Book Review

Oxford Textbook of Clinical Nephrology

N Engl J Med 1993; 328:1205April 22, 1993

Article

Oxford Textbook of Clinical Nephrology
Edited by Stewart Cameron, Alex M. Davison, Jean-Pierre Grunfeld, David Kerr, and Eberhard Ritz. 2348 pp. in three volumes, illustrated. New York, Oxford University Press, 1992. $295. ISBN: 0-19-262093-2

Clinical nephrology has important roots in Europe and in the work of European scholars such as Addis, Bywaters, Black, and Hamburger. The newest and most massive addition to nephrology's crowded libraries comes from this tradition. Its editorial goal is to take a different approach to textbooks of clinical nephrology, as reflected mainly in four specific features: emphasis on rare renal problems and renal manifestations of systemic diseases that might be encountered by non-nephrologists; an international perspective that includes renal diseases in developing countries; an awareness of special problems in the very young and the very old; and a qualified deemphasis of basic science. The result is a refreshingly nontraditional textbook that successfully communicates the depth and breadth of clinical nephrology in a style that softens the more common encyclopedic approach.

For purposes of review, I consulted the book daily in the course of my clinical and teaching responsibilities in order to assess its content in relation to the practice and theory of nephrology as encountered in a North American setting. In addition, I selected some chapters for fuller review on the basis of content of special interest.

Major strengths of the textbook are its international perspective and its comprehensive scope, which encompasses all aspects of nephrology and includes fuller expositions of pediatric nephrology, obstetrical nephrology, medical urology, and urologic oncology than are provided by its shelf-mates. Topic by topic, readers can expect to encounter more information in this book than in its major competitors. In addition, it includes novel, informative chapters on molecular genetics and acute renal failure in the tropics, and superb individual contributions on amyloidosis, sickle cell disease, and vascular access. The approaches to diagnostic problems are clear and practical, with minimal resort to algorithms. Therapeutic recommendations are presented in appropriate tones of either mature conviction or tentativeness. The half-tone photomicrographs and x-ray images are ample, if not overdone, and of very high quality; the few color figures are unimportant and disconnected from the corresponding text. On the negative side, the mechanical problems of finding material in a three-volume set are at least triple those encountered with a single volume. This situation is not helped by an index that lacks specificity and fails to indicate the volume number.

The editorial objectives and style are generally preserved throughout more than 2300 pages by over 200 authors. Fresh approaches to familiar topics are ensured in part because fewer than 5 percent of the authors are from the United States. There is some unevenness in the distribution of content, however. The section on kidney diseases from the perspective of non-nephrologists is generally superficial and redundant. Other excesses include 10 pages devoted to clinical estimates of the glomerular filtration rate, whereas only a 7-page chapter is devoted to immunosuppression of graft rejection and there are largely superfluous chapters on ischemic renal disease and acute renal failure in the nephrotic syndrome.

Overall, the Oxford Textboook of Clinical Nephrology is a unique and important resource that should be available in every major medical library. It has definite advantages for nephrologists who combine pediatric and adult nephrology and for those who need concise, authoritative information on kidney diseases in geographically focused areas. North American nephrologists should view this as an alternative to the two other major, comprehensive nephrology textbooks -- R.W. Schrier and C.W. Gottschalk's Diseases of the Kidney (4th ed. Boston: Little, Brown, 1988) and B.M. Brenner and F.C. Rector's The Kidney (4th ed. Philadelphia: W.B. Saunders, 1991) -- and clearly superior to the more abbreviated books.

Vincent W. Dennis, M.D.
Cleveland Clinic Foundation, Cleveland, OH 44195