Rees L et al. (2007) Paediatric Nephrology. Oxford: Oxford University Press

This comprehensive, pocket-size, flexicover handbook—one of the Oxford Medical Publications series—is excellent. It is not only suited to the busy pediatric nephrologist, but it also presents a very readable, understandable and useful guide to the investigation and management of acute and chronic kidney conditions and diseases in childhood to the general pediatrician, the trainee pediatric nephrologist and others involved in the clinical care of children with renal disease. The authors—Lesley Rees, Nicholas Webb and Paul Brogan—have achieved their aim of creating a text that is decidedly clinically relevant, very therapy-oriented, and highly practical. They have deliberately not included excessive detail on pathogenesis and mechanisms of disease.

The layout of the handbook is very simple, so the reader can find his or her way around it easily. The 30 chapters listed in the Contents have short headings that are easy to scan and also give a balanced representation of all of the main issues in pediatric nephrological practice. Immediately following the Contents, a Detailed Contents section breaks the chapters down into digestible subheadings, which guide the reader quickly to a topic of immediate interest. Individual sections of text in the chapters are also uncomplicated, very simple to read and laid out in bullet-point format, which allows a substantial amount of detail to be succinctly presented. The written word is supported by excellent illustrations, tables, figures and flow diagrams, which are uncluttered and easy to follow. There is a wealth of useful information in this handbook to assist the practicing clinician on a day-to-day basis, and the text is not overburdened with references, which is appropriate for a handbook of this type.

Inevitably, as the text is in the form of a handbook, it is not always easy to distinguish the sections that have a strong evidence base from those in which opinion necessarily prevails because of insufficient evidence. In pediatrics, the lack of randomized controlled trials is always an issue. The authors have made considerable attempts to indicate where evidence is lacking, for example in the section on treatment of steroid-resistant nephrotic syndrome and similarly in the 'Treatment' segment of the section on hemolytic uremic syndrome. At the same time, they have assiduously tried to provide the clinician with suggestions for clinical care based on whatever evidence is available. The text also contains a series of useful and practical protocols (e.g. for the assessment of glomerular filtration rate and the use of intravenous cyclophosphamide).

Although the text is very current, there are a few areas in which the terminology and content could perhaps be slightly more up to date and a little more global in their relevance. First, the term 'chronic renal failure' has been almost entirely replaced in the adult nephrological literature1 by 'chronic kidney disease' (CKD), and there is an increasing need for those of us involved in the care of children to adopt similar terminology, particularly in the context of end-stage renal disease (including transplantation). Such consistent use of terminology could also be important at the vital stage of transition from pediatric to adult care. I was pleased to at least observe, however, that the generally agreed classification of CKD was included, although the 'T' and 'D' suffixes used in the latest update of this classification to denote patients with transplants or on maintenance dialysis were omitted.2 Pleasingly, in the section on renal osteodystrophy, the relationship of renal bone disease to calcium and phosphate balance and associated vascular disease3 is mentioned, albeit briefly.

Second, CKD is decisively linked to long-term outcomes. In this setting, cardiovascular disease accounts for a disproportionately high number of deaths compared with the age-matched general population, especially in younger patients.4 The main references to cardiovascular disease appear at the end of Chapter 29 ('Long-Term Patient Survival, Non-Adherence, Ethics and Palliative Care') in two bullet points discussing patients on dialysis and those with transplants. I think, however, that the whole issue of CKD and cardiovascular disease could have had more emphasis, as it is very important for pediatricians to understand that at the point of adolescence and young adulthood the risk of cardiovascular disease and associated events is much higher in CKD patients than in their counterparts without kidney disease.5 For example, a whole separate reference or section on cardiovascular risk in the 'Chronic Renal Failure' chapter might have been appropriate.

Third, in the transplantation section, there are a number of statements that, although not incorrect, have local (i.e. UK) relevance or implications that might not necessarily be translatable to other parts of the world. For instance, ABO-incompatible kidney transplantation is well established in some areas of Europe; in Japan, many centers use deceased donors younger than 5 years of age ('en bloc' transplants) and the use of anti-interleukin-2-receptor blockade is routine in many parts of the world not only because of the associated reduction in the incidence of rejection, but also because of the better long-term survival rates.6 In the case of ABO-incompatible transplantation and use of en bloc kidneys, the reader might, however, gain the impression from the book that these techniques are unacceptable. It should perhaps also have been mentioned that mTOR inhibitors must be used with care in patients with established proteinuria and impaired renal function.7,8

Finally, I believe the book would also be improved by having a separate section—or even a chapter—covering the transition to adult institutional care.

Nevertheless, this book really is exceptionally good. The authors and those who provided support to produce it need to be congratulated. I believe the book will prove popular with a range of readers and will be adopted widely in ward settings and consultation rooms. I think it can only enhance the care of children with kidney disorders, and hopefully over time it will contribute to improving the outcomes of this population.