Brenner and Rector's The Kidney, 8th ed.


For the past 35 years, one of my main professional activities has been devoted to the formidable task of editing the serial editions of Brenner and Rector's The Kidney, initially with my colleague Dr. Floyd C. Rector, Jr., and for the past four editions as sole editor. The greatest challenge has been to recognize and incorporate an ever-increasing body of new knowledge that has spurred enormous progress in nephrology. As the treadmill spins faster and faster, the task for each edition has been to meet this challenge for our readership in ways that ensure clarity, accuracy and extensive documentation.

As readers approach this Eighth edition, they will immediately appreciate our radical change in book design, with vibrant cover art and pages in full color to enhance visual appeal and illustration clarity. Despite growth in knowledge, we have beseeched authors to adhere to strictly assigned length limitations and to emphasize literature published since 1990, since older references are readily available in cited reviews and previous editions. As a result, overall book length is less than the previous edition, despite growing from 66 to 70 chapters. To more effectively integrate the ever-enlarging knowledge base in renal physiology, pathophysiology, clinical diagnosis and therapeutics, we have also initiated a radical reorganization of the textbook into 12 sections, each distinguished by separate color code. This is the first such reorganization since publication of the First edition in 1976. Of the 70 chapters, one-fourth are entirely new titles, one-fourth have been completely revised by newly invited authors and for the remaining half each chapter has undergone major updates and revisions, often with addition of new co-authors. Through the collective efforts of our very able contributors, the intellectual and practical value of this new edition of Brenner and Rector's The Kidney has not only been continued but further strengthened. There are now 161 contributors to the Eighth Edition (compared to 151 in the Seventh Edition), and 73 of these 161 (over 40%) are new to this edition.

The new organization in 12 sections proceeds as follows:



Section I: Normal Renal Function: Molecular, Cellular, Structural and Physiological Principles. This section devoted to basic renal structure and function is made up of nine chapters, dealing in detail with embryology, anatomy and topography, hemodynamics, tubule solute transport, urinary acidification, concentration and dilution, and the cellular actions of vasopressin. The principles outlined enable the reader to approach subsequent considerations of pathogenesis, pathophysiology and clinical nephrology in the most rational way possible.



Section II: Integrated Control of Body Fluid Volume and Composition. Of the seven chapters in this section, two deal with vasoactive peptides and arachidonate metabolites, molecules that greatly influence renal function. These are followed by in-depth discussions of disorders of sodium and water, acid-base, potassium, calcium, magnesium and phosphate homeostasis.



Section III: Epidemiology and Risk Factors in Kidney Disease. This novel section contains five chapters dealing with epidemiology, risk factor assessment, and the increasingly recognized roles of nephron endowment, gender and aging on renal disease risk and outcomes.



Section IV: Pathogenesis of Renal Disease. In this section of seven chapters, experienced clinicians describe the approach to the patient with known or suspected kidney disease, and how to apply the most cost-effective diagnostic assessments by laboratory evaluation and radiologic and other new imaging procedures. This very extensive imaging library is in itself a comprehensive primer for the nephrologist. Also reviewed in this section are the growing number of interventional approaches made possible by these ingenious new imaging procedures. Finally, this section includes two chapters dealing with the fundamental renal and systemic adaptations to nephron injury and chronic loss of renal function, providing insight into the mechanisms that ultimately contribute to the progression of renal disease and its attendant systemic complications.



Section V: Disorders of Kidney Function. The ten chapters in this section deal with the major clinical entities that constitute the full spectrum of acute and chronic kidney disease. Pathogenesis, diagnosis and therapy of acute kidney injury, primary and secondary glomerulopathies, micro- and macrovascular disorders of the kidney, tubulo-interstitial disease, diabetic nephropathy, urinary tract infection, obstruction, nephrolithiasis, and renal neoplasia are extensively reviewed by authors with vast clinical experience in each of their assigned areas.



Section VI: Genetic Basis of Kidney Disease. The three chapters devoted to this very active area of renal research address the inherited podocytopathies and tubule transport disorders as well as the various cystic diseases of the kidney, with thorough discussions of relevant genetic abnormalities and current understanding of how mutational events lead to clinical manifestations of disordered renal structure and function.



Section VII: Hypertension and the Kidney. This section of five chapters deals with the important clinical entities of primary and secondary hypertension, renovascular disease and ischemic nephropathy, and hypertension and kidney disease in pregnancy. Treatment for these conditions has evolved considerably, and these advances are thoroughly reviewed in two relevant chapters on antihypertensive drugs and diuretics, again by recognized experts.



Section VIII: The Consequences of Renal Failure. The six chapters in this section examine the biochemical and pathophysiological consequences of advancing renal insufficiency on cardiovascular, hematologic, endocrine, neurologic and musculoskeletal systems, areas in which new research findings have shed considerable light on causes and management of these systemic manifestations of the uremic state.



Section IX: Conservative and Pharmacological Management of Kidney Disease. This section of five chapters reviews in detail the best available dietary and pharmacologic therapies for patients with progressive kidney disease, including specific pharmacologic approaches to renoprotection, and the rational uses of erythropoietic stimulating proteins, vitamin D analogs and calcimimetic and phosphate binding agents. The final chapter in this section updates our knowledge of faulty drug metabolism in the patient with advancing renal disease and the necessary precautions that must be applied to drug use in this at-risk population.



Section X: Invasive Therapy of Renal Failure. In five chapters in this section the major treatment modalities of hemodialysis, peritoneal dialysis, and plasmapheresis are reviewed, along with the special challenges that increasingly confront nephrologists in the sett-ing of the intensive care unit and in the patient in whom intentional or accidental poisoning necessitates extracorporeal treatment for toxin-removal and life support.



Section XI: Renal Transplantation. The three chapters in this penultimate section deal with the still-challenging treatment modality of renal transplantation, with extensive reviews of relevant basic immunology, specific issues related to both the organ donor and recipient, and principles of management of the early and later phases of the post-transplant clinical response.



Section XII: Frontiers in Nephrology. In these final five chapters, experts working at the cutting edge of the frontiers that hold great promise for nephrology are asked to foresee the future from their unique vantage points. Can we ultimately attain immunologic tolerance, achieve success with xenotransplantation, engineer the regrowth of normal renal parenchyma, and utilize stem cells and the promise of genomics and proteomics to advance our diagnostic and therapeutic horizons in nephrology? The answers to these provocative challenges will hopefully spur dramatic improvements in the care of our deserving patients with end stage renal disease.

As was the case with previous editions of Brenner and Rector's The Kidney, our goal for the Eighth edition is to educate and update all those concerned with the workings of the kidney in health and disease, i.e., medical and graduate students, internists, pediatricians, urologists and of course nephrologists, from trainees to highly experienced clinicians and scientists.

But even a two-volume, extensively illustrated, updated and abundantly referenced tome cannot by itself encompass the full universe of nephrology of 2008 and beyond. In recognition of this limitation, we have systematically labored to construct a formidable Library of Nephrology consisting of several regularly revised and updated Companion Volumes, including Therapy in Nephrology and Hypertension, second edition, edited by Hugh Brady and Christopher Wilcox, Hypertension, second edition, edited by Suzanne Oparil and Michael Weber, Chronic Kidney Disease, Dialysis, and Transplantation, second edition, edited by Brian Pereira, Mohamed Sayegh, and Peter Blake, Acute Renal Failure, edited by Bruce Molitoris and William Finn, Acid-Base and Electrolyte Disorders, edited by Thomas DuBose and Lee Hamm, Diagnostic Atlas of Renal Pathology, edited by Agnes Fogo and Michael Kashgarian and Pocket Companion, edited by Michael Clarkson and Barry Brenner. The aim of these, and several additional volumes now in preparation or planned, is to assist the active and often time-constrained renal physician and scientist in acquiring familiarity with the latest advances in contemporary nephrology.

Keeping pace can also be achieved by utilizing the e-dition of the Eighth edition, which provides immediate electronic access to the entire text and its myriad of tables and figures, all of which can be readily downloaded in PowerPoint format for individual use. Moreover, since our four year cycle for new editions still leaves time gaps for those most in immediate need of new information, I now routinely scan dozens of relevant journals each month and prepare abstracts of articles that I believe contain important new information. These abstracts are posted at frequent intervals directly into the page of the electronic text dealing with the exact topic so as to create a constantly updated e-dition, in effect a living textbook.

My goal for the Eighth edition is the most user-friendly informational resource possible in nephrology via print and electronic formats. I am particularly indebted to our many renowned and devoted authors whose scholarly and practical contributions constitute the essence of this enterprise. For their adherence to deadlines, page and content constraints, I am in their debt. Nor could my goal have been accomplished without the extraordinary efforts of my local editorial associates, Gabriela Salomé Álvarez and Anna Elizabeth Besch, and the highly professional and devoted staff of Elsevier. I especially thank Susan Pioli, Publishing Director, Arlene Chappelle, Senior Developmental Editor, and Mary B. Stermel, Senior Project Manager, for their guidance, technical excellence, and unrelenting support. I also thank Berta Steiner for overseeing the production of the edition and Steven Stave for his innovative book design.

My appreciation also extends to our many devoted readers who have reacted so favorably to previous editions and offered encouragement and sound advice over the years. It is to them and the betterment of their patients that our efforts are ultimately directed.

Finally, to my family and friends, for their continued acceptance of my benign neglect due to the assumption of this and all too many other time-consuming projects, I express my heartfelt gratitude and unbounded love. And soon their patience will be rewarded. Just as blazing embers eventually grow dimmer, I recognize that now is the appropriate time to begin the orderly transition of responsibility for future editions of Brenner and Rector's The Kidney, as well as the other components of our Library of Nephrology, to a new generation of editors. An international team consisting of Drs. Glenn M. Chertow (San Francisco, California, USA), Philip A. Marsden (Toronto, Canada), Karl L. Skorecki (Haifa, Israel), Maarten W. Taal (Derby, United Kingdom) and Alan S. L. Yu (Los Angeles, California, USA) will join me in developing the Ninth edition and I am certain that with their exceptional abilities and dedication to task the future excellence of Brenner and Rector's The Kidney, and indeed our entire Library will be assured.



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