Book Review

Brenner & Rector's The Kidney

N Engl J Med 1996; 335:680August 29, 1996

Article

Brenner & Rector's The Kidney
Fifth edition. Edited by Barry M. Brenner. 2702 pp., illustrated. Philadelphia, W.B. Saunders, 1996. $325. ISBN: 0-7216-5075-9

Memories of my renal training returned as I read the fifth edition of Brenner & Rector's The Kidney. It was nearly a decade ago that I read the entire third edition of this book during the first year of my nephrology fellowship. Nightly, even when physically exhausted after being on call, I looked forward to settling down with coffee and digesting four or five pages of clinical nephrology or basic physiology. Much has changed in nephrology during the past decade — apparently nearly 1000 pages worth! However, the thoroughness and objectivity of previous editions persist and have even improved.

The two volumes are organized in five sections encompassing elements of normal renal structure and function, disturbances in control of body-fluid volume and composition, the pathogenesis of renal disease, the pathophysiology of renal disease, and the management of renal failure. Overlap has been minimized by strictly separating the basic mechanisms of nephron function and physiology from the clinical sections that follow. This allows easy readability and smooth flow between chapters. This edition has several new chapters. One reviews cell–cell and cell–matrix interactions. It serves as an example of how the horizons of nephrologic research can be eloquently summarized and neatly included in the context of the classic teachings of renal structure and function. The structure, expression, and function of matrix adhesion molecules are reviewed, interactions between leukocytes and renal cells in inflammation are described, and tables classifying leukocyte molecules and the effects of blocking monoclonal antibodies are included. Another excellent new chapter reviews reactive nitrogen and oxygen intermediates and their effects on the kidney.

The clinical chapters provide the framework for understanding acid–base and fluid–electrolyte disorders, and diseases involving various renal structures. The organization of the chapters allows the reader to approach the subject of renal disease in a structured fashion. For example, an extensive review of the renal contribution to acid–base homeostasis is followed by an overview of clinical disorders of acid–base balance. This allows a beginner to develop a logical approach to diagnosing complicated renal diseases. Occasionally, uncommon clinical syndromes are mentioned only in passing and the reader must depend on the references to research these areas further. A chapter on the effect of race on the incidence and progression of kidney disease, as well as on outcomes in dialysis and kidney transplantation, could have been included, although the topic is addressed briefly in the relevant chapters. Fortunately, the extensive and well-updated reference list ending each chapter is unparalleled in any other major renal textbook.

This textbook will educate students of nephrology regardless of their levels of expertise. The clinical chapters contain concise tables and figures, providing for rapid information gathering. Several of the tables are similar to those that have appeared in review books. Medical students and house officers will be able to peruse these tables, quickly arrive at differential diagnoses, and learn the characteristics of major clinical syndromes. Nephrologists and renal fellows will want to read pertinent chapters to learn the approaches of experts to their fields of interest. Likewise, basic scientists can gain insights into newly developed techniques in the initial section. I cannot envision anyone in nephrology who would not find much useful information in this superbly written and referenced book.

Barry I. Freedman, M.D.
Bowman Gray School of Medicine, Winston-Salem, NC 27157