Book Review

Clinical Nephrology in Medical Practice

N Engl J Med 1993; 328:1205-1206April 22, 1993

Article

Clinical Nephrology in Medical Practice
By Gavin J. Becker, Judith A. Whitworth, and Priscilla Kincaid-Smith. 393 pp., illustrated. Boston, Blackwell Scientific, 1992. $89.95. ISBN-0-632-03167-0.

The authors of this reasonably brief book attempt to cover virtually the entire scope of topics that define clinical nephrology. The 35 short chapters succinctly touch on the major points of these subjects, avoiding discussion of research and therapeutic controversies. Many of the chapters are superb, especially those that deal with the clinical approach to the patient with renal disease, the interpretation of the urinalysis, and the characterization of the renal syndromes. The price one can pay for being concise, however, is that some subjects may be covered too superficially. This problem applies to some of the chapters, especially those dealing with renal physiology and tubular disorders. Their terseness renders these discussions difficult to understand from a mechanistic and cellular standpoint and leaves them insufficiently linked to clinical indications and interpretation.

Excessive concision can also be a problem with respect to balance in clinical descriptions. For instance, the 49 pages devoted to problems uncommonly seen in U.S. clinical-nephrology practice, such as rare types of glomerulonephritis (rapidly progressive glomerulonephritis, scleroderma, vasculitides, and thrombotic thrombocytopenic purpura) and other relatively unusual nephropathies (reflux, analgesic, uric acid, and obstruction) seem disproportionately numerous in comparison with the attention given much more common nephrologic conditions such as diabetic nephropathy (6 pages) and dialysis and transplantation (11 pages).

The book is very well written, with a crisp, condensed style and an apparently single authorial voice. The photomicrographs and x-ray images are clear, the many tables comprehensive, and the line drawings, though used too infrequently, helpful. Bulleted summaries at the beginnings of sections are quite nicely done and are good teaching aids. The reference lists are well chosen and refer the reader who requires more depth to longer books and more comprehensive reviews.

In summary, this is an excellent textbook for advanced medical students and house staff to use as a concise review of the complex and diverse subjects that make up modern nephrology.

Martin G. Cogan, M.D.
University of California, San Francisco, CA 94143