Full Description
Renal Failure Prevention and Treatment in the 19808 It appears logical to juxtapose in this volume prevention-low cost and nonmorbid-with uremia therapy, which is very morbid and very high cost. Treated uremic patients constitute an important, complex, and demanding group of survivors of a formerly universally fatal disease. Throughout the developed nations of the world, an increasing fraction of the health care budget is devoted to sustaining lives by dialytic therapy and renal transplantation. In the United States, for example, patients in renal failure comprise 0.2% of those eligible for support by Medicare, but consume 5.0% of the Medicare budget. Economic stresses in funding kidney patients have, in some countries such as Great Britain, forced a return to restrictive selection policies abhorrent to empathetic physicians. For third world residents, attention to nutrition, sanitation, and infections such as malaria must take a higher priority than costly uremia therapy. Thus the solution of one problem (retarding death from uremia) created several equally vexing other dilemmas (who should be treated and at what cost?). While sociologists, economists, and ethicists struggle with the new field of psychonephrology,1 a group of investigators and clinicians convened to examine medical aspects of long-surviving treated uremic patients. These proceedings represent the first American analyis of those unique patients who have lived for ten or more years beyond what would have formerly been certain death in uremia.
Contents
I. Nutrition and Divalent Ion in Retarding Progression.- 1. Low-Protein Diets and the Nondialyzed Uremic Patient.- 2. Delay of Progression of Renal Failure.- 3. Phosphate and Prevention of Renal Failure.- 4. Improvement of Acidosis in Long-Term Dietary Treatment of Chronic Renal Failure.- II. Glomerular Damage and Its Prevention.- 5. Hyperfiltration as a Major Causative Factor in Initiation and Progression of Glomerulosclerosis.- 6. Aggravation of Glomerulonephritis by Hypertension.- III. Genesis and Prevention of Diabetic Nephropathy: New Concepts.- 7. Relationship Between Hyperglycemia and Diabetic Glomerulosclerosis.- 8. The Role of Hemodynamic Alterations in the Pathogenesis of Diabetic Glomerulopathy.- IV. Use and Misuse of Pharmacologic Agents in Kidney Disease.- 9. Prevention of Glomerular Damage with Pharmacologic Agents.- 10. Prognosis and Prevention of Renal Failure Induced by Toxins.- V. New Insights into Complications of Uremia.- 11. Functional Abnormalities of the Autonomic Nervous System in Uremic and Dialysis Patients.- 12. The Pathogenesis, Treatment, and Possible Prevention of Uremic Bone Disease.- VI. Uremia Therapy and the Long-Term Dialysis Patient: Natural History and Clinical, Psychological, and Economic Characteristics of the Over-Decade Frontier.- 13. Treatment of Chronic Renal Failure in Seattle: The First 20 Years.- 14. The Long Island College Hospital Experience with the Decade or Longer Hemodialysis Patient.- 15. Pathophysiology of Anephric Patients on Dialysis Over a Decade: Significance of Relative Hypotension.- 16. Cardiovascular Effects of a Decade or Longer of Mainteneance Hemodialysis: A Noninvasive Study.- 17. Over-Decade Maintenance Hemodialysis: Its Effect on Uremic Anemia and Coagulation.- 18. The Effects of Long-Term Hemodialysis on Gastrointestinal Function.- 19. Pulmonary Function and Arterial Blood Gas in the Long-Term Hemodialysis Patient.- 20. Musculoskeletal Abnormalities of the Ten-Year Hemodialysis Patient.- 21. NIH, Kidney Research, and the Patient with Renal Disease.- 22. Patients on Hemodialysis for Over Ten Years.- 23. Personality and Psychological Factors Influencing Survivorship on Hemodialysis.- VII. The Transplantation Alternative.- 24. Long-Term Survivors After Renal Transplantation.- 25. Brighter Outlook for Kidney Transplantation.- 26. Triggering Signals for T-Cell Activation in Renal Transplantation.- Author Index.
