Developments in Nephrology – serie
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Increasing the accumulation of aluminum in the bone (body) in cases of renal osteodystrophy may influence the histopathologic aspect of the bones. Alumi- num blunts the effect of increased PTH secretion and favours the genesis of osteoid. That means, in cases of renal failure combined with aluminum accumulation, a relatively low bone tunover is found and no fibrosis of the bone marrow. Furthermore the amount of osteoid is increased. This means that there is evidence of osteomalacia especially when the latter is defined as an increased amount of osteoid covered with a relatively low number of cubic osteoblasts. To a certain extent the effect of aluminum accumulation is comparable to the effect of PTX. Treatment with DFO may normalize the bone, although not necessarily with a concomittant disappearance of alumi- num from the bone. The presence of aluminum in the bone can be suggested by routine histologic investigation of the bone and can be made rather probably by the aluminum staining combined with iron-staining, but can only be proven by more advanced techniques like ET AAS and LAMMA. References 1.Boyce BF, Elder HY, Elliot HL, Fogelman I, Gell GS, lunor Bl, Beastall G, Boyle YT, 1982: Hypercaicaemic ostemalacia due to aluminium toxicity. Lancet 6: 1009. 2. Verbueken AH, Visser Wl, Van de Vyver FL, Van Grieken RE, De Broe ME, 1986: The use of laser microprobe mass analysis (LAMMA) to control the staining of aluminum by aurin tricarboxylate (aluminon). Stain Technology 61: 287.
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What regulation shall we have for the operation? Shall a man transfuse he knows not what. to correct he knows not what. God knows how (l)? Dr. Henry Stubbs Royal College of Physicians circa 1670 If dialysis therapy were a new phannaceutical product being evaluated by the FDA now, it might not be approved for marketing. The recommended dose, its potential toxicity, the side effects of under-or over-dialysis as well as its efficacy have been the subject of very few studies. The high mortality rate associated with the treatment may raise a few eyebrows. That it is a life-saving modality of treatment is undoubtedly true for more than 100,000 patients in the United States and for more than a million patients world wide. Because dialysis has extended the lives of many people by a variable period of time, most nephrologists have "rested on their laurels" and did not vigorously pursue studies to optimize these treatments. But facts have a way of intruding in all our lives and the facts are that the overall mortality rate of dialysis patients in the United States is rising and stands close to 25% per year and is closer to 33% per year for patients between the ages of 65 and 74 (2). These mortality figures are considerably higher for age-adjusted dialysis populations in Europe and particu larly in Japan, and certainly for the age-adjusted nonnal population.
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Del 30 - Developments in Nephrology
New Therapeutic Strategies in Nephrology
Proceedings of the 3rd International Meeting on Current Therapy in Nephrology Sorrento, Italy, May 27–30, 1990
Inbunden, Engelska, 1991
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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.
Tubulo-Interstitial Nephropathies
Proceedings of the 4th Bari Seminar in Nephrology, Bari, Italy, April 25–28, 1990
Inbunden, Engelska, 1991
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We are pleased to present to our readers the proceedings of the Fourth Bari Seminars in Nephrology. The Topic of these proceedings deals with tubulo- interstitial nephropathies. The Bari Seminars in nephrology are bi-annual meetings attended by a large international audience comprised of clinician-scientists in the various disci- plines of nephrology and related fields. We trust that our readers will find the content of these proceedings reward- ing and interesting. We are indebted for the generous financial support of the Centro Nationale delle Richerche, Italy. Alberto Amerio Pasquale Coratelli Shaul G. Massry TUBULO-INTERSTITIAL NEPHROPATHIES 1 STRUCTURAL, ASPECTS OF THE RENAL INTERSTITIUM W.KRIZ AND K.V. LEMLEY Institute of Anatomy and Cell Biology, University of Heidelberg, D-6900 Heidelberg 1, F.R.G. Childrens Hospital of Los Angeles, Division of Nephrology, Los Angeles, U.S.A. The interstitium of the kidney includes the extravascular inter- tubular spaces of" the renal parenchyma, with their attendant cellular elements and extracellular substances. It is bounded on all sides by tubular and vascular basement membranes.The lymphatics are considered as part of the interstitium.
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"Clinical Management of Renal Transplantation" presents the Belfast City and University Hospital experience in renal transplantation. Over the years, the Belfast Renal Transplant Unit has acquired considerable experience in all aspects of renal transplantation which have led to excellent results, and the team working in the Unit has build up an outstanding reputation. This volume is a comprehensive, practical reference work for senior medical students and nurses, as well as for the established nephrologist and transplantation surgeon. It provides a clear and concise picture of the care needed by patients who are being prepared for renal transplantation or who have recently received a kidney transplant.
Del 33 - Developments in Nephrology
Ethical Problems in Dialysis and Transplantation
Inbunden, Engelska, 1992
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An overview of issues with which nephrologists and decision makers are confronted in their daily practice. The search for a universal system of ethics and theories of justice are addressed. Furthermore, the work provides a normative ethical discussion of ways of distributing resources with a view to selection and commercialization. Other chapters discuss a philosophical and religious analysis of stopping treatment and the clinical and ethical aspects of stopping treatment in dialysis. Different views from different countries on the subject of dialysis and transplantation are covered, including the views expressed by contributors from India, Africa, Japan, Great Britain and China. The book provides the clinician with a guide to the ethical considerations underlying the treatment of dialysis and renal transplantation patients.
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This text presents the transactions of the Brooklyn meeting, held in April 1993, including an analysis by Scribner and Schreiner and an introduction by Edmund Bourke. Authors include the heads of dialysis registries for Japan, Europe, and the United States, as well as protagonists of dialyser reuse and short dialysis times. The book examines the view which champions the determination of adequacy of dialysis by formulae or by clinical assessment. The reader will be able to judge the data on key controversies in planning dialysis protocols and schedules.
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This volume addresses the latest developments in the treatment of urolithiasis and biliary stones. The emphasis of the book is on the selection of the cheapest and most effective treatment and is based upon the experience of editors and authors from both the Western countries and developing countries in Asia. With health care budgets becoming increasingly restricted, there is a growing interest in cost-controlled and effective treatment methods. This volume covers urinary tract calculi as well as biliary tract calculi, including epidemiology, etiology, choices in the management of calculi, efficacy and safety of treatment and the prevention of urolithiasis.
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This second edition of "Quality Assurance in Dialysis" expands the original format in which authors with special expertise in the various aspects of caring for patients with end-stage renal disease were asked to write about how to ensure the quality of that care. It provides a series of discussions focused on providing the reader with the conceptual tools necessary for insuring that the care they render is of a high quality. As in the original edition, much of the writing addresses dialysis in its various forms. There is, in addition, information on providing quality in transplantation from the medical perspective. This expanded text now includes many new chapters that address, for example, the impact of government regulatory bodies on the quality assurance process and new information on adequacy criteria and their use in improving care. Professional and technical personnel involved with delivering care to the end-stage renal failure patient, as well as those involved in training others in this rapidly changing field, should find the perspectives offered valuable.
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Although there have been considerable advances in the management of renal failure by dialysis and transplantation, there has been relatively little progress in its prevention. The term glomerulonephritis covers a wide range of conditions with different immunological, histological and clinical features. This volume therefore starts with reviews of the immunology and pathology of different types of glomerulonephritis. This is followed by detailed consideration of the treatment of the commoner primary and secondary forms of the disease. There are separate chapters on special circumstances, such as glomerulonephritis in pregnancy or following renal transplantation. In each chapter, attempts are made to review the evidence for the effectiveness of treatment, based on controlled trials, immunopathological principles and the authors' considerable experience. Although some aspects of the treatment of glomerulonephritis can be found in the standard texts on renal disease, this volume provides an up-to-date, thoroughly referenced, and practical guide to management.As such, it should be of value to nephrologists and general physicians, including those in training, and to postgraduate students of nephrology.
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In 1986, the Committee of Experts on Blood Transfusion and Immunohae- tology of the Council of Europe chose for their Programme of Co-ordinated Research "An investigation of the procurement and sharing of transplantable organs for potential recipients who are highly sensitized to HLA-antigens". This topic was of common concern to all centres practising renal transplan- tion. The terms of reference of the study were: To estimate the number of patients who are virtually "untransplantable" because of high sensitization in each European country. To study the nature of immunization in terms of the type and specificity of antibodies present in the blood and techniques used for their detection. To investigate possible practical solutions - both current and future, invo- ing cross-matching procedures, the circulation of reference material from patients, and the willingness of the national organizations to share resources. 4. To explore other methods of resolving this problem. Although the study did not offer the prospect of a brilliant new insight into the problem of high sensitization, it was unique in several ways: for the first time we saw all European organizations collaborating in a common project to provide information on their activities, their problems and the methods to resolve them; it introduced, for this subject, relatively novel statistical methods to investigate susceptibility to sensitization and factors affecting transplant outcome; it enabled a large database of transplanted highly sensitized patients and matched controls to be assembled, that would have been unavailable as a research resource at any single centre.
Neonatal Kidney and Fluid-Electrolytes
Proceedings of Pediatric Nephrology Seminar IX, held at Bal Harbour, Florida, January 31 - February 4, 1982
Inbunden, Engelska, 1983
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The purpose of this volume and Pediatric Nephrology Seminar IX from which it was created is to provide easy access to current concepts in the diagnosis and management of kidney diseases in the newborn. Complimentary to this purpose is the opportunity the Seminar structure gives me to invite those particularly interested in the subject chosen to come together, share experiences and ideas in an unhurried, unpressured atmosphere for four con tinuous days - an oasis for me and, I am told, also for the faculty and registrants. This year's subject choice is an expression of my perennial interest in the kidney of the newborn. A step back to view the steps forward reveals unwittingly intertwined associations and actions which now fall into focus. When I was just beginning my pediatric nephrology training with Sol Kaplan at Downstate in Brooklyn, we discussed Bob Usher's pioneering thought that there was something wrong with the kidneys of babies with RDS. Without really knowing what needed to be done, I started looking at the kidneys of those babies. Subsequently, Dick Day who was Chairman of the Department of Pedia trics there, stopped me in the hall, and asked me to come into his office. Glowing in quiet introspection, he extolled the joy of working with one's hands, then hurried away to his laboratory. He had been the Director of the Newborn Nursery at Babies Hospital before coming to Downstate, and (as I later found out) was trying to do something with oxygen electrodes.
Acute Renal Disorders and Renal Emergencies
Proceedings of Pediatric Nephrology Seminar X held at Bal Harbour, Florida, January 30 – February 3, 1983
Inbunden, Engelska, 1984
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My thoughts about the Hemolytic Uremic Syndrome (HUS) got started in 1961 along with my attempt to return to Argentina. As I sought my way in Buenos Aires, I visited Carlos Gianantonio whom I had met in Caracas the year before during the Pan American pediatric meetings. At that time he was actively working on HUS which had become an epidemic in Buenos Aires and other parts of Argentina. I was impressed by the team effort and devotion of his group to such heavy demands. They obviously were meeting the challenge at an amazingly high level under a very crippling physical situation with shortages of space, laboratories and equipment. His group together with Dr. Becu, at the time the pathologist at the Children's Hospital of Buenos Aires (we had met through his mother who was instrumental in arranging my return to Buenos Aires), wrote some of the classic papers on HUS. Through the years as Dr. Gianantonio became more involved in general pediatrics, the administrative aspects and its orientation in Latin America, he became known for his deep philosophical questions as to what we are doing and where we are going. His questions have obvious implications regarding an agressive approach to our pediatric nephrology patients.
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The strength of the volume lies in the incorporation of those data on renal cellular structure and function which hold the key to the etiology of the majority of renal diseases we now call 'end-stage'. Fully, two-thirds of the volume is devoted to current concepts of renal function and related subcellular structure of various renal tissues.
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Collected Papers from the Seventh International Symposium on Biochemical Aspects of Kidney Function, Bratislava, 9-12 April 1984
Homeostasis, Nephrotoxicity, and Renal Anomalies in the Newborn
Proceedings of Pediatric Nephrology Seminar XI held at Bal Harbour, Florida January 29–February 2, 1984
Inbunden, Engelska, 1985
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This is the 11th of the Pediatric Nephrology series created to help us be in touch with developments which are relevant to the problems we face daily in clinical practice and the questions we ask and try to answer in clinical and experimental research. Like volume IX, this one focuses on one of the subgroups to which we are committed--the neonates' special fluid and electrolyte requirements. This volume has more on blood pressure and renal function and looks at the hormonal regulators. There is greater depth about intoxications and nephrotic agents, congenital disorders and mineral metabolism. The exchanges were stimulating and the controversies were brought out without need of much of my usual prodding. At Julie Ingelfinger's suggestion, at the end of each panel discussion I have added a comment to highlight the main points as I see them. Otherwise, the format remains as in past editions: the papers given related to the four major topic areas, each followed by panel and registrant discussion. Although the transcription is almost verbatim, you will not find the names of the discussants, purposely omitted to ease my editorial work and to encourage everyone to speak candidly. Some of the questions and answers are those submitted to the panelists after the sessions, incorporated here by request. Also, frequent references are made to others' work but their names have been omitted.
Del 12 - Developments in Nephrology
Geriatric Nephrology
The medical, psychosocial, nursing, financial and ethical issues of treating end-stage renal disease in the elderly
Inbunden, Engelska, 1986
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The year was 1943. As a third-year medical student at Stanford, I was about to witness the beginning of a medical miracle. Dr. Arthur Bloomfield, Professor of Medicine, had selected my patient, a middle aged man, who was dying of acute pneumococcal pneumonia, as one of the first patients to receive miniscule doses (by today's standards) of his meagre supply of a new drug - penicillin. The patient's response amazed everyone especially this impressionable medical student. The rest of the story is history. With one stroke, the introduction of penicillin removed from the medical scene the 'friend of the aged' - lobar pneumonia. The consequences, which no one could have imagined at the time, are still becoming manifest as other 'miracles' such as respirators, artificial kidneys and many potent new antibiotics have come upon the scene. All of us are aware that these miracles have created a variety of new challenges around the states of dying and near dying. We have no easy answers for these problems. Nevertheless as dialysis techniques, especially CAPD, are applied more widely to the treatment of the elderly, the task of helping the patient meet death with dignity becomes increasingly important and vexing because once begun, dialysis is difficult to terminate.
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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%.
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Blood pressure control is central to all bodily functions. There are many points in the multifaceted cybernetic system wherein hypertension may be produced. Hypertension is a 'young' disorder whose existence has been known for less than a century. It is not only extremely prevalent among every popula tion, but also deleterious to the health of mankind. The more we understand about hypertension's harmful effects, the more urgent is the need for its effective control. The kidney is the central organ that controls vascular tone and body fluid volume; these two factors are dominant in determining arterial blood pres sure. Hence, it is not surprising to find in hypertensive disorders that there are abnormalities in the kidneys, functional or anatomical, subtle or overt, that cause or are the consequence of hypertension. The first suggestion that the kidney could cause hypertension was made in 1836, before arterial pressure could even be measured, by Richard Bright. He observed that cardiac hypertrophy was often present in patients who died of renal disease. It was, however, Goldblatt and his colleagues in 1934 who opened the modern era of experimental and clinical research in renal hypertension. Since then, although far from complete, enthusiastic and intensive research efforts have greatly improved our understanding of the nature of renal hypertension.
Persistent Renal-Genitourinary Disorders
Current Concepts in Dialysis and Management Proceedings of Pediatric Nephrology Seminar XII held at Bal Harbour, Florida February 25–28, 1985
Inbunden, Engelska, 1986
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This Pediatric Nephrology series is a focus on salient points which at the time of each annual seminar are of importance to the practicing pediatrician and nephrologist, the clinical researcher, and basic researcher interested in clinical problems. Hence the format of selected papers and panel discussions to capture the tenor of the times. More thorough coverage of many of the subjects can be found in current journals and textbooks listed in the authors' references. Those searching for the conventional should look there rather than here since our aim is not to cover each subject in its entirety but to secure attention to the controversial aspects of the subjects, dispel the notion that there is one answer to a question, and raise the level of inclination toward dynamic problem solving. The basic subject chosen this year reflects dominant concerns this year and the participants chosen--speakers and discussants--represent certain views relevant to the subject at this time. To reflect the tempo and flavor produced by this unique blend, the discussions are included almost verbatim. For some this means readability; for others, excess verbiage. The careful reader will notice that I have been the chairman of all sessions and have moderated all discussions. This is in keeping with our aim to ferret out interrelated basic questions and varying answers to the subjects--seen as related in problems and solutions. In the discussions, all names have been deleted.
Diuretics: Basic, Pharmacological, and Clinical Aspects
Proceedings of the International Meeting on Diuretics, Sorrento, Italy, May 26–30, 1986
Inbunden, Engelska, 1987
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The need for adequate means by which to improve urine output is very old. Even in the "Scuola Salernitana", the oldest medieval medical school in Western Europe, about 1000 years ago it was taught how to improve urine output. The list of known "diuretica" included herbs, plants, roots, vegetables, in particular asparagus, fennel and carrot. The first diuretic drugs, however, were mercurial compounds. Thus, calomel, mercurous chloride, was initially used as a diuretic in the sixteenth century by Paracelsus, being one of the ingredients of the so-called "Guy's Hospital pill". But calomel had a cathartic effect so that it was replaced by organic mercurial compounds. These diuretics were clearly toxic. After the discovery of the car bonic anhydrase, in the early 1930s, and the introduction of sulfanilamide as a chemotherapeutic agent, it was observed that this drug was inhibiting carbonic anhydrase in vitro and urinary acidification in vivo thereby causing metabolic acidosis; urine output, however, appeared to increase. Subsequent studies led to the synthesis of more potent analogs, in particular acetazolamide. Studies on car bonic anhydrase inhibitors led to the synthesis of benzothiadiazides which disclosed much less inactivating action on carbonic anhydrase and much more diuretic effect through an inhibition of tubular transport of sodium and chloride. Chlorothiazide was the first member of this class of diuretics. Thiazides are still used in clinical practice.
Current Therapy in Nephrology
Proceedings of the 2nd International Meeting on Current Therapy in Nephrology Sorrento, Italy, May 22–25, 1988
Häftad, Engelska, 2011
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This book includes the proceedings of the 2nd International Meeting on Cur- rent Therapy in Nephrology held in Sorrento, Italy, May 22-25, 1988. The book provides a comprehensive update on new therapeutic strategies in the broad field of Nephrology. The reader will receive information on advances in treatment of glomerulonephritis, new dialysis techniques and progress in renal transplantation. In addition, sections deal with provocative experimental ap- proaches to treating renal disease. Topics include: cyclosporine in treatment of nephrotic syndrome, plasma ex- change in ARF, treatment of beta-2 microglobulin amyloidosis, nutritional of dialytic adequacy revisited after assessment in patients on RDT, standards development of biocompatible membranes, drug interaction with cyclosporine, renal transplantation in elderly recipients, and renal transplantation with elderly donors. A special effort was made to recruit contributors among the most important scientific authorities in their respective fields: we are grateful to Drs. Cameron, Lamm, Isemberg, Meyrier, Niaudet, Brynger, Lundgren, Fauchald, Cockburn, Gotch, Kopple, Cheung and Horl for having accepted our invitation.We are also indebted to all other authors who participated in the meeting and submitted their original papers for publication. I.
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What regulation shall we have for the operation? Shall a man transfuse he knows not what. to correct he knows not what. God knows how (l)? Dr. Henry Stubbs Royal College of Physicians circa 1670 If dialysis therapy were a new phannaceutical product being evaluated by the FDA now, it might not be approved for marketing. The recommended dose, its potential toxicity, the side effects of under-or over-dialysis as well as its efficacy have been the subject of very few studies. The high mortality rate associated with the treatment may raise a few eyebrows. That it is a life-saving modality of treatment is undoubtedly true for more than 100,000 patients in the United States and for more than a million patients world wide. Because dialysis has extended the lives of many people by a variable period of time, most nephrologists have "rested on their laurels" and did not vigorously pursue studies to optimize these treatments. But facts have a way of intruding in all our lives and the facts are that the overall mortality rate of dialysis patients in the United States is rising and stands close to 25% per year and is closer to 33% per year for patients between the ages of 65 and 74 (2). These mortality figures are considerably higher for age-adjusted dialysis populations in Europe and particu larly in Japan, and certainly for the age-adjusted nonnal population.
Diuretics: Basic, Pharmacological, and Clinical Aspects
Proceedings of the International Meeting on Diuretics, Sorrento, Italy, May 26–30, 1986
Häftad, Engelska, 2011
2 207 kr
Skickas inom 10-15 vardagar
The need for adequate means by which to improve urine output is very old. Even in the "Scuola Salernitana", the oldest medieval medical school in Western Europe, about 1000 years ago it was taught how to improve urine output. The list of known "diuretica" included herbs, plants, roots, vegetables, in particular asparagus, fennel and carrot. The first diuretic drugs, however, were mercurial compounds. Thus, calomel, mercurous chloride, was initially used as a diuretic in the sixteenth century by Paracelsus, being one of the ingredients of the so-called "Guy's Hospital pill". But calomel had a cathartic effect so that it was replaced by organic mercurial compounds. These diuretics were clearly toxic. After the discovery of the car bonic anhydrase, in the early 1930s, and the introduction of sulfanilamide as a chemotherapeutic agent, it was observed that this drug was inhibiting carbonic anhydrase in vitro and urinary acidification in vivo thereby causing metabolic acidosis; urine output, however, appeared to increase. Subsequent studies led to the synthesis of more potent analogs, in particular acetazolamide. Studies on car bonic anhydrase inhibitors led to the synthesis of benzothiadiazides which disclosed much less inactivating action on carbonic anhydrase and much more diuretic effect through an inhibition of tubular transport of sodium and chloride. Chlorothiazide was the first member of this class of diuretics. Thiazides are still used in clinical practice.
557 kr
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Diabetic nephropathy is a tragic illness. Its often insidious onset in the insulin dependent (type I) diabetic, typically a young adult, heralds the last act in the course of a disease that will increasingly become the dominant preoccupation in the patient's shortened life. For most type II diabetics, the beginning of clinical renal insufficiency is but a phase in a continuous deterioration that affects the integrity ofjob, marriage, and family. The nephropathic diabetic is hypertensive, has worsening retinopathy, and more often than not, is also plagued by peripheral vascular insufficiency, heart disease, gastrointestinal malfunction, and deepening depression. Until the 1980's, few type I diabetics who became uremic (because ofdiabetic nephropathy) lived for more than two years. Hardly any attained true rehabilitation. This dismal prognosis is changing substantially for the better. Research in diabetes has resulted in striking advances at both ends of the type I diabetic's natural history. In one exciting clinical trial now underway in London, Ontario, halfofchildhood diabetics treated with cyclosporine within six weeks of onset evince"permanent" disappearanceofhyperglycemia and the need for insulin. At the otherendofthe natural historyofdiabetes for the nephropathic patientwith worsening eye disease (renal-retinal syndrome), who receives a kidney transplant, patient and graft survival, two years after cadaveric kidney transplantation in type I diabetics is now equal to that of the nondiabetic.
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The initial observations of dialytic support were brought from the laboratory and confined to patients with reversible acute renal failure. 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.
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The purpose of this book is to provide information for the nephrologist to gain a perspective on the medical, scientific, and technical aspects of reprocess ing of hemodialyzers. The book is also designed to serve the needs of the associated medical, nursing, and technical staffs of dialysis facilities for data on reuse of hemodialyzers. As an information source, the book will prove to be useful for those who may be considering reprocessing of dialyzers, as well as persons who are currently involved in this aspect of the practice of nephrology. We have focused on the clinical and technological aspects of hemodialyzer reprocessing and have not dealt with socioeconomic considerations. We do wish to share with physicians performing hemodialysis several observations we have made as a result of assembling this volume. We believe that hemodialyzer reuse has had a beneficial impact on the quality of care for hemodialysis patients in consideration of the following factors. There is an increased awareness of membrane biocompatibility issues that has been brought to the forefront with the application of reuse. Utilization ofhemodialyzer reprocess ing has enabled nephrologists . to compare the effect of various measures on biocompatibility when the patient is exposed to either a new or a reprocessed device. Previously, few readily available comparisons existed. In the practice of dialysis, water quality has always been of considerable importance. With the advent of widespread hemodialyzer reprocessing, the issues of water bacteriology and water quality have become more prominent.
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The strength of the volume lies in the incorporation of those data on renal cellular structure and function which hold the key to the etiology of the majority of renal diseases we now call 'end-stage'. Fully, two-thirds of the volume is devoted to current concepts of renal function and related subcellular structure of various renal tissues.