During the latter half of the last century immunology shaped our understanding of renal diseases. The roles of antibodies and of various cell effectors with their mediators have been progressively identified. More recently their mechanisms have been unravelled by progress in cellular and molecular biology, with attendant new therapeutic perspectives.
In this second edition of Immunologic Renal Diseases, Eric G. Neilson and William G. Couser assemble the currently available experimental and clinical information, which is subdivided into 53 chapters and authored by more than 100 leading investigators, mainly from the USA.
After a brief historical outline, four chapters (Chapters 25, Section I) review the pathophysiological processes, whether immunological or not, underlying most renal immune diseases. The subsequent 11 chapters (Chapters 616, Section II), grouped under the heading Immune Response and Renal Injury, include a series of in-depth reviews related either to the induction of the nephritogenic immune response or to the mechanisms of immune injury. Section III, Mediation of Immune Renal Injury, is subdivided into a description of the humoral (Chapters 1723) and the cellular (Chapters 2431) mediators of immune injury. In section IV, two chapters (32 and 33) review animal models of glomerular and tubulo-interstitial injury, whereas the last 20 chapters are clinically oriented; they concern patient evaluation and primary and secondary glomerular diseases, as well as acute interstitial nephritis (Chapters 3436, 3743, 4452, and 53, respectively).
The editors hope that this textbook will facilitate and clarify the application of basic science to the understanding of immunologic renal disease in man. In chapter 3, they therefore provide a short overview and guide to the more detailed discussion of diseases and their mechanisms, which is found in later chapters. This goal would have been served by more systematic cross referencing between the various narrower topics so as to reduce redundancies. Furthermore, several contributions do not refer to the most recent advances, published in the late 1990s or thereafter. Despite this, most chapters are thoroughly enjoyable, in particular Mechanisms of Renal Fibrogenesis (Chapter 5), Proteases and Oxidants in Glomerular Injury (Chapter 19), Growth Factors and Cytokines (Chapter 20), Endothelin and Nitric Oxide (Chapter 21) and Macrophages in Immune Renal Injury (Chapter 28).
The second aim of this textbook is to improve the care and treatment of sick patients as a result of a better appreciation for the mechanism of disease. The last 20 more clinically oriented chapters support this effort. Unfortunately, the link with the previous more basic chapters is not always evident. Rather than benefiting from the first three sections by referring to them, each chapter is written to stand alone, despite the efforts of the authors of several basic chapters to outline the clinical implications of their findings. As in the basic sections, references in most chapters do not include very recent data; for instance, the last chapter on acute interstitial nephritis includes 112 references, only five of which are from 1996 onwards. Nevertheless, many of these chapters provide an excellent, in-depth review, independent of the other contributions. Of particular note, the chapter on the interpretation of clinical studies of renal disease is a must for clinicians inundated with the results of large multicentre studies, each with various claims regarding therapeutic success.
Altogether, Immunologic Renal Diseases provides the renal physician with a comprehensive view of the various facets of renal immunopathology. Even if basic findings are not always successfully integrated with the clinical approach, a task perhaps out of reach at present, this second edition will undoubtedly provide a useful reference for many renal units.