlight text and add notes with one click