Kidney Protection: Strategies for Renal Preservation.

Abstract

e64 www.anesthesia-analgesia.org August 2020 • Volume 131 • Number 2 DOI: 10.1213/ANE.0000000000004898 A to the National Kidney Foundation, 15% of the American adult population suffers from chronic kidney diseases (CKD), which often go undetected until very advanced stages.1 Technological advancements in early identification, renal replacement therapies, and transplantation have developed enormously to reduce the growing burden of kidney disease.2 However, prevention and protection of kidney function and control of the progression of kidney disease are extremely important as well.3 Kidney Protection: Strategies for Renal Preservation is among the most compelling and up-to-date clinically focused review books on kidney protection. To address the awareness of primary prevention of kidney disease, it covers current research articles, technology assessments, and practice guidelines in the field. A total of 46 authors from multidisciplinary backgrounds, including internal medicine, pathology, oncology, nephrology, and organ transplantation, cocreated this prodigious review with the goal of sharing the latest pertinent information from an interdisciplinary approach and providing guidelines on how to manage kidney preservation in systemic illness and transplantation. In particular, 3 of the editors, Dr Vijay Lapsia, Dr Bernard G. Jaar, and Dr A. Ahsan Ejaz, are expert clinicians in the field of nephrology with an impressive publication history, including early diagnosis of acute kidney injury, epidemiology of chronic renal failure, and kidney protection in patients with peripheral vascular disease. The book is spectacularly well written in a way that could potentially benefit not only the practicing nephrologist but also clinicians or researchers interested in kidney disease and renal protection. The 2015 Global Burden of Disease study estimated that kidney failure caused 1.2 million deaths in 2015—a surprising increase of 30% since 2005.4 Kidney disease has become a global health problem of increasing incidence, with staggering morbidity and mortality rates.5 Although the disease itself is sometimes temporary and typically considered reversible in early stages,6 many of the strategies proposed aim to reduce the growing burden of renal disease. Nevertheless, we are still struggling with the difficulties of early detection and lack of therapeutic interventions. To break through the limitations, many experimental studies have been conducted to find out the molecular target of the disease, such as enhancing nucleotide metabolism to elicit adaptive responses during ischemic injury7–9 or interrupting cell-to-cell interactions in the immune system.10 Therefore, it is prerequisite for the exact assessment of kidney disease with multiple perspectives in renal physiology and pathology,11,12 making early diagnosis and future interventions even more challenging. We are in dire need of advancing knowledge about kidney protection, treatment, and patient outcomes, and this is exactly what the book Kidney Protection: Strategies for Renal Preservation focuses on. Kidney Protection: Strategies for Renal Preservation gathered top-ranking researchers and clinicians to summarize the latest pertinent information of medical care and studies in the field of clinical and epidemiologic studies of kidney disease. The book provides interdisciplinary approaches to give insights for better patient outcomes to clinicians in the intensive care unit (ICU), perioperative, and outpatient care. The structure of the book is well organized. The book is categorized into 6 sections on understanding and assessing kidney disease, general concepts in protecting kidney function, current drug therapies and adverse drug effects on the kidneys, and kidney protection in systemic illness and transplantation, allowing readers with varied backgrounds (from research to clinical) to follow along easily. Each section is composed of several defining chapters that fit logically into the topic of the section and maintain a sense of continuity throughout the book. To understand kidney physiology and pathology, Section I introduces the epidemiology and etiology of kidney disease, mechanistic pathogenesis of acute kidney injury (AKI), and the importance of being aware of CKD risk factors, including nonalterable and alterable factors. Since kidney disease is silent, without clear manifestations until the disease is quite advanced, precise assessment and monitoring are necessary. Section II emphasizes supportive investigation in the laboratory and use of imaging systems for clinical evaluation to understand the fundamentals of renal pathology. Section III describes renal protection and effective strategies to manage AKI and to reduce the risk of CKD progression in perioperative, ICU, and renal replacement therapy. Section IV introduces not only therapeutic agents to enhance the reduced kidney function but also the nephrotoxicity profile of conventional treatment. Section V covers how to protect kidney function from systemic illness such as hypertension, inflammatory Kidney Protection: Strategies for Renal Preservation Lapsia V, Jaar B, Ejaz AA. New York, NY: Oxford University Press, 2019, 512 pages, Paperback $95.00 (USD), ISBN: 978-0-190-61162-0