JRSM >
Volume 95, Number 5 >
Pp. 265-266
Renal Unit, Bristol Royal Hospital for Children, Bristol, UK
C A O'Callaghan, B Brenner
128pp Price £14.95 (p/b) ISBN 0-632-052066
Oxford: Blackwell
What a marvellous book: would that such had been available to me as a medical student nearly 40 years ago when I grappled semicomprehendingly with types I and II nephritis and the countercurrent multiplier system.
The kidney is, of course, the most sophisticated and fascinating of organs—the heart a mere pump; the brain an electrical junction box; the lungs crude bellows—and those of us who treat its malfunctions sit above such lowly specialties. The kidney protects us from dehydration and biochemical disequilibration; filters metabolic and immunological garbage (recycling where possible); allows us to stand erect without our blood pressure and bodies tumbling; keeps our blood red and our bones strong; and limits the calamitous results of doctors' tendency to prescribe drugs and patients' enthusiasm for taking them. Small wonder that renal failure was the first replacement endeavour: and how spectacularly successful it has been.
By now you will need no persuading of the imperative for a sound undergraduate renal textbook, and The Kidney at a Glance, from the youthful O'Callaghan and the seasoned Brenner, offers the necessary blend of immediacy and balance. The forty-plus chapters give generous glances (lingering looks actually) at the topics mentioned above, and many more, each in a couple of crisp pages containing well labelled diagrams and easy-to-follow text, broken up with bullet points and other modern publishing techniques to make the information stick. Also, a website is available for help and to test one's newly minted knowledge against multiple choice questions. (A set of questions is provided for reviewers of the book, and on this, luckily for the publisher, I got full marks.) There is a formidable index. Any postgraduate examiner would obtain satisfaction from a candidate possessing half the information in this book, and it would be helpful to mature specialists such as myself needing a shot of revision before delivering a lecture on, say, tubular physiology.
And yet, and yet... Where is the passion? I have been a privileged navigator to scores of patients and relatives steering through the arduous journey of renal disease. Many have symptoms which I have only been able to palliate and all the molecular biology in the world is not going to help end-of-the-road patients and relatives wracked by the decision whether to have one last crack at interventionist medicine. This is the warp and woof of bedside renal medicine which few textbooks come near to conveying and which gives nephrologists the greatest rewards—knowledge of having been of personal assistance. And where is the context? How will an undergraduate fresh to renal medicine know that renal stones are more common in children in Karachi than Kidderminster and that unexplained and life-demeaning urinary frequency and urgency are more common than nephrotic syndrome? Presumably the educationalists, assembling the joined-up medical curriculum, will ensure these are covered in the ethics and communication skills and epidemiology courses, but I wonder whether students will make the necessary links with clinical practice. Academic nephrologists neglect or delegate these wider aspects of our blessed specialty at its peril; the young watch and mark.
And now an admission. My daughter cramming for part 1 MRCP(UK) spotted the review copy on my desk, skimmed it through, declared it ‘cool’ and filched it. Perhaps her judgment is the one to be heeded.
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