Book Review

Nephrology

N Engl J Med 1999; 340:1295-1296April 22, 1999

Article

Nephrology
Edited by Rex L. Jamison and Robert Wilkinson. 1152 pp., illustrated. New York, Chapman & Hall, 1997. $192.95. ISBN: 0-412-60930-4

The editors of this work had a new vision when they embarked on a single-volume textbook of nephrology. They wished to offer a readable textbook with an international perspective that falls somewhere between the tome and the practical manual. This book contains 1152 pages divided into 89 chapters. There are 114 authors, 74 of whom are European and 40 of whom are American. Of the American authors, 17 hail from Stanford. The book has three major sections that deal with the normal structure and function of the kidney, impaired renal function, and diseases of the kidney and their treatment.

One of the strengths of this book is that, despite its relatively small size, it is inclusive. Since the chapters are short and succinct, there is an opportunity to cover many topics. All of the requisite general issues can be found: diagnostic imaging, urinalysis, electrolyte and acid–base disorders, and renal biopsy. There are also important chapters that might have been omitted in a single-volume book, such as those on vasoactive mediators, the aging kidney, Balkan nephrology, and management of nutrition for the predialysis patient.

Another strength is the exquisite visual representations, at both the microscopical and the clinical levels. Discussion of the function of various portions of the nephron are matched with detailed schematic diagrams and beautiful photographs. Furthermore, sections on clinical entities include numerous color photographs of skin lesions and tissue-biopsy specimens.

The portion of the book that distinguishes it from others on this subject is the section on renal-replacement therapy. This topic is often seriously neglected even by multivolume sets, but here the authors do more than hit the high points, and the text on the topic is peppered with photographs and diagrams. In particular, the chapters on vascular access, technical and mechanical aspects of hemodialysis, and peritoneal dialysis are all extremely readable and are supplemented with carefully chosen visual representations. A series of chapters on transplantation follows, with attention to the current basic knowledge of immunology as well as the logistics of the donor workup, caveats for acute management, and the realities of long-term care.

We used the book to look up problems encountered in the course of a month's schedule of nephrology consultations at a medium-sized general hospital. As is perhaps to be expected in a single-volume work, there are several omissions. These omissions include cholesterol emboli, calciphylaxis, and the milk-alkali syndrome. Dilutional acidosis and contraction alkalosis are not discussed. No caution is provided about the risk of provoking tetany with sodium bicarbonate when treating uremic acidosis accompanied by hypocalcemia. The index does not mention fibrillary glomerulonephritis, radiocontrast nephropathy, or the effects of lithium and cocaine. In the chapter on the sympathetic nervous system, there is no mention of the considerable effects of fasting and feeding on sympathetic nervous activity and blood pressure and no discussion of the problem of postural hypotension in conjunction with edema, which often accompanies autonomic dysfunction. In the chapter on pregnancy and the kidney, some issues important to the general internist or obstetrician are not addressed, including the effect of normal pregnancy on the excretion of protein in patients with preexisting proteinuria, the effect of pregnancy on the risk of disseminated intravascular coagulation in patients with gram-negative sepsis, and the effect of magnesium injections on serum calcium.

The sections on the normal and abnormal handling of salt and water, potassium, divalent cations, and acid are separated; however, in all cases the same authors wrote the chapters in both sections and the chapters complement each other. The chapter on acid–base disorders and their management is unfortunately limited to only those disorders that arise from renal dysfunction. In the chapter on acute renal failure, there is no mention of the possible role of selective medullary hypoxia or of the inflammatory cascade that, at least in animals, appears to exacerbate and perpetuate acute renal failure.

This book is concise and easy to read. Yet it is also a victim of its own uniqueness. Limited space and aggressive editing forced cursory discussions and many omissions. Still, the first edition of this book reads as a fresh, new work rather than as a tired reprint. There are no apologies, such as “a detailed discussion is beyond the scope of this textbook,” or “for a more detailed discussion, see the previous edition.” Nephrology can serve as a quick and easy reference for rounds or as the starting point for a literature search.

Melanie P. Derman, M.D.
Franklin H. Epstein, M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215