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This book guides readers through a wide spectrum of clinical presentations in patients with arterial hypertension and different degrees of renal impairment, ranging from asymptomatic urine abnormalities to end stage renal disease. On the basis of six case studies, the author reviews and discusses current guidelines and recommendations aimed at optimizing the diagnostic and therapeutic approach both to renal and cardiovascular risk in commonly encountered real-world clinical scenarios including challenging cases of diabetic kidney disease, ischemic nephropathy and resistant hypertension. It also explores anti-hypertensive drug combinations, including single or multiple RAAS-I, lipid lowering and antiplatelet drugs, as well as the appropriate use of glucose lowering drugs in the context of chronic kidney disease. This handy and practical book provides physicians in the area of general and internal medicine, as well as specialists in the cardiovascular, metabolic and renal fields valuable insights into optimal therapeutic targets for blood pressure and glucose control in renal patients.

This guide provides a comprehensive review of the full spectrum of hypertension in chronic kidney disease (CKD). Targeted towards the busy practitioner, the focus of this volume is on various therapies and how to lower blood pressure through lifestyle changes. Specialist patient populations and hypertension and causes of hypertension are also covered in detail. Clinically-focused and authoritative, this resource offers a rationalized approach to diagnosing and treating hypertension in CKD.

The treatment of hypertension has become the most important intervention in the management of all forms of chronic kidney disease. Chronic Kidney Disease and Hypertension is a current, concise, and practical guide to the identification, treatment and management of hypertension in patients with chronic kidney disease. In depth chapters discuss many relevant clinical questions and the future of treatment through medications and or novel new devices.Written by expert authors, Chronic Kidney Disease and Hypertension provides an up-to-date perspective on management and treatment and how it may re-shape practice approaches tomorrow.

Cardiovascular complications are not only responsible for more than half of our patients'mortality, they also represent the bulk of everyday problems in a dialysis unit. Yet, the space allocated to them in the major textbooks covers only 2-8% of their total content. The origins of this book lie in many years of day-to-day care of dialysis patients. It gradually became clear to the author that systematic application of well-known pathophysiological principles could improve patients'conditions beyond expectations. More importantly, it appeared that world literature was mainly concerned with evaluating risk factors and that efforts to improve prognosis were concentrated on urea removal. It is important, therefore, to notice that `Volume Control', the central issue of this book, is not incorporated into the `Adequacy'concept. While primarily intended for dialysis doctors, the author sincerely hopes that dialysis nurses, who carry the lion's share of day-to-day responsibility for dialysis patients, will also find this book a useful and practical guide to dialysis treatment.

medical research covered in thisvolume: epidemiology, physiologyand pathophysio­ logy, laboratory methodology, and renal pathology. New studies deal with the diagnosis and treatment of both incipient and overt nephropathy by metabolie, antihypertensive, and dietary invention. Considerable progress has been made in the management of end-stage renal failure and also in the management and treatment of nephropathy in the pregnant diabetic woman. Diabetic nephropathy is a worldwide problem, but it is more clearly defined in Europe and North America where facilities for the diagnosis and treatment of diabetes and its complications are readily available. Much more work needs to be done in other parts of the world, as it appears from this book. It is hoped that we now have a handbook for the kidney and hypertension in diabetes and that further progress can be made in clinical work in diagnosing and treating diabetic patients. Much more work still needs to be done regarding patient education with respect to complications. Many diabetics have now been trained to take part in the management of their metabolie control; they should also be trained to take part in the follow-up and treatment of complications. This volume also underlines the considerable need for future research. So far, research in this field has been carried out in relatively few countries and centers in the world. The editor is sure that this volume will also stimulate further advan­ cement in clinical science within the field of diabetic renal disease.

The Kidney and Hypertension in Diabetes mellitus, Third Edition endeavors to cover all aspects of renal involvement in diabetes. It is written by colleagues who are themselves active in the many fields of medical research covered in this volume: epidemiology, physiology and pathophysiology, laboratory methodology and renal pathology. This new edition focuses on pressure-induced and metabolic related aberration, in relation to genetic abnormalities, and also changes developing in fetal life. New chapters also include exercise, lipidemia, and retinopathy in diabetic renal disease. In addition, new data are included regarding structural changes in NIDDM-patients and the comparison of diabetic and non-diabetic renal disease.

Few complications of systemic diseases are better understood than diabetic nephropathy. In large part, progress in this area is due to Carl Erik Mogensen's steadfast preoccupation over more than three decades with the disorder's epidemiology, pathogenesis, pathophysiology, clinical diagnosis and evolving strategies of management. Though he sparked progress in each of these areas, he generously opens the forum of discussion to many expert contributors to this latest and most comprehensive edition of this exemplary textbook. In eliciting all relevant and up-to-date views, the reader, whether internist, pediatrician or specialist in endocrinology or nephrology, is assured a thorough review of the entire subject and in a format which is exceptionally well-written, well-illustrated and easy to read. Each of the prior editions have been an essential resource for my own work in this field and the 5th edition will no doubt continue to provide the information I and others will require to move forward in the years ahead. If only the other renal diseases were as masterfully synthesized, how much easier our task would be of achieving a comprehensive vision of all else in clinical nephrology. Barry M. Brenner, M.D., Samuel A. Levine Professor of Medicine, Harvard Medical School

Blood pressure control is central to all bodily functions. There are many points in the multifaceted cybernetic system wherein hypertension may be produced. Hypertension is a'young'disorder whose existence has been known for less than a century. It is not only extremely prevalent among every popula­ tion, but also deleterious to the health of mankind. The more we understand about hypertension's harmful effects, the more urgent is the need for its effective control. The kidney is the central organ that controls vascular tone and body fluid volume; these two factors are dominant in determining arterial blood pres­ sure. Hence, it is not surprising to find in hypertensive disorders that there are abnormalities in the kidneys, functional or anatomical, subtle or overt, that cause or are the consequence of hypertension. The first suggestion that the kidney could cause hypertension was made in 1836, before arterial pressure could even be measured, by Richard Bright. He observed that cardiac hypertrophy was often present in patients who died of renal disease. It was, however, Goldblatt and his colleagues in 1934 who opened the modern era of experimental and clinical research in renal hypertension. Since then, although far from complete, enthusiastic and intensive research efforts have greatly improved our understanding of the nature of renal hypertension.

How exciting it is to see a field so well established as the ren- angiotensin system continue to grow and mature. Originally, following the original identification of renin by Tigerstedt and Bergman over 100 years ago, workers in this area spent years attempting to establish its role in experimental and renal hypertension. The early work by Goldblatt, in 1934, demonstrated that the placement of a clip around a renal artery was clearly related to the subsequent development of hypertension. However, it wasn't until the simultaneous finding by two different geographically separated teams, Page, et al, in the United States and Braun-Menendez, et al, in Argentina that the peptide angiotensin was identified. Thus, the rate-limiting enzyme renin was released from the kidney and catalyzed a biochemical cascade which was eventually shown to produce the elevated arterial pressure. Subsequently, many workers contributed to the elucidation of the concept and sequence of angiotensin I1 generation. Thus, the enzyme renin acted upon its protein substrate, produced in the liver, to liberate the decapeptide angiotensin I which, upon circulating through the pulmonary circulation, finally produced the potent octapeptide angiotensin. Several important subsequent findings demonstrated that angiotensin I1 promoted the release of the adrenal corticosteroid from that gland, thereby resulting in a larger system, the renin-angiotensin-aldosterone system. Further, this system demonstrated a classical biofeedback and the circulating octapeptide was shown to have additional biological activities in organs other than heart, vessels, kidney, adrenals, and even brain.

Now in its sixth edition, The Kidney and Hypertension in Diabetes Mellitus retains its position as the comprehensive resource for information on diabetic kidney disease. The book covers all aspects of renal involvement in diabetes and incorporates information from important publications and new trials conducted during the last three years. The new

Chronic kidney disease is one of the world's major public health problems, and the prevalence of kidney failure is rising steadily. Among the risk factors for a faster progression of renal disease are hypertension and proteinuria, many studies clearly demonstrating that hypertension is both a cause and consequence of chronic kidney disease. Namely, renal blood pressure regulation seems to be involved in five major pathophysiological mechanisms (all closely related to the renin-angiotensin system): Pressure-natriuresis, renal sympathetic nervous system, renal blood flow, intraglomerular pressure and tubuloglomerular feedback. This book reviews experimental data which form the basis of our current understanding of the association between hypertension and kidney diseases: The pathogenesis of increased blood pressure, the mechanisms by which systemic hypertension promotes progressive kidney failure, and the impact of antihypertensive agents on experimental renal mechanisms involved in hypertension. Furthermore, the role of angiotensin II receptor blockers in both the control of systemic blood pressure and the reduction of proteinuria is examined in an attempt to define optimal therapeutic strategies to prevent the otherwise inexorable deterioration of renal function in patients with chronic kidney disease.