This pocket-sized manual serves as a concise and ideal reference work for therapeutic approaches using apheresis, Covering both basic theory and clinical details to facilitate improved treatment and patient outcomes, the text considers a variety of diseases, including myasthenia gravis, multiple sclerosis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, nephrotic syndrome, TTP/TMA, dilated cardiomyopathy, and many other conditions. The books also reviews the growing trend towards adopting this unique therapy for a wide range of health management issues such as morbid obesity and/or type 2 diabetes, and for lowering LDL-cholesterol (cholesterol apheresis) in patients unresponsive to medication or lifestyle modification.

Few complications of systemic diseases are better understood than diabetic nephropathy. In large part, progress in this area is due to Carl Erik Mogensen's steadfast preoccupation over more than three decades with the disorder's epidemiology, pathogenesis, pathophysiology, clinical diagnosis and evolving strategies of management. Though he sparked progress in each of these areas, he generously opens the forum of discussion to many expert contributors to this latest and most comprehensive edition of this exemplary textbook. In eliciting all relevant and up-to-date views, the reader, whether internist, pediatrician or specialist in endocrinology or nephrology, is assured a thorough review of the entire subject and in a format which is exceptionally well-written, well-illustrated and easy to read. Each of the prior editions have been an essential resource for my own work in this field and the 5th edition will no doubt continue to provide the information I and others will require to move forward in the years ahead. If only the other renal diseases were as masterfully synthesized, how much easier our task would be of achieving a comprehensive vision of all else in clinical nephrology. Barry M. Brenner, M.D., Samuel A. Levine Professor of Medicine, Harvard Medical School

In 1962, 30 years after the discovery by du Vigneaud have pathologic consequences. One potentially sig- of a new sulfur amino acid, homocysteine; Carson and nificant health outcome of such mild to moderate Neil reported two siblings with mental retardation in hyperhomocysteinemia is an increased risk of occlu- northern Ireland with elevated urinary homocystine. sive vascular disease. Homocysteine concentrations in Nearly simultaneously, Gerritsen and Waisman patients with vascular disease were, on average, 31 % greater than in normal controls. Prospective assess- identified increased homocystine in the urine of a mentally retarded infant in Wisconsin. Within two ment of vascular disease risk among men with higher years, Harvey Mudd, James Finkelstein, and their homocysteine concentrations indicated that plasma coworkers at the National Institutes of health (USA) homocysteine at only 12% above the upper limit of that the enzyme cystathionine ~- normal levels was associated with a 3. 4-fold increase had reported synthase was lacking in a liver biopsy specimen from in risk of acute myocardial infarction. Studies from another patient with homocystinuria. This was the original Framingham Heart Study cohort (USA) the first indication of a vitamin relationship to have shown strong, positive correlation between homocystinuria, because that enzyme has as its co- plasma homocysteine concentration and degree of factor vitamin B6 (pyridoxal phosphate). Thereafter, carotid stenosis.

The provision of optimal dialysis therapy to children requires a thorough understanding of the multi-disciplinary manner in which the pediatric patient is affected by renal insufficiency. Knowledge of the technical aspects of peritoneal dialysis, hemodialysis and continuous renal replacement therapy must be complemented by attention to issues such as anemia, renal osteodystrophy, hypertension, growth, cognitive development, nutrition, nursing care and the psychosocial adaptation of the child and family to chronic disease. The inaugural edition of Pediatric Dialysis provides a comprehensive review of these and other related topics with a singular emphasis on the unique aspects of their application to children. With authoritative, clinically relevant, well-referenced chapters written by a host of recognized international experts who emphasize key aspects of contemporary management, Pediatric Dialysis has been designed to serve as a primary resource to all clinicians involved in the care of the pediatric dialysis patient.

The successful series of International Meetings on "Current Therapy in Nephrology" (now known around the world as "Sorrento Meeting") has continued this year with the third meeting of the series, updating on new therapeutic strategies in Nephrology. This time the meeting was held at the Cocumella Hotel of Sorrento, Italy, on May 27-30, 1990, in a wonderful atmosphere, with the participation of outstanding scientists, such as Drs. H. Auchincloss (Boston, USA), E. Bartoli (Udine, Italy), V. Bonomini (Bologna, Italy), M. Broyer (Paris, France), V. Cambi (Parma, Italy), G. Camussi (Naples, Italy), J.M. Dubemard (Lyon, France), G. Haycock (London, U.K.), G. Jacobs (Paris, France), C. Kjellstrand (Minneapolis, USA), R. Maiorca (Brescia, Italy), G. Maschio (Verona, Italy). As many as five hundred nephrologists from all over the world (European Countries, Israel, U.S.A., Taiwan, Corea, Japan) attended the meeting, actively participating in the discussion of a great number of good papers and posters. Important lectures by invited speakers have dealed with mediators of inflammation, cellular immunity in glomerular pathology, immunosuppressive therapy in autoimmune nephropathies, treatment of hypertension in chronic renal failure, dialysis compatibility, xenogenic transplantation. Very interesting controversies have been included in the programme: "Extracorporeal or peritoneal dialysis for uremic children?" (M. Broyer against G. Haycock) and "Extracorporeal or peritoneal dialysis for diabetic uremic patients?" (c. Kjellstrand against C. Jacobs). Their presentation has been quite successful with a great participation in the discussion by Congress members.

Designed for daily use by professionals responsible for caring for patients with renal disease, this long-awaited primer provides a simplified, up-to-date review of peritoneal dialysis. Dealing concisely with all aspects of PD, it is written in such a style that even beginners with elementary knowledge of the subject could benefit from its use, and thus it is the perfect text for trainees or new and junior staff members. It is also an ideal text for nurses, a virtual how-to guide on PD. A book like this one, crafted specifically as a bench text and a learning tool, is hard to find. Emphasis is placed on the plentiful illustrations and tables that immediately clarify and expand upon the text. The illustrations, many in full color, are deftly drawn by one of the foremost medical artists in the world, Bernard Tardieu. Few texts can boast such a cast of distinguished authors. Ramesh Khanna, Karl Nolph, and Dimitrios Oreopoulos are among the most respected practitioners of dialysis.

Part one of the book presents the gastrointestinal problems that commonly face the general practitioner. Emphasis is placed on analysis of clinical data and how this may provoke the most profitable lines of investigation. Many of the investigation and treatment protocols are within the scope of general practice, but hospital management is also included. It was possible to deal with common oesophageal diseases under the heading of oeso phageal problems in Part 1. In contrast, it proved impossible to discuss adequately all of the common diseases affecting other organs of the digestive system under the problem headings. For this reason, a fuller ac count of many common alimentary diseases is provided in Part two. M. L.-5. K. G. D. W. 9 Series Foreword This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collec tive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well-accustomed to working in consultation."

During the past quarter century there has been a renaissance of interest in the use of peritoneal dialysis as the primary dialytic modality for the treatment of children with end-stage renal disease (ESRD). The development of continuous ambulatory peritoneal dialysis (APD) has facilitated the provision of prolonged dialysis to infants, children and adolescents and has provided pediatric nephrologists worldwide with a real opportunity to administer effective dialysis therapy to all patients afflicted with ESRD. It has been more than a decade since the initial publication of CAPD/CCPD in Children. In the interim, a great deal of clinical experience with patients receiving peritoneal dialysis has been accumulated and research efforts have substantially increased our understanding of the technique. Therefore, we felt that a second edition of CAPD/CCPD in Children was propitious to update the advances of the past decade.

The initial observations of dialytic support were brought from the laboratory and confined to patients with reversible acute renal failure. The thought at that time was one of short term maintenance. It was theorized that removal of waste products from the blood, albeit incomplete and inefficient, might allow these patients time to regenerate damaged tubules and regain renal function. After a dis appointing earlier experience in survival, greater sophisti cation and broader practice refined the dialysis skills and reduced mortality. It also became apparent that long periods of support were possible and successful attempts were then made in utilizing this technology in patients with chronic renal failure. These early young patients were a very select group who possessed only renal dysfunction and no other systemic involvement. Nonetheless, they demonstrated a one year survival of only 55-64%. There are presently over 80,000 patients on dialytic support in the United States and over 250,000 patients worldwide dependent on artificial replace ment. Mortality statistics vary but despite a 20-30% systemic disease involvement and a fifth decade average age in the North American experience, the one year survival has risen to apparently 90%."

During the past decade, there has been a renaissance of interest in the use of peritoneal dialysis as a primary dialytic modality for the treatment of children with end stage renal disease (ESRD). The development of the technique of continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) has markedly changed the approach to children requiring dialytic therapy. The availability of these techniques has facilitated prolonged dialysis in infants and has for the first time given pediatric nephro logists in many areas of the world an opportunity to consider dialysis in chil dren afflicted with ESRD. I have enlisted the collaboration of colleagues from Europe, South America, Canada, and the United States in compiling this multidisciplinary text, which hopefully contains the most up-to-date, comprehensive information regarding the use of CAPD/CCPD in children. It is my hope that every nephrologist (pediatric and adult); nephrology nurse (pediatric and adult); nephrology tech nician, or allied health professional dealing with children who require these therapeutic modalities will be able to resolve immediately any confounding clinical or technical issues that arise by using the information contained in this text. Demographic data on the use of CAPD/CCPD in children in Europe is provided from the EDTA Registry and in the United States from the National Peritoneal Dialysis Registry. The particular problems encountered in the use xiii xiv Preface of CAPD in children in developing countries is detailed by Dr. Grunberg and his colleagues in Uruguay."

Peritoneal dialysis represents an internal technique for membrane are becoming apparent. Studies of peritoneal blood purification. In this dialyzer the blood path, the dialysis increase understanding of the anatomy and phy membrane and the dialysate compartment are provided by siology of biological membranes and the factors influencing nature. The developments of chronic peritoneal catheters, the passive movement of solutes across the microcirculation and related structures. Peritoneal dialysis provides a 'win automated cycling equipment, solution preparation by reversed osmosis, manipulations of transport with drugs dow' to the visceral microcirculation in animals and hu and the experiences with continuous ambulatory peritoneal mans. dialysis and continuous cycling peritoneal dialysis have Peritoneal dialysis may be useful to treat problems other increased the interest in peritoneal dialysis. Publications than renal failure. Beneficial effects in the treatment of related to peritoneal dialysis probably exceed 400 annually. dysproteinemias, psoriasis, hypothermia, and many meta Peritoneal Dialysis International (formally Peritoneal Dialy bolic problems have been reported. The intraperitoneal sis Bulletin) the official journal of the International Society administration of chemotherapeutic agents draws upon and for Peritoneal Dialysis is a journal solely devoted to contributes to our understanding of peritoneal dialysis."

After the great success of the fIrst issue of the series, the International Yearbook of Nephrology 1989, we were encouraged to proceed in our editorial venture to update nephrologists yearly, on all rapidly-changing areas of nephrology. Thus we have chosen new topics and appointed experts in the fIeld, asking them to give an objective review of the topic, up-dating the readers on the world-wide literature and providing them with a complete, accurate and up-to-date list of important, recent references. We have decided to maintain the successful format of the International Yearbook of Nephrology 1989. Thus each annual issue will be devided into sections; each section will have a different primary focus every year, depending upon what area is of greatest interest at the time. In other words, the Yearbook will remain different from the numerous books which appear every year covering all aspects of nephrology. In the Yearbooks you will fInd topics usually anavailable in nephrology textbooks. In this issue we have improved the printing quality of the book, with a more uniform format throughout the volume, despite the use of camera-ready manuscripts for direct photo-offset reproduction (a procedure mandatory for a rapid publication).

Many advances in vitamin D physiology and biochemistry have been made in recent years. Vitamin D metabolites and analogs have found increasing application in clinical medicine. The purpose of this text is to review what is known about vitamin D physiology and draw attention to areas of vitamin D research that have changed within the last 2-3 years. Additionally, information concerning clinical aspects of vitamin D is also presented. More than 40 scientists have generously contributed chapters to this text; I thank them for their efforts. As might be expected, not everyone has the same point of view. Finally, I would like to acknowledge the secretarial and editorial efforts of Mrs. Cheryl Collins without whom this book would not have been completed. CONTRIBUTORS ETSUKO ABE, Department of Biochemistry, School of Dentistry, Showa University, 1-5-8, Hatanodai, Shinagawa-KU, Tokyo 142, Japan DAVID J. BAYLINK, Department of Medicine, Loma Linda University, Loma Linda, CA, and Pettis Veterans Hospital, 11201 Benton Street, Loma Linda, CA, 92357, USA NORMAN H. BELL, Department of Medicine, Medical University of South Carolina and Veterans Administration Medical Center, 109 Bee Street, Charleston, SC, 29403, USA WARNER M. BURCH, Jr. , Departments of Medicine and Physiology, Duke Univer sity Medical Center, Durham, NC, 27710, USA DAVID V. COHN, ICCRH, Inc. , 1238 Wyncrest Court, Arden Hills, MN, 55112, USA ROBERT A. CORRADINO, Department of Physiology, New York State College of Veterinary Medicine, Cornell University, 720 VRT, Ithaca, NY, 14853, USA HECTOR F.

The clinical specialty of adult nephrology has enjoyed spectacular growth during the past three decades. Such a statement is no less true for pediatric nephrology. This book stands in quiet testimony to that fact. Practitioners of pediatric nephrology are now concerned with the diagnosis and treat ment of young patients with a widened spectrum of primary and sec ondary diseases of the kidneys and urinary tract, hypertension and disorders of water, electrolyte and acid-base metabolism. Their science, deriving from an exciting blend of physiology, morphology, pathology, immunology, biochemistry, microbiology, genetics and pharmacology, must also include an understanding of human developmental biology an insight that colleagues who practice adult nephrology require to a somewhat lesser extent. Dramatic, continuing advances in our understanding of the pathogen esis, pathophysiology, diagnosis and treatment of kidney diseases has led to a cascade of books and monographs on various aspects of the subject. Nevertheless, in view of the clear emergence of pediatric nephrology as a distinct medical specialty, it is most appropriate that a practical book, which focuses almost exclusively on approaches to the evaluation and diagnosis of young patients with kidney disease and related disorders, should appear. In that sense this book is unique. It provides an easily accessible, practical compendium or guide to the clinical investigation of all facets of kidney disease in children. Its special and unique emphasis is directed toward various approaches to the evaluation of such patients and the interpretation of associated laboratory or radiographical data."

This monograph provides in-depth information on exercise-induced acute renal failure after short-term anaerobic exercise, which causes severe pain in the loin and patchy renal ischemia with no sign of rhabdomyolysis. This complete clinical reference book includes characteristics of the disease, diagnosis, treatment and prognosis, and corresponding preventive measures. It also includes important information on gene analysis and etiology.

The book focuses on pharmacological and non-pharmacological approaches of psychiatric syndromes that commonly occur in patients with kidney disease. It specifically reviews principles of psychotherapy and psychopharmacology with an emphasis on organ impairment and drug-drug interactions specific to nephrology. This book also covers issues with medication nonadherence in patients with chronic kidney disease and psychiatric comorbidity, as well as the associated issues in dialysis and renal transplantation. Additionally, chapters cover various other topics addressing an active stance towards health promotion in chronically ill patients, including the critical role of the diet and physical activity. Such advice is often complex and changing depending on the stage of chronic kidney disease and the individual needs of the patient. Written by specialists in the field, Psychonephrology: A Guide to Principles and Practice serves as a valuable reference and teaching tool that provides an opportunity for learning across a rapidly evolving medical field.

This book examines renal disease from an immunological perspective; it has been designed to be suitable both as an introductory overview of the area, as well as a guide to further reading. Following an introductory chapter, which discusses general immunological principles of particular relevance to autoimmunity and immunological mechanisms of renal injury, each of the major forms of renal disease with a significant immunopathogenesis is considered. The immunogenetics of each condition is reviewed, followed by a discussion of the immunopathology in animal models and in human disease. A section on therapeutic aspects of immunological relevance is followed by a concluding section which contains more speculative material. A final chapter summarises the various therapeutic strategies available. The volume is suitable for consultants and clinicians in training, particularly in the areas of nephrology and immunology, and for basic scientists working on relevant animal models, autoimmunity and renal disease.

Uric acid (UA) is an end-product of purine derivatives in human metabolism. Without further metabolism, it is excreted by kidneys and intestinal tract. Its serum concentration is controlled by the balance between production and excretion. High concentration of UA in human body has been discovered to be associated with various diseases, such as gout, hyperuricaemia, Lesch-Nyan disease, obesity, diabetes, high cholesterol, hypertension, kidney disease and heart disease. This book discusses the detection, applications and role in health and disease of uric acid.

Diabetic Nephropathy (DN) is the leading cause to end-stage renal disease all over the world. Unfortunately, no effective treatment is available to stop its progression. So far, many key issues remain unrevealed in relation to its pathogenesis, new forms of therapy, and complication intervention. In this book, the authors aim to provide updated medical knowledge and practical management strategies to medical professionals who are caring for DN patients based on their ample clinical experiences, strong bench and bedside research background, and tight collaboration with experts in other fields caring for common complications in DN. The authors also want to shed light on the work of bench researchers in fields of DN and its complications from a clinical perspective.

Anemia in the elderly has been properly defined as the silent epidemic, representing 3 million people in the United States aged 65 years and older. Incidence and prevalence of this condition increase with age. It differs in its etiology, pathogenesis and treatment from anemia in children and younger adults. Anemia is associated with reduced survival, increased risk of functional dependence and hospitalization, increased risk of congestive heart failure and stage renal disease and cognitive disorders. Approximately 70% of anemia in older individuals is reversible.